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Sarac DC, Bayraktar D, Ozer Kaya D, Altug Gucenmez O, Oskay D. The effects of inspiratory muscle training on cardiorespiratory functions in juvenile idiopathic arthritis: A randomized controlled trial. Pediatr Pulmonol 2024; 59:562-573. [PMID: 38038160 DOI: 10.1002/ppul.26783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Although inspiratory muscle training (IMT) has proven effective in adult rheumatic diseases, its impact on juvenile idiopathic arthritis (JIA) remains unexplored. The present study aimed to investigate the effects of IMT in children with JIA. METHODS Thirty-three children (13-18 years) with JIA were divided into two groups as exercise (n = 17) and control (n = 16). The exercise group performed IMT at home daily for 8 weeks. The initial IMT load was set as 60% of maximal inspiratory pressure (PImax ) and increased by %10 of the initial load every 2 weeks. The control group received no additional intervention. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), FVC/FEV1 , PImax , and maximal expiratory pressure (PEmax ) were evaluated. Peak oxygen consumption (VO2max ), metabolic equivalents (METs), and maximal heart rate were measured with cardiopulmonary exercise test. Functional capacity and quality of life were assessed with 6-min walk distance and Pediatric Quality of Life Inventory 3.0 Arthritis Module. All participants were evaluated at baseline and post-treatment. RESULTS FVC ( ↑ 0.20 (95% CI: 0.07/0.32) liters), FEV1 ( ↑ 0.14 (95% CI: 0.02/0.25) liters), PImax (↑19.11 (95% CI: 9.52/28.71) cmH2 O), PEmax (↑12.41 (95% CI: 3.09/21.72) cmH2 O), VO2peak (↑158.29 (95% CI: 63.85/252.73) ml/min), and METs (↑0.92 (95% CI: 0.34/1.49) [ml/kg/min]) significantly improved only in the exercise group (p < .05). The difference over time in FVC, FEV1 , PImax , VO2peak , and METs were significantly higher in exercise group compared to control group (p < .05). CONCLUSIONS IMT seems to be an effective option for improving respiratory functions and aerobic exercise capacity in JIA.
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Affiliation(s)
- Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Ozge Altug Gucenmez
- Clinic of Pediatric Rheumatology, University of Health Sciences Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkiye
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkiye
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Tender and swollen joint counts are poorly associated with disability in chikungunya arthritis compared to rheumatoid arthritis. Sci Rep 2021; 11:18578. [PMID: 34535727 PMCID: PMC8448837 DOI: 10.1038/s41598-021-98164-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023] Open
Abstract
Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) are described after chikungunya virus infection. We aimed to compare the relevance of joint counts and symptoms to clinical outcomes in RA and chronic chikungunya disease. Forty patients with chronic chikungunya arthralgia and 40 patients with RA were enrolled in a cross-sectional study. The association of tenderness and swelling, clinically assessed in 28 joints, and patient evaluations of pain and musculoskeletal stiffness with modified Health Assessment Questionnaire (HAQ) and quality of life (QoL) assessments were investigated. Tender and swollen joint counts, pain and stiffness scores were all associated with the HAQ disability index in RA (all r > 0.55, p ≤ 0.0002), but only stiffness was significantly associated with disability in chikungunya (r = 0.38, p = 0.02). Joint counts, pain and stiffness were also associated with most QoL domains in RA patients. In contrast, in chikungunya disease, tender joint counts were associated only with one QoL domain and swollen joints for none, while pain and stiffness were associated with several domains. Our results confirm the relevance of joint counts in RA, but suggest that in chronic chikungunya disease, joint counts have more limited value. Stiffness and pain score may be more important to quantify chikungunya arthritis impact.
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Leonard G, Paquet N, Guitard P, Toupin-April K, Cavallo S, Paterson G, Aydin SZ, Bakirci S, Coulombe-Lévêque A, Brosseau L. The effects of an 8-week knitting program on osteoarthritis symptoms in elderly women: A pilot randomized controlled trial. J Bodyw Mov Ther 2021; 27:410-419. [PMID: 34391264 DOI: 10.1016/j.jbmt.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 03/18/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exercise therapy is effective in reducing symptoms and disability associated with hand osteoarthritis (HOA) but often has low adherence. An intervention consisting in a meaningful occupation, such as knitting, may improve adherence to treatment. This pilot randomized controlled trial (RCT) studied the adherence and clinical effectiveness of a knitting program in older females suffering from HOA to evaluate the acceptability of this intervention and assess the feasibility of a larger-scale RCT. METHODS Single-blind, two-arm pilot RCT with a parallel group design with 37 participants (18 control, 19 intervention). Control participants were given an educational pamphlet and assigned to a waiting list. The knitting program (8-week duration) had two components: bi-weekly 20-min group knitting sessions and daily 20-min home knitting session on the 5 remaining weekdays. Measures included knitting adherence (implementation outcomes) as well as stiffness, pain, functional status, hand physical activity level, patient's global impression of change, health-related quality of life, self-efficacy, and grip strength (clinical outcomes measured throughout the 8-week program and 4 weeks after the intervention). RESULTS Our protocol is feasible and the intervention was acceptable and enjoyable for participants, who showed high adherence. No difference was observed between the two groups for any of the clinical outcome measures (all p > .05). CONCLUSION Knitting is a safe and accessible activity for older women with HOA. However, our 8-week knitting program did not result in improvements in any of our outcome measures. Knitting for a longer period and/or with higher frequency may yield better outcomes.
