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Delle Sedie A, Terslev L, Bruyn GAW, Cazenave T, Chrysidis S, Diaz M, Di Carlo M, Frigato M, Gargani L, Gutierrez M, Hocevar A, Iagnocco A, Juche A, Keen H, Mandl P, Naredo E, Mortada M, Pineda C, Karalilova R, Porta F, Ravagnani V, Scirè C, Serban T, Smith K, Stoenoiu MS, Tardella M, Torralba K, Wakefield R, D'Agostino MA. Standardization of interstitial lung disease assessment by ultrasound: results from a Delphi process and web-reliability exercise by the OMERACT ultrasound working group. Semin Arthritis Rheum 2024; 65:152406. [PMID: 38401294 DOI: 10.1016/j.semarthrit.2024.152406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.
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Affiliation(s)
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - George A W Bruyn
- Reumakliniek Lelystad, Lelystad, and Tergooi Hospital, Hilversum, the Netherlands
| | - Tomas Cazenave
- Instituto de Rehabiltacion Psicofisca, Buenos Aires, Argentina
| | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Esbjerg Hospital, Denmark
| | - Mario Diaz
- Fundacion Santa Fe de Bogotá, Bogotà, Colombia
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | - Marilena Frigato
- S.C. Allergologia, Immunologia e Reumatologia, ASST "Carlo Poma" Mantova, Mantova, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche - AO Mauriziano di Torino, Università di Torino, Turin, Italy
| | - Aaron Juche
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Helen Keen
- Department of Medicine and Pharmacology, University of Western Australia, Murdoch, Perth, WA, Australia
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Fundación Jiménez Díaz, Madrid, Spain
| | - Mohamed Mortada
- Department of Rheumatology Rehabilitation and Physical Medicine, Zagazig University, Zagazig, Egypt
| | - Carlos Pineda
- Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Rositsa Karalilova
- Medical University of Plovdiv, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Santa Maria Maddalena Hospital, Rovigo, Italy
| | | | - Carlo Scirè
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | | | - Kate Smith
- NIHR Leeds Biomedical Research Centre and University of Leeds, UK
| | - Maria S Stoenoiu
- Rheumatology Department, Clinique Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marika Tardella
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | | | | | - Maria Antonietta D'Agostino
- Rheumatology division, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
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Perrotta FM, Scrivo R, D'Angelo S, Scriffignano S, Delle Sedie A, Coates L, Lubrano E. Assessment of Patient-Physician Interactions in Psoriatic Arthritis: National Results of the ASSIST Study. Rheumatol Ther 2024:10.1007/s40744-024-00655-4. [PMID: 38446398 DOI: 10.1007/s40744-024-00655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION An overarching principle for the management of psoriatic arthritis (PsA) is a shared decision-making process between physicians and patients. The aim of this study is to assess the patient-physician relationship in a group of patients with PsA, by using the Perceived Efficacy in Patient-Physician Interactions (PEPPI) and CollaboRATE instruments. METHODS This is a cross-sectional multicenter study where consecutive patients with PsA were enrolled. For each patient, the main demographic, comorbid conditions, and clinical data were collected, including the assessment of disease activity, function, quality of life, and impact of disease. PEPPI and CollaboRATE questionnaires were used, respectively, to evaluate the patient's perception of the patient-physician relationship and the shared decision-making process. RESULTS A total of 81 patients with PsA were enrolled at four centers in Italy. Overall, our patients showed a high level of confidence in obtaining needed health care, with relatively high median (IQR) values of PEPPI (20; 16-23), and a good shared decision-making process, with high median (IQR) values of CollaboRATE questionnaire (7; 6-9). PEPPI and CollaboRATE scores showed a statistically significant inverse correlation with different clinical variables such as disease duration, Leeds Enthesitis Index, PsA impact of Disease, Health Assessment Questionnaire, pain, patient's global assessment of disease activity and clinical disease activity for PsA. The presence of comorbidities did not appear to be associated with lower values of PEPPI and CollaboRATE. CONCLUSIONS In this study, few patients with PsA were at risk of suboptimal communication with their physician. This phenomenon appeared to be primarily related to higher disease activity and burden.