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Affiliation(s)
- Guillaume Leonard
- Faculté de médecine et des sciences de la santé, École de réadaptation, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Research Center on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada.
| | - Nicole Paquet
- Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - Paulette Guitard
- Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - Karine Toupin-April
- Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, Faculty of Medicine, Ottawa, Ontario, Canada.
| | - Sabrina Cavallo
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - Gail Paterson
- The Arthritis Society, Ottawa Office, Ontario Division, Ottawa, Ontario, Canada.
| | - Sibel Z Aydin
- Rheumatologist, Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Sibel Bakirci
- Rheumatologist, Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Alexia Coulombe-Lévêque
- Faculté de médecine et des sciences de la santé, École de réadaptation, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Research Center on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada.
| | - Lucie Brosseau
- Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
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Oh H, Bang S, Im B, Lee S, Seo W. Development and Validity Testing of a Morning Stiffness Assessment Scale for Patients with Rheumatoid Arthritis. Orthop Nurs 2021; 40:23-32. [PMID: 33492907 DOI: 10.1097/nor.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Morning stiffness is known to exert a significant impact on functional ability, quality of life, and employment status. There is an increasing need for a valid, reliable tool to comprehensively assess morning stiffness. The purpose of this study was to develop and verify a Morning Stiffness Assessment Scale. Items were developed on the basis of a framework of the conceptual attributes of morning stiffness. Validity and reliability tests were conducted on the devised scale. Eighty-five patients with rheumatoid arthritis were included to verify the devised scale. A 10-item Morning Stiffness Assessment Scale was developed. Its content and construct validities were well supported. The scale was found to have good reliability. The devised scale is simple and brief, but it provides a more comprehensive means of evaluation for morning stiffness. We believe this scale offers a clinically useful means of properly assessing morning stiffness and has potential utility for evaluating the effects of morning stiffness treatments.
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Affiliation(s)
- HyunSoo Oh
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuHyang Bang, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- BoAe Im, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SiWon Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - SuHyang Bang
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuHyang Bang, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- BoAe Im, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SiWon Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - BoAe Im
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuHyang Bang, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- BoAe Im, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SiWon Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - SiWon Lee
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuHyang Bang, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- BoAe Im, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SiWon Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - WhaSook Seo
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuHyang Bang, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- BoAe Im, MSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SiWon Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
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Watson H, Lynggård Hansen A, Calusi G, Bartels LE. Musculoskeletal stiffness is common in healthy adults and increases with age. Musculoskeletal Care 2020; 19:3-8. [PMID: 32812344 DOI: 10.1002/msc.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION/OBJECTIVE Musculoskeletal stiffness is a common feature in rheumatologic inflammatory diseases but little is known about background joint stiffness in the healthy population. The aim of this survey was to determine the variation in musculoskeletal stiffness with age in a cohort of healthy adults using a patient reported outcome instrument designed to assess stiffness in rheumatoid arthritis. METHODS Healthy subjects ≥18 years old were enrolled at two sites. Those with a diagnosis of rheumatological disease were excluded. Each subject completed a 21-item questionnaire designed to evaluate the severity of musculoskeletal stiffness, its physical impact and psychosocial impact, and to provide an overall stiffness score, expressed as a percentage. Scores were analyzed by age group. RESULTS Two hundred eighty-two subjects were included with a mean age of 42 years (±17, range 18-85). More than 50% of subjects reported stiffness in each age group but with a low median overall stiffness score of 5.4% (IQR 0, 12.6). Scores were markedly higher in those aged ≥60 years, median 10.0% (IQR 2.6, 21.9), and only in this age group did the majority of subjects report a physical or psychosocial impact of stiffness. Scores in males and females were similar. CONCLUSION The prevalence of musculoskeletal stiffness in healthy subjects of all ages is not negligible, and the high frequency of stiffness and greater severity in the upper age cohort suggest that the background joint stiffness amongst older subjects should be considered when interpreting stiffness in rheumatologic patients.