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Affiliation(s)
- Fabio Massimo Perrotta
- Dipartimento di Medicina e di Scienze Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy.
| | - Rossana Scrivo
- UOC Di Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari. Sapienza, Università Di Roma, Rome, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), Potenza, Italy
| | - Silvia Scriffignano
- Dipartimento di Medicina e di Scienze Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
| | - Andrea Delle Sedie
- U.O. Reumatologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ennio Lubrano
- Dipartimento di Medicina e di Scienze Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
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D'Angelo S, Tirri E, Giardino AM, De Rosa T, Matucci-Cerinic M, Dagna L, Santo L, Ciccia F, Frediani B, Govoni M, Pallavicini FB, Grembiale RD, Sedie AD, Mulè R, Cantatore FP, Foti R, Gremese E, Conigliaro P, Salaffi F, Viapiana O, Cauli A, Giacomelli R, Arcarese L, Guggino G, Russo R, Puenpatom A, Capocotta D, Nacci F, Anelli MG, Picerno V, Binetti C, Iannone F. Real-world effectiveness and persistence of golimumab as second-line anti-TNFα drug in rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis patients in Italy: GO-BEYOND, a 12-month prospective observational study. Int J Rheum Dis 2024; 27:e15091. [PMID: 38433479 DOI: 10.1111/1756-185x.15091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Salvatore D'Angelo
- Istituto Reumatologico Lucano (I.Re.L) e Dipartimento Regionale di Reumatologia, AOR San Carlo di Potenza, Potenza, Italy
| | - Enrico Tirri
- UOSD di Reumatologia, Ospedale San Giovanni Bosco, Napoli, Italy
| | | | | | - Marco Matucci-Cerinic
- A.O. Careggi Università, Firenze, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Francesco Ciccia
- AOU Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Bruno Frediani
- UOC di Reumatologia, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Marcello Govoni
- AOU S. Anna di Ferrara, UOC Reumatologia, Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | | | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Dipartimento di Scienze della Salute, Università degli studi "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | | | - Rita Mulè
- UO Reumatologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | | | - Rosario Foti
- A.O.U. Policlinico G. Rodolico-S. Marco, U.O di Reumatologia, Catania, Italy
| | - Elisa Gremese
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Conigliaro
- UOC Reumatologia, Dipartimento di Medicina dei Sistemi, Università di Roma "Tor Vergata", Rome, Italy
| | - Fausto Salaffi
- Clinica Reumatologica, Ospedale "C. Urbani" Università Politecnica delle Marche, Ancona, Italy
| | - Ombretta Viapiana
- Ospedale Borgo Roma Policlinico G.B. Rossi, U.O.C. Reumatologia, Verona, Italy
| | - Alberto Cauli
- Azienda Osped/Universitaria Policlinico Monserrato, Cagliari, Italy
| | - Roberto Giacomelli
- UOC ImmunoReumatologia, Università CampusBio Medico di Roma, Roma, Italy
| | - Luisa Arcarese
- UOC ImmunoReumatologia, Università CampusBio Medico di Roma, Roma, Italy
| | | | | | - Amy Puenpatom
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, New Jersey, USA
| | | | - Francesca Nacci
- Divisions of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Valentina Picerno
- Istituto Reumatologico Lucano (I.Re.L) e Dipartimento Regionale di Reumatologia, AOR San Carlo di Potenza, Potenza, Italy
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Coyle C, Watson L, Whately-Smith C, Brooke M, Kiltz U, Lubrano E, Queiro R, Trigos D, Brandt-Juergens J, Choy E, D'Angelo S, Delle Sedie A, Dernis E, Wirth T, Guis S, Helliwell P, Ho P, Hueber A, Joven B, Koehm M, Morales CM, Packham J, Pinto Tasende JA, Garcia FJR, Ruyssen-Witrand A, Scrivo R, Twigg S, Welcker M, Soubrier M, Gossec L, Coates LC. How do patient reported outcome measures affect treatment intensification and patient satisfaction in the management of psoriatic arthritis? A cross sectional study of 503 patients. Rheumatology (Oxford) 2024:kead679. [PMID: 38191998 DOI: 10.1093/rheumatology/kead679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES The ASSIST study investigated prescribing in routine psoriatic arthritis (PsA) care and whether the patient reported outcome: PsA Impact of Disease questionnaire (PsAID-12), impacted treatment. This study also assessed a range of patient and clinician factors and their relationship to PsAID-12 scoring and treatment modification. METHODS Patients with PsA were selected across the UK and Europe between July 2021-March 2022. Patients completed the PsAID questionnaire, with the results shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded. RESULTS 503 patients recruited. 36.2% had changes made to treatment, 88.8% of this had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; the PsAID-12 score was associated with odds of treatment escalation (OR: 1.58; p< 0.0001). However, most clinicians reported PsAID-12 did not impact their decision to escalate treatment, instead supporting treatment reduction decisions. Physician's assessment of disease activity had the most statistically significant effect on likelihood of treatment escalation, (OR = 2.68, per 1-point score increase). Escalation was more likely in patients not treated with biologic therapies. Additional factors associated with treatment escalation included: patient characteristics, physician characteristics, disease activity and disease impact. CONCLUSION This study highlights multiple factors impacting treatment decision making for individuals with PsA. PsAID-12 scoring correlates with multiple measures of disease severity and odds of treatment escalation. However, most clinicians reported the PsAID-12 did not influence treatment escalation decisions. PsAID scoring could be used to increase confidence in treatment de-escalation.
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Affiliation(s)
- Conor Coyle
- Oxford University, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Lily Watson
- University of Bristol, Department of Cellular and Molecular Medicine, Bristol, UK
| | | | - Mel Brooke
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Uta Kiltz
- Ruhr-Universität Bochum, and Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Ennio Lubrano
- Academic Rheumatology Unit, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Ruben Queiro
- Rheumatology & ISPA Translational Immunology Division, Faculty of Medicine, Rheumatology Service & the Principality of Asturias Institute for Health Research (ISPA), Universidad de Oviedo, Oviedo, Spain
| | | | - Jan Brandt-Juergens
- Rheumatologische Schwerpunktpraxis, Bundesallee 104/105, Berlin, 12161, Germany
| | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | | | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emmanuelle Dernis
- Rheumatology Department, Centre Hospitalier du Mans, Le Mans, France
| | - Théo Wirth
- Rheumatology Department, INSERM UMRs1097 Autoimmune Arthritis, Aix Marseille University, Marseille, France
| | - Sandrine Guis
- Rheumatology department, Aix Marseille University, Arthrites Autoimmunes, Marseille, France
| | - Philip Helliwell
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Pauline Ho
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Axel Hueber
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Beatriz Joven
- Rheumatology Department, Hospital Universitario 12 Octubre, Madrid, ES. & Universidad Complutense de Madrid, Avda de Córdoba sin, Madrid, 28041, Spain
| | - Michaela Koehm
- Rheumatology, Universitiy Hospital Frankfurt, Fraunhofer-Institute for Translational Medicine and Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt am Main, Germany
| | | | - Jon Packham
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, UK
| | | | | | - Adeline Ruyssen-Witrand
- Rheumatology Center, Toulouse University Hospital, CIC 1436 Inserm, Rheumatology, Tolouse, France & Paul Sabatier University, Toulouse III Toulouse, France
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sarah Twigg
- Rheumatology, Bradford Teaching Hospitals NHS foundation trust, Bradford, UK
| | - Martin Welcker
- MVZ für Rheumat ologie Dr M. Welcker GmbH, Bahnhofstr. 32, Planegg, 82152, Germany
| | - Martin Soubrier