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Affiliation(s)
- Hugh Watson
- Evotec ID, Virology, Lyon, France.,Department of Clinical Pharmacology, Aarhus University, Aarhus, Denmark
| | - Amalie Lynggård Hansen
- Department of Internal Medicine, Rheumatology, Randers Regional Hospital, Randers, Denmark
| | | | - Lars Erik Bartels
- Department of Internal Medicine, Rheumatology, Randers Regional Hospital, Randers, Denmark
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Glerup M, Rypdal V, Arnstad ED, Ekelund M, Peltoniemi S, Aalto K, Rygg M, Toftedal P, Nielsen S, Fasth A, Berntson L, Nordal E, Herlin T. Long‐Term Outcomes in Juvenile Idiopathic Arthritis: Eighteen Years of Follow‐Up in the Population‐Based Nordic Juvenile Idiopathic Arthritis Cohort. Arthritis Care Res (Hoboken) 2020; 72:507-516. [DOI: 10.1002/acr.23853] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Mia Glerup
- Aarhus University Hospital Aarhus Denmark
| | - Veronika Rypdal
- University Hospital of North Norway and UiT – The Arctic University of Norway Tromsø Norway
| | - Ellen Dalen Arnstad
- NTNU – Norwegian University of Science and Technology and Levanger HospitalNord‐Trøndelag Hospital Trust Levanger Norway
| | - Maria Ekelund
- Uppsala University, Uppsala, Sweden, and Ryhov County Hospital Jonkoping Sweden
| | - Suvi Peltoniemi
- Hospital for Children and AdolescentsUniversity of Helsinki Helsinki Finland
| | - Kristiina Aalto
- Hospital for Children and AdolescentsUniversity of Helsinki Helsinki Finland
| | - Marite Rygg
- NTNU – Norwegian University of Science and Technology and St. Olavs Hospital Trondheim Norway
| | - Peter Toftedal
- Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Susan Nielsen
- Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Anders Fasth
- Institute of Clinical SciencesSahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | | | - Ellen Nordal
- University Hospital of North Norway and UiT – The Arctic University of Norway Tromsø Norway
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Craig ET, Orbai AM, Mackie S, Bartlett SJ, Bingham CO, Goodman S, Hill C, Holt R, Leong A, Karyekar C, Leung YY, Richards P, Halls S. Advancing Stiffness Measurement in Rheumatic Disease: Report from the Stiffness Special Interest Group at OMERACT 2018. J Rheumatol 2019; 46:1374-1378. [PMID: 30770511 PMCID: PMC6697231 DOI: 10.3899/jrheum.181074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To improve measurement of stiffness in rheumatic disease. METHODS Data presented included (1) 2 qualitative projects, (2) the rheumatoid arthritis (RA) stiffness patient-reported outcome measure (RAST), and (3) 3 items assessing stiffness severity, duration, and interference. RESULTS Stiffness is multidimensional and includes aspects of stiffness experience such as duration, severity, and effect. Stiffness items showed construct validity in RA. Further efforts are required to develop an instrument that will be taken through the Outcome Measures in Rheumatology (OMERACT) Filter 2.1 for instrument selection. CONCLUSION The research agenda for the group includes domain content voting for individual diseases, and development of stiffness item banks and disease-specific short forms.
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Affiliation(s)
- Ethan T Craig
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore.
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors.
| | - Ana-Maria Orbai
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Sarah Mackie
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Susan J Bartlett
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Clifton O Bingham
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Susan Goodman
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Catherine Hill
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Robert Holt
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Amye Leong
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Chetan Karyekar
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Ying Ying Leung
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Pamela Richards
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
| | - Serena Halls
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Horizon Pharma Inc., Lake Forest; College of Pharmacy, University of Illinois, Chicago, Illinois; Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health, Santa Barbara, California; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds; University of Bristol; University of the West of England, Bristol, Bristol, UK; McGill University, Montreal, Quebec, Canada; Division of Medicine, The University of Adelaide, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Singapore General Hospital, Duke-National University of Singapore (NUS) Medical School, Singapore
- E.T. Craig, MD, MHS, Johns Hopkins University School of Medicine; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; S. Mackie, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; S.J. Bartlett, PhD, McGill University, and Johns Hopkins University School of Medicine; C.O. Bingham III, MD, Johns Hopkins University School of Medicine; S. Goodman, MD, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; C. Hill, MBBS, MD, MSc, FRACP, Division of Medicine, The University of Adelaide, and Rheumatology Unit, The Queen Elizabeth Hospital; R. Holt, PharmD, MBA, Horizon Pharma Inc., and Adjunct Professor, College of Pharmacy, University of Illinois; A. Leong, MBA, Healthy Motivation, Bone and Joint Decade Global Alliance for Musculoskeletal Health; C. Karyekar, MD, PhD, Janssen Scientific Affairs LLC; Y.Y. Leung, MD, MB ChB, MRCP, FHKAM, FAMS, Singapore General Hospital, Duke-NUS Medical School; P. Richards, Patient Research Partner, University of Bristol; S. Halls, PhD, University of the West of England. Dr. Craig and Dr. Orbai are co-first authors
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8
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The mediating role of pain and function in the association between stiffness and quality of life in patients with axial spondyloarthritis. Semin Arthritis Rheum 2019; 49:377-380. [PMID: 30905490 DOI: 10.1016/j.semarthrit.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/09/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The relationship between stiffness and quality of life (QoL) remains unclear. We therefore aimed to examine the role of pain and function in linking stiffness and QoL in patients with axSpA. METHODS We used cross-sectional data from a registry of axSpA patients in a tertiary referral centre to assess the links among stiffness, pain and function on QoL. Path analysis was used to analyse the associations between these domains, pursuing four hypotheses: H1 - More stiffness is associated with poor QoL; H2 - More pain and decreased function are associated with poor QoL; H3 - More stiffness is associated with more pain and decreased function; H4 - The linkage between stiffness and QoL is mediated by function and pain. RESULTS Data from 221 patients (Mean age 38.5, 79.0% males and 83.1% Chinese) were analyzed. Our mediation model achieved good fit (χ2 (10) = 7.06, p = 0.719, CFI= 1.00 TLI = 1.00, RMSEA < 0.001). Results supported all 4 hypotheses (p < 0.001): More stiffness, more pain, decreased function were associated with poor QoL. Function was associated directly with QoL. Stiffness was associated with QoL through both pain and function. CONCLUSION Optimization of QoL in patients with stiffness in axSpA requires effective control of both function and pain. Physiotherapy, exercises and medications may improve the QoL in these patients.