- Rheumatology Departement, Gabriel-Montpied Teaching Hospital of Clermont-Ferrand, France
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, FR. & AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Di Battista M, Delle Sedie A, Romei C, Tavanti L, Da Rio M, Morganti R, Della Rossa A, Mosca M. Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2023:kead642. [PMID: 38048612 DOI: 10.1093/rheumatology/kead642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES Lung ultrasound (LUS) and high-resolution computed tomography (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a one-year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes. METHODS SSc-ILD patients who started NIN were enrolled and followed for twelve months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after one year and quantitatively analysed with CALIPER software. RESULTS Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after twelve months (from 175.1 ± 66.7-120.8 ± 70.3 for BL, p= 0.005 and from 50.6 ± 32.5-37.2 ± 22.4 for PLI, p= 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction of both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (p= 0.016 and p= 0.04, respectively) and Saint George's Respiratory Questionnaire (p= 0.006 and p= 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after twelve months of NIN, thus paralleling the stabilization obtained at pulmonary function tests. CONCLUSIONS We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | | | - Laura Tavanti
- Cardiovascular Thoracic Department, University of Pisa, Pisa, Italy
| | | | | | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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Watson L, Coyle C, Whately-Smith C, Brooke M, Kiltz U, Lubrano E, Queiro R, Trigos D, Brandt-Juergens J, Choy E, D'Angelo S, Delle Sedie A, Dernis E, Guis S, Helliwell P, Ho P, Hueber AJ, Joven B, Koehm M, Montilla C, Packham J, Pinto Tasende JA, Ramirez Garcia FJ, Ruyssen-Witrand A, Scrivo R, Twigg S, Soubrier M, Wirth T, Gossec L, Coates LC. An international multi-centre analysis of current prescribing practices and shared decision-making in psoriatic arthritis. Rheumatology (Oxford) 2023:kead621. [PMID: 38011669 DOI: 10.1093/rheumatology/kead621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/02/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Shared decision-making (SDM) is advocated to improve patient outcomes in Psoriatic arthritis (PsA). We analysed current prescribing practices and the extent of SDM in PsA across Europe. METHODS The ASSIST study was a cross-sectional observational study of PsA patients aged ≥18 years attending face-to-face appointments between July 2021-March 2022. Patient demographics, current treatment and treatment decisions were recorded. SDM was measured by the clinician's effort to collaborate (CollaboRATE questionnaire) and patient communication confidence (PEPPI-5 tool). RESULTS 503 patients were included from 24 centres across the UK, France, Germany, Italy and Spain. Physician- and patient-reported measures of disease activity were highest in the UK. Conventional synthetic DMARDs constituted a higher percentage of current PsA treatment in UK than continental Europe (66.4% vs 44.9%), which differed from biologic DMARDs (36.4% vs 64.4%). Implementing treatment escalation was most common in the UK. CollaboRATE and PEPPI-5 scores were high across centres. Of 31 patients with low CollaboRATE scores (<4.5), no patients with low PsAID-12 scores (<5) had treatment escalation. However, of 465 patients with CollaboRATE scores ≥4.5, 59 patients with low PsAID-12 scores received treatment escalation. CONCLUSIONS Higher rates of treatment escalation seen in the UK may be explained by higher disease activity and a younger cohort. High levels of collaboration in face-to-face PsA consultations suggests effective implementation of the SDM approach. Our data indicate that, in patients with mild disease activity, only those with higher perceived collaboration underwent treatment escalation. Prospective studies should examine the impact of SDM on PsA patient outcomes. TRIAL REGISTRATION clinicaltrials.gov, NCT05171270.
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Affiliation(s)
- Lily Watson
- Department of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Conor Coyle
- Oxford University Hospital, University of Oxford, Oxford, UK
| | | | - Melanie Brooke
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany
- Ruhr-University Bochum, Claudiusstr 45, Herne, Germany
| | - Ennio Lubrano
- Academic Rheumatology Unit, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division., Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | | | | | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emmanuelle Dernis
- Rheumatology Department, Centre Hospitalier du Mans, Le Mans, France
| | - Sandrine Guis
- Rheumatology Department, CHU Marseille, Marseille, France
| | | | - Pauline Ho
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Axel J Hueber
- Division of Rheumatology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario, 12 de Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Michaela Koehm
- Division of Rheumatology, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP & Fraunhofer Centre of Excellence Immunemediated Diseaes CIMD, Frankfurt am Main, Germany
| | - Carlos Montilla
- Rheumatology Department, Hospital Universitario Salamanca, Salamanca, Spain
| | - Jon Packham
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Adeline Ruyssen-Witrand
- Rheumatology Centre, Toulouse University Hospital, Toulouse, France
- Paul Sabatier University, Toulouse III, Toulouse, France
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sarah Twigg
- Rheumatology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Martin Soubrier
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Théo Wirth
- Rheumatology Department, CHU Marseille, Marseille, France
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Sirotti S, Terslev L, Filippucci E, Iagnocco A, Moller I, Naredo E, Vreju FA, Adinolfi A, Becce F, Hammer HB, Cazenave T, Cipolletta E, Christiansen SN, Delle Sedie A, Diaz M, Figus F, Mandl P, MacCarter D, Mortada MA, Mouterde G, Porta F, Reginato AM, Schmidt WA, Serban T, Wakefield RJ, Zufferey P, Sarzi-Puttini P, Zanetti A, Damiani A, Pineda C, Keen HI, D'Agostino MA, Filippou G. Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. Lancet Rheumatol 2023; 5:e474-e482. [PMID: 38251579 DOI: 10.1016/s2665-9913(23)00136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology. METHODS In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology. Following a previous systematic review to gather available evidence on existing scoring systems for CPPD, the novel scoring system was developed through a Delphi survey based on the expert opinion of the members of the OMERACT Ultrasound working group-CPPD subgroup. The reliability of the scoring system was then tested on a web-based and patient-based exercise. Intra-reader and inter-reader reliability of the new scoring system was assessed using weighted Light's κ coefficients. FINDINGS The four-grade semiquantitative scoring system consisted of: grade 0 (no findings consistent with CPPD), grade 1 (≤3 single spots or 1 small deposit), grade 2 (>3 single spots or >1 small deposit or ≥1 larger deposit occupying ≤50% of the structure under examination in the reference image-ie, the scanning view with the highest grade of depositions), and grade 3 (deposits that occupy more than 50% of the structure under examination in the reference image). The score should be applied to the knee (menisci and hyaline cartilage) and the triangular fibrocartilage complex of the wrist. The intra-reader and inter-reader reliabilities on static images were almost perfect (κ 0·90 [95% CI 0·79-1·00] and κ 0·84 [0·79-0·88]), and on the eight patients recruited (four [50%] female and four [50%] male) were substantial (κ 0·72 [95% CI 0·47 to 0·96] and 0·66 [0·61 to 0·71]). INTERPRETATION This OMERACT ultrasound scoring system for CPPD was reliable on both static images and patients. The scoring system might be a valuable tool for ensuring valid and comparable results in clinical trials and could help monitor the extent of crystal deposition in patients with CPPD in clinical practice. FUNDING The Italian Ministry of Health - Ricerca Corrente.