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9
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Mok CC. Morning Stiffness in Elderly Patients with Rheumatoid Arthritis: What is Known About the Effect of Biological and Targeted Agents? Drugs Aging 2018; 35:477-483. [PMID: 29704191 DOI: 10.1007/s40266-018-0548-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects all age groups, but the prevalence appears to increase with age. Elderly-onset RA (after the age of 60 years) has distinct clinical patterns. Treatment of RA in older individuals is confounded by the presence of medical comorbidities, concurrent medications, drug interactions, and the altered pharmacokinetics and pharmacodynamics related to aging and organ dysfunction. Patients with RA commonly experience morning stiffness, which is associated with reduced quality of life and work disability. However, despite its importance, morning stiffness is seldom assessed in clinical practice and usually only its duration is measured in the research setting. Whether the intensity, timing, location and impact of this symptom should be assessed in future clinical trials requires further evaluation. The biologic and newer targeted synthetic disease-modifying anti-rheumatic drugs have been shown to be effective in reducing the duration of morning stiffness in patients with RA. Glucocorticoids are a double-edged sword in RA. Although they can effectively reduce inflammation and retard radiological damage (disease modifying), the long-term use of glucocorticoids is associated with numerous adverse effects. Thus, glucocorticoids should be used for short-term treatment of RA only. Night-time administration of glucocorticoids has been shown to alleviate morning stiffness and should be considered in patients with serious morning joint stiffness symptoms.
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Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong SAR, China.
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10
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Halls S, Dures E, Kirwan JR, Pollock J, Baker G, Edmunds A, Hewlett S. Development and testing of candidate items for inclusion in a new rheumatoid arthritis stiffness patient-reported outcome measure. Rheumatology (Oxford) 2018; 57:263-272. [PMID: 28407140 DOI: 10.1093/rheumatology/kex085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Indexed: 12/31/2022] Open
Abstract
Objective To qualitatively develop and test a set of candidate items for a new RA stiffness patient-reported outcome measure (PROM) that capture the patient perspective. This is an essential first step in PROM development, prior to quantitative development, assessment and validation. Methods Focus groups further examined the previously developed stiffness conceptual model and explored the patient perspective regarding stiffness assessment. Data were analysed using thematic analysis. An iterative process of item development was then performed by the expert study team of researchers, patients and clinicians, based on the two qualitative datasets and informed by measurement theory and guidelines. Finally, these candidate items were tested using formal cognitive interview methodology and subsequently refined. Results Sixteen RA patients from the UK participated in focus groups. Data confirmed the conceptual model of the RA patient experience of stiffness and provided insight into stiffness assessment, including suggestions regarding patient-relevant stiffness assessment categories such as impact, location and timing. These data informed the development of 77 candidate stiffness PROM items, including multiple formats for some. Eleven RA patients participated in cognitive interviews. Minor changes were made to items to enhance understanding and 32 items were removed, resulting in 45 candidate PROM items. Conclusion Rigorous qualitative methodology and considerable patient involvement has underpinned items for a new RA stiffness PROM with strong content validity. Crucially, patient involvement broadened assessment beyond early morning stiffness duration, which may address existing PROM limitations. Items are now suitable for quantitative item reduction, structural development of the final PROM and validation.
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Affiliation(s)
- Serena Halls
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - John R Kirwan
- School of Clinical Sciences, University of Bristol, UK
| | - Jon Pollock
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Gill Baker
- Rheumatology Department, Bristol Royal Infirmary, Bristol, UK
| | - Avis Edmunds
- Rheumatology Department, Bristol Royal Infirmary, Bristol, UK
| | - Sarah Hewlett
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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11
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Guitard P, Brosseau L, Wells GA, Paquet N, Paterson G, Toupin-April K, Cavallo S, Aydin SZ, Léonard G, De Angelis G. The knitting community-based trial for older women with osteoarthritis of the hands: design and rationale of a randomized controlled trial. BMC Musculoskelet Disord 2018; 19:56. [PMID: 29444664 PMCID: PMC5813366 DOI: 10.1186/s12891-018-1965-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/06/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prevalence of hand osteoarthritis (HOA) has been reported to be higher amongst women over 50 years old (66%) compared to men of the same age (34%). Although exercise therapy has been shown effective in reducing symptoms and disability associated with HOA, adherence to treatment programs remains low. The primary objective of this RCT is to examine the effectiveness of a 12-week knitting program for morning stiffness (primary outcome) and pain relief (secondary outcome) 2 h post-wakening in females (aged 50 to 85 years old) with mild to moderate hand osteoarthritis (HOA). METHODS/DESIGN A single-blind, two-arm randomized controlled trial (RCT) with a parallel group design will be used to reach this objective and compare results to a control group receiving an educational pamphlet on osteoarththritis (OA) designed by the Arthritis Society. The premise behind the knitting program is to use a meaningful occupation as the main component of an exercise program. The knitting program will include two components: 1) bi-weekly 20-min knitting sessions at a senior's club and 2) 20-min home daily knitting sessions for the five remaining weekdays. Participants assigned to the control group will be encouraged to read the educational pamphlet and continue with usual routine. Pain, morning stiffness, hand function, self-efficacy and quality of life will be measured at baseline, six weeks, 12 weeks (end of program) with standardized tools. We hypothesize that participants in the knitting program will have significant improvements in all clinical outcomes compared to the control group. A published case study as well as the preliminary results of a feasibility study as examined through a 6-week pre-post study (n = 5 women with HOA) involving 20-min daily knitting morning sessions led to this proposed randomized controlled trial research protocol. This article describes the intervention, the empirical evidence to support it. DISCUSSION This knitting RCT has the potential to enhance our understanding of the daily HOA symptoms control and exercise adherence, refine functional exercise recommendations in this prevalent disease, and reduce the burden of disability in older women. TRIAL REGISTRATION (ACTRN12617000843358) registered on 7/06/2017.