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Affiliation(s)
- Silvia Sirotti
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Annamaria Iagnocco
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Ingrid Moller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; IIS-FJD, Universidad Autónoma of Madrid, Madrid, Spain
| | - Florentin A Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Antonella Adinolfi
- Rheumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Diaz
- Rheumatology Unit, University Hospital Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Fabiana Figus
- Rheumatology Service, ASL Torino 3, Collegno Pinerolo, Turin, Italy
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Daryl MacCarter
- Department of Rheumatology, North Valley Hospital, Whitefish, MT, USA
| | - Mohamed A Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Gael Mouterde
- Rheumatology Department & IDESP, CHU Montpellier, Montpellier University, Montpellier, France
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Rheumatology Section, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Anthony M Reginato
- Division of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK
| | - Pascal Zufferey
- Rheumatology Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piercarlo Sarzi-Puttini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Arianna Damiani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, WA, Australia
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Georgios Filippou
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy.
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8
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Eder L, Mathew AJ, Carron P, Bertheussen H, Cañete JD, Azem M, Delle Sedie A, Salvarani C, Ranza R, Elliott A, Turkiewicz A, de Toledo RA, Bukulmez H, Stoenoiu MS, Mandelin AM, Koehm M, Lindsay CA, Siegel E, Mease PJ. Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2023; 50:258-264. [PMID: 36319005 DOI: 10.3899/jrheum.220312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Enthesitis is a key pathological and clinical feature of psoriatic arthritis (PsA) in children and adults. Enthesitis is typically assessed clinically using several validated enthesitis scoring systems that have been used in clinical trials. Enthesitis treatment response has been reported as change in the total enthesitis score or the proportion of patients who achieved complete resolution. The majority of trials in PsA did not require patients to have enthesitis at study entry since enthesitis was evaluated only as a secondary outcome. Despite the inherent limitations of the clinical assessment of enthesitis, imaging of the entheses using ultrasound or magnetic resonance imaging has rarely been used in clinical trials to assess response to treatment of enthesitis. This systematic review summarizes existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA to facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA. METHODS We performed a systematic literature review to identify 41 randomized clinical trials that reported enthesitis treatment response in patients with PsA. For each intervention, the response effect size was summarized and the quality of evidence was graded. Recommendations were then formulated for the various pharmacological and nonpharmacological therapies. RESULTS We included 41 randomized clinical trials in our review and graded each intervention. CONCLUSION Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA.
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Affiliation(s)
- Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada;
| | - Ashish J Mathew
- A.J. Mathew, MBBS, DNB, DM, The Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Philippe Carron
- P. Carron, MD, PhD, Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, and VIB Center for Inflammation Research, Ghent, Belgium
| | | | - Juan D Cañete
- J.D. Cañete, DMD, PhD, Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - May Azem
- M. Azem, MD, Solo Private Practice, and Department of Internal Medicine, Lake Hospital, University Hospital Systems, Cleveland, Ohio, USA
| | - Andrea Delle Sedie
- A. Delle Sedie, MD, Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carlo Salvarani
- C. Salvarani, MD, Dipartimento Specialità Mediche, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia and Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Ranza
- R. Ranza, MD, PhD, Rheumatology Unit, Hospital de Clinicas, EBSERH, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Ashley Elliott
- A. Elliott, MB Bch BAO, MSc, MRCP, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Ricardo Acayaba de Toledo
- R.A. de Toledo, MD, MSc, Regional School of Medicine Foundation of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Hulya Bukulmez
- H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria S Stoenoiu
- M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Arthur M Mandelin