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Affiliation(s)
- Paulette Guitard
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - George A. Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON Canada
| | - Nicole Paquet
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Gail Paterson
- The Arthritis Society, Ottawa Office, Ontario Division, Ottawa, ON Canada
| | - Karine Toupin-April
- Children’s Hospital of Eastern Ontario Research Institute, Department of Pediatrics, Faculty of Medicine and School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
| | - Sabrina Cavallo
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON Canada
| | | | - Guillaume Léonard
- Val-des-Monts, University of Sherbrooke; and researcher, Research Center on Aging, Sherbrooke, QC Canada
| | - Gino De Angelis
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
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Brosseau L, Toupin-April K, Paterson G, Cavallo S, Shallwani SM, Barette JA, Duong P, Paquet N, Rududura EG, D'Entremont R, King J, Poulin L, Cardinal D, Loew L. La version franco-canadienne de l'outil « OA Go Away » : Au revoir Arthrose | Comité d'experts pour la rédaction de la première version expérimentale de l'outil « OA Go Away » | Comité d'experts pour l'évaluation de la deuxième version expérimentale de l'outil « OA Go Away ». Physiother Can 2018; 70:330-338. [PMID: 30745718 PMCID: PMC6361405 DOI: 10.3138/ptc.2017-56.f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: the purpose of the article is to produce a French-Canadian translation of the "OA Go Away" tool and to assess the validity of its contents as well as its test-retest reliability. "OA Go Away" is a customized tool that measures the various symptoms, their impact, and the physical activities of people with osteoarthritis of the hip or knee to improve self-care and help them be physically active. Method: Vallerand's cross-cultural validation methodology was used. First, professional translators and rehabilitation professionals produced a parallel reverse translation of the "OA Go Away" tool. Then, a committee of experts examined the translated versions and created a first experimental draft of the "Au revoir arthrose" tool. This draft was assessed and modified by a second committee of experts. Three users with osteoarthritis of the knee then assessed this version. Finally, a linguist examined the draft and an expert produced a final reverse translation of that version. The main co-researchers proposed final modifications of that version. Results: Twenty-one users indicated that the wording of the final "Au revoir arthrose" version was clear. The test-retest reliability was acceptable for the main elements of the "Au revoir arthrose" journal. Conclusions: The process's five rigorous steps enabled the creation of a valid French-Canadian version of the "Au revoir arthrose" tool. On average, the French-Canadian version of the "Au revoir arthrose" tool has moderate test-retest reliability for all of its elements. This tool can prove to be relevant for people suffering from osteoarthritis of the hip or knee, motivating them to be physically active, and for the health professionals who care for them.
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Affiliation(s)
| | - Karine Toupin-April
- Institut de recherche de l'hôpital pour enfants de l'Est de l'Ontario
- Faculté de médecine
- Faculté des sciences de la santé
| | | | - Sabrina Cavallo
- Professeure adjointe, École de Réadaptation, Ergothérapie, Université de Montréal, Montréal (Québec)
| | | | | | | | - Nicole Paquet
- École des sciences de la réadaptation
- Programme de physiothérapie
| | - Eva-Gazelle Rududura
- Consortium national de formation en santé (CNFS), Volet, Université d'Ottawa / Soins à domicile et en milieu communautaire, Hawesbury (Ontario)
| | | | - Judy King
- École des sciences de la réadaptation
- Programme de physiothérapie
| | - Lucie Poulin
- École des sciences de la réadaptation
- Programme de physiothérapie
| | - Dominique Cardinal
- Consortium national de formation en santé (CNFS), Volet, Université d'Ottawa / Soins à domicile et en milieu communautaire, Hawesbury (Ontario)
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Mok CC, Cha HS, Perez EC, Tsay GJ, Yoon KH. Dissonance between physicians’ and patients’ perspectives on managing impaired morning function in Asian patients with rheumatoid arthritis. HONG KONG BULLETIN ON RHEUMATIC DISEASES 2017. [DOI: 10.1515/hkbrd-2017-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
To estimate the prevalence of impaired morning function (IMF) in rheumatoid arthritis (RA), and to understand physicians’ and patients’ perceptions on the impact of IMF and treatment in selected Asian countries.
Methods
A survey on the impact of IMF was conducted in Asia on rheumatologists and patients with moderate-to-severe RA who experienced IMF for ≥3 mornings a week. Participants underwent comprehensive face-to-face interviews using structured questionnaires.