- A.M. Mandelin II, MD, PhD, Northwestern University, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michaela Koehm
- M. Koehm, MD, Rheumatology Division, University Hospital Frankfurt and Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
| | - Chris A Lindsay
- C.A. Lindsay, PharmD, GRAPPA Patient Research Partner, Aurinia Pharmaceuticals Inc., Rockville, Maryland, USA
| | - Evan Siegel
- E. Siegel, MD, Arthritis and Rheumatism Associates, Rockville, Maryland, and Georgetown University School of Medicine, Washington, DC, USA
| | - Philip J Mease
- P.J. Mease MD, MACR, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA
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9
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Mathiessen A, Hammer HB, Terslev L, Kortekaas MC, D'Agostino MA, Haugen IK, Bruyn GA, Filippou G, Filippucci E, Kloppenburg M, Mancarella L, Mandl P, Möller I, Mortada MA, Naredo E, Sedie AD, Sexton J, Wittoek R, Iagnocco A, Ellegaard K. Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study. Arthritis Care Res (Hoboken) 2022; 74:2005-2012. [PMID: 34137211 DOI: 10.1002/acr.24734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). METHODS The Outcome Measures in Rheumatology Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores. A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with 6 sonographers testing inflammatory and structural features in 12 hand OA patients. We used Cohen's kappa for intrareader and Light's kappa for interreader reliability for all features except PD, in which prevalence-adjusted bias-adjusted kappa (PABAK) was applied. Percentage agreement was also assessed. RESULTS The web-based reliability exercise demonstrated substantial intra- and interreader reliability for all inflammatory features (κ > 0.64). In the patient-based exercise, intra- and interreader reliability, respectively, varied: SH κ = 0.73 and 0.45; JE κ = 0.70 and 0.55; PD PABAK = 0.90 and 0.88; PIP joint cartilage κ = 0.56 and 0.45; and STT osteophytes κ = 0.62 and 0.36. Percentage close agreement was high for all features (>85%). CONCLUSION With ultrasound, substantial to excellent intrareader reliability was found for inflammatory features of hand OA. Interreader reliability was moderate, but overall high close agreement between readers suggests that better reliability is achievable after further training. Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less reliability and the latter is not endorsed.
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Affiliation(s)
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | | | | | | | | | | | | | | | | | | | - Peter Mandl
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - Ruth Wittoek
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Karen Ellegaard
- Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
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10
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D’Angelo S, Tirri E, Giardino AM, Mattucci-Cerinic M, Dagna L, Santo L, Ciccia F, Frediani B, Govoni M, Bobbio Pallavicini F, Grembiale RD, Delle Sedie A, Mulè R, Cantatore FP, Foti R, Gremese E, Conigliaro P, Salaffi F, Viapiana O, Cauli A, Giacomelli R, Arcarese L, Guggino G, Russo R, Puenpatom A, Capocotta D, Nacci F, Anelli MG, Picerno V, Binetti C, Iannone F. Effectiveness of Golimumab as Second Anti-TNFα Drug in Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondyloarthritis in Italy: GO-BEYOND, a Prospective Real-World Observational Study. J Clin Med 2022; 11:jcm11144178. [PMID: 35887946 PMCID: PMC9322086 DOI: 10.3390/jcm11144178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
In this prospective observational study, data were collected from 34 rheumatology clinics in Italy in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) who started golimumab (GLM) as a second anti-TNFα drug. The primary objective was to evaluate the effectiveness of GLM after 6 months. Changes in quality of life using the EQ-5D-5L were also assessed. A total of 194 patients aged 53.2 ± 12 years started GLM as a second anti-TNF drug: 39 (20.1%) with RA, 91 (46.9%) with PsA and 64 (32.9%) with axSpA. After 6 months of GLM treatment, 68% of RA patients achieved low disease activity (LDA; DAS28-CRP ≤ 3.2), 31.9% of PsA patients achieved minimal disease activity and 32.5% of axSpA patients achieved LDA (ASDAS-CRP < 2.1). Good/moderate EULAR response was achieved in 61.9% and 73.8% of patients with RA and PsA, respectively, and 16% of axSpA patients achieved a 50% improvement in BASDAI. Across all indications, improvements in disease activity measures and EQ-5D-5L domains were observed over 6 months. The main reasons for GLM interruption were lack/loss of efficacy (7.2%) or adverse events (2%). This study confirms the effectiveness of GLM as a second-line anti-TNF for the treatment of RA, PsA and axSpA in a real-world setting in Italy.
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Affiliation(s)
- Salvatore D’Angelo
- Istituto Reumatologico