Results
Sixty physicians and 300 patients from Hong Kong, Philippines, Singapore, South Korea, and Taiwan were surveyed. Rheumatologists estimated that two-thirds of patients with RA experienced IMF and believed that the prevalence of IMF increased with RA severity (present in 42%, 73%, and 87% of patients with mild, moderate, and severe disease, respectively). Patients’ survey revealed that, on an average, patients with RA experienced IMF 5 days a week for 2 h each day. Thirty-eight percent of patients with RA considered a reduction in morning stiffness as an important treatment goal, but this was agreed by only 3% of rheumatologists. Only 22% of rheumatologists modified the treatment regimen specifically for IMF. Physicians considered prednisolone and other glucocorticoids (GCs) to be the most effective medication for the treatment of IMF. Fifty-one percent of patients with RA did not find their current medication effective in relieving IMF, and as a result, they reported negative emotions such as frustration, defeat, and anger, and 56% had missed work because of this symptom.
Conclusions
IMF is prevalent in RA and significantly affects patients’ quality of life (QoL). A higher proportion of patients compared to physicians view the reduction of morning stiffness as an important goal. More should be done to address the dissonance between physicians’ and patients’ views on IMF.
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Affiliation(s)
| | | | - Emmanuel C Perez
- De La Salle University Medical Center, Health Science Institute , Dasmarinas City, Cavite , Philippines
| | - Gregory J Tsay
- China Medical University and China Medical University Hospital , Taichung , Taiwan
| | - Kam Hon Yoon
- El Shaddai Arthritis and Rheumatism Specialist Medical Centre , Gain city , Singapore
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14
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Abstract
PURPOSE OF REVIEW Incorporation of the patients' perspective in clinical research is critical to ensure that outcomes measured reflect those, which matter most to patients. This review summarizes recent efforts to include the patients' perspective in the development of outcome measures and the importance of encouraging patient participation in decision-making and self-management. RECENT FINDINGS Since the inclusion of fatigue as a patient-endorsed core outcome measure in rheumatoid arthritis (RA) trials, OMERACT has been instrumental in advocating for patient involvement in the development of core domains and instruments; current endeavors include cultivating an understanding of remission through the eyes of patients and gaining a sense of how to measure features of pain and 'stiffness' deemed as important to patients. The concept of remission was further explored in RA patients, highlighting a common goal of returning to normality; additionally, various tools have been developed to assess for unmet needs in rheumatology patients. Advances have also been made in the development and revision of patient-centered core measures in rheumatologic diagnoses outside of RA. SUMMARY Incorporating the patients' perspective is now considered an essential feature in outcomes research. Future research should focus on how best to involve patients in specific research activities.
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15
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Twigg S, Hensor EMA, Emery P, Tennant A, Morgan AW. Patient-reported Outcomes as Predictors of Change in Disease Activity and Disability in Early Rheumatoid Arthritis: Results from the Yorkshire Early Arthritis Register. J Rheumatol 2017; 44:1331-1340. [PMID: 28668806 DOI: 10.3899/jrheum.161214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess patient-reported variables as predictors of change in disease activity and disability in early rheumatoid arthritis (RA). METHODS Cases were recruited to the Yorkshire Early Arthritis Register (YEAR) between 1997 and 2009 (n = 1415). Predictors of the 28-joint Disease Activity Score (DAS28) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) at baseline and change over 12 months were identified using multilevel models. Baseline predictors were sex, age, symptom duration, autoantibody status, pain and fatigue visual analog scales (VAS), duration of early morning stiffness (EMS), DAS28, and HAQ-DI. RESULTS Rates of change were slower in women than men: DAS28 fell by 0.19 and 0.17 units/month, and HAQ-DI by 0.028 and 0.023 units/month in men and women, respectively. Baseline pain and EMS had small effects on rates of change, whereas fatigue VAS was only associated with DAS28 and HAQ-DI at baseline. In patients recruited up to 2002, DAS28 reduced more quickly in those with greater pain at baseline (by 0.01 units/mo of DAS28 per cm pain VAS, p = 0.024); in patients recruited after 2002, the effect for pain was stronger (by 0.01 units/mo, p = 0.087). DAS28 reduction was greater with longer EMS. In both cohorts, fall in HAQ-DI (p = 0.006) was greater in patients with longer EMS duration, but pain and fatigue were not significant predictors of change in HAQ-DI. CONCLUSION Patient-reported fatigue, pain, and stiffness at baseline are of limited value for the prediction of RA change in disease activity (DAS28) and activity limitation (HAQ-DI).
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Affiliation(s)
- Sarah Twigg
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds; National Institute for Health Research - Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals UK National Health Service (NHS) Trust, Leeds, UK; Swiss Paraplegic Research, Nottwil, Switzerland.,S. Twigg, MD, Clinical Lecturer, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; E.M. Hensor, PhD, Biostatistician, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; P. Emery, PhD, Arthritis Research UK Professor of Rheumatology, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; A. Tennant, PhD, Senior Advisor, LIRMM, School of Medicine, University of Leeds, and Swiss Paraplegic Research; A.W. Morgan, PhD, Professor of Molecular Rheumatology/Hon. Consultant Rheumatologist, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust
| | - Elizabeth M A Hensor
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds; National Institute for Health Research - Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals UK National Health Service (NHS) Trust, Leeds, UK; Swiss Paraplegic Research, Nottwil, Switzerland.,S. Twigg, MD, Clinical Lecturer, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; E.M. Hensor, PhD, Biostatistician, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; P. Emery, PhD, Arthritis Research UK Professor of Rheumatology, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; A. Tennant, PhD, Senior Advisor, LIRMM, School of Medicine, University of Leeds, and Swiss Paraplegic Research; A.W. Morgan, PhD, Professor of Molecular Rheumatology/Hon. Consultant Rheumatologist, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust
| | - Paul Emery
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds; National Institute for Health Research - Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals UK National Health Service (NHS) Trust, Leeds, UK; Swiss Paraplegic Research, Nottwil, Switzerland.,S. Twigg, MD, Clinical Lecturer, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; E.M. Hensor, PhD, Biostatistician, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; P. Emery, PhD, Arthritis Research UK Professor of Rheumatology, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; A. Tennant, PhD, Senior Advisor, LIRMM, School of Medicine, University of Leeds, and Swiss Paraplegic Research; A.W. Morgan, PhD, Professor of Molecular Rheumatology/Hon. Consultant Rheumatologist, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust
| | - Alan Tennant
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds; National Institute for Health Research - Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals UK National Health Service (NHS) Trust, Leeds, UK; Swiss Paraplegic Research, Nottwil, Switzerland.,S. Twigg, MD, Clinical Lecturer, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; E.M. Hensor, PhD, Biostatistician, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; P. Emery, PhD, Arthritis Research UK Professor of Rheumatology, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; A. Tennant, PhD, Senior Advisor, LIRMM, School of Medicine, University of Leeds, and Swiss Paraplegic Research; A.W. Morgan, PhD, Professor of Molecular Rheumatology/Hon. Consultant Rheumatologist, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust
| | - Ann W Morgan
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds; National Institute for Health Research - Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals UK National Health Service (NHS) Trust, Leeds, UK; Swiss Paraplegic Research, Nottwil, Switzerland. .,S. Twigg, MD, Clinical Lecturer, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; E.M. Hensor, PhD, Biostatistician, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; P. Emery, PhD, Arthritis Research UK Professor of Rheumatology, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; A. Tennant, PhD, Senior Advisor, LIRMM, School of Medicine, University of Leeds, and Swiss Paraplegic Research; A.W. Morgan, PhD, Professor of Molecular Rheumatology/Hon. Consultant Rheumatologist, LIRMM, School of Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust.
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16
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Abstract
PURPOSE OF REVIEW Incorporation of the patients' perspective in clinical research is critical to ensure that outcomes measured reflect those, which matter most to patients. This review summarizes recent efforts to include the patients' perspective in the development of outcome measures and the importance of encouraging patient participation in decision-making and self-management. RECENT FINDINGS Since the inclusion of fatigue as a patient-endorsed core outcome measure in rheumatoid arthritis (RA) trials, OMERACT has been instrumental in advocating for patient involvement in the development of core domains and instruments; current endeavors include cultivating an understanding of remission through the eyes of patients and gaining a sense of how to measure features of pain and 'stiffness' deemed as important to patients. The concept of remission was further explored in RA patients, highlighting a common goal of returning to normality; additionally, various tools have been developed to assess for unmet needs in rheumatology patients. Advances have also been made in the development and revision of patient-centered core measures in rheumatologic diagnoses outside of RA. SUMMARY Incorporating the patients' perspective is now considered an essential feature in outcomes research. Future research should focus on how best to involve patients in specific research activities.
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17
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Halls S, Sinnathurai P, Hewlett S, Mackie SL, March L, Bartlett SJ, Bingham CO, Alten R, Campbell I, Hill CL, Holt RJ, Hughes R, Kirwan JR, Leong AL, Leung YY, Lyddiatt A, Neill L, Orbai AM. Stiffness Is the Cardinal Symptom of Inflammatory Musculoskeletal Diseases, Yet Still Variably Measured: Report from the OMERACT 2016 Stiffness Special Interest Group. J Rheumatol 2016; 44:1904-1910. [DOI: 10.3899/jrheum.161073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective.The objectives of the Outcome Measures in Rheumatology (OMERACT) Stiffness special interest group (SIG) are to characterize stiffness as an outcome in rheumatic disease and to identify and validate a stiffness patient-reported outcome (PRO) in rheumatology.Methods.At OMERACT 2016, international groups presented and discussed results of several concurrent research projects on stiffness: a literature review of rheumatoid arthritis (RA) stiffness PRO measures, a qualitative investigation into the RA and polymyalgia rheumatica patient perspective of stiffness, data-driven stiffness conceptual model development, development and testing of an RA stiffness PRO measure, and a quantitative work testing stiffness items in patients with RA and psoriatic arthritis.Results.The literature review identified 52 individual stiffness PRO measures assessing morning or early morning stiffness severity/intensity or duration. Items were heterogeneous, had little or inconsistent psychometric property evidence, and did not appear to have been developed according to the PRO development guidelines. A poor match between current stiffness PRO and the conceptual model identifying the RA patient experience of stiffness was identified, highlighting a major flaw in PRO selection according to the OMERACT filter 2.0.Conclusion.Discussions within the Stiffness SIG highlighted the importance of further research on stiffness and defined a research agenda.
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18
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Kobayashi Y, Ikeda K, Nakamura T, Yamagata M, Nakazawa T, Tanaka S, Furuta S, Umibe T, Nakajima H. Severity and Diurnal Improvement of Morning Stiffness Independently Associate with Tenosynovitis in Patients with Rheumatoid Arthritis. PLoS One 2016; 11:e0166616. [PMID: 27851825 PMCID: PMC5113064 DOI: 10.1371/journal.pone.0166616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although morning stiffness has long been recognized as a characteristic feature of rheumatoid arthritis (RA), it is no more included in the 2010 ACR/EULAR Classification Criteria or in the current major instruments for evaluating disease activity of RA. In this cross-sectional study, we aimed to determine the independent value and the optimal measurement of morning stiffness by clarifying the associations between morning stiffness and synovial inflammation. PATIENTS AND METHODS We enrolled 76 consecutive RA patients who underwent musculoskeletal ultrasound examination and agreed to participate in the study. In addition to asking the duration of morning stiffness, we asked patients to complete a diagram which represents the time course of their morning stiffness in the dominant hand. Based on this diagram, we calculated the severity and the diurnal improvement of morning stiffness. We also determined the activity of intra-articular synovitis in 11 joints and tenosynovitis in 8 tendons/tendon compartments in the same hand by using power Doppler (PD) ultrasound with a semiquantitative score (0-3). RESULTS For intra-articular synovitis, swollen/tender joint counts more strongly correlated with total PD scores (ρ = 0.379-0.561, p ≤ 0.001) than did any parameters of morning stiffness (ρ = 0.217-0.314, p = 0.006-0.021). For tenosynovitis, however, the severity on awakening and the improvement of morning stiffness more strongly correlated with total PD scores (ρ = 0.503-0.561, p < 0.001) than did swollen/tender joint counts (ρ = 0.276-0.388, p = 0.001-0.016). Multivariate analyses identified the severity on awakening and the improvement but not the duration of morning stiffness as factors that independently associate with the total tenosynovial PD score. CONCLUSIONS Our data demonstrate a pathophysiological link between morning stiffness and tenosynovitis and also give an insight into the optimal measurement of morning stiffness. Our data support an independent value of evaluating morning stiffness in the management of RA.
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Affiliation(s)
- Yoshihisa Kobayashi
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Rheumatology Center, Matsudo City Hospital, Matsudo, Chiba, Japan
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- * E-mail:
| | - Takayuki Nakamura
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Mieko Yamagata
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan
| | - Takuya Nakazawa
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Department of Rheumatology, Allergy, and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Shigeru Tanaka
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Takeshi Umibe
- Rheumatology Center, Matsudo City Hospital, Matsudo, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
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19
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Bartlett SJ, Bykerk VP, Cooksey R, Choy EH, Alten R, Christensen R, Furst DE, Guillemin F, Halls S, Hewlett S, Leong AL, Lyddiatt A, March L, Montie P, Orbai AM, Pohl C, Voshaar MS, Woodworth TG, Bingham CO. Feasibility and Domain Validation of Rheumatoid Arthritis (RA) Flare Core Domain Set: Report of the OMERACT 2014 RA Flare Group Plenary. J Rheumatol 2015; 42:2185-9. [PMID: 25684764 DOI: 10.3899/jrheum.141169] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop an approach to identify and measure RA flares. An overview of our OMERACT 2014 plenary is provided. METHODS Feasibility and validity of flare domains endorsed at OMERACT 11 (2012) were described based on initial data from 3 international studies collected using a common set of questions specific to RA flare. Mean flare frequency, severity, and duration data were presented, and domain scores were compared by flare status to examine known-groups validity. Breakout groups provided input for stiffness, self-management, contextual factors, and measurement considerations. RESULTS Flare data from 501 patients in an observational study indicated 39% were in flare, with mean (SD) severity of 6.0 (2.6) and 55% lasting > 14 days. Pain, physical function, fatigue, participation, and stiffness scores averaged ≥ 2 times higher (2 of 11 points) in flaring individuals. Correlations between flare domains and corresponding legacy instruments were obtained: r = 0.46 to 0.93. A combined definition (patient report of flare and 28-joint Disease Activity Score increase) was evaluated in 2 other trials, with similar results. Breakout groups debated specific measurement issues. CONCLUSION These data contribute initial evidence of feasibility and content validation of the OMERACT RA Flare Core Domain Set. Our research agenda for OMERACT 2016 includes establishing duration/intensity criteria and developing criteria to identify RA flares using existing disease activity measures. Ongoing work will also address discordance between patient and physician ratings, facilitate application of flare criteria to clinical care, elucidate the role of self-management, and finalize recommendations for RA flare measurement.
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Affiliation(s)
- Susan J Bartlett
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University.
| | - Vivian P Bykerk
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Roxanne Cooksey
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Ernest H Choy
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Rieke Alten
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Robin Christensen
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Daniel E Furst
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Francis Guillemin
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Serena Halls
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Sarah Hewlett
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Amye L Leong
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Anne Lyddiatt
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Lyn March
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Pamela Montie
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Ana Maria Orbai
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Christoph Pohl
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Marieke Scholte Voshaar
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Thasia G Woodworth
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Clifton O Bingham
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
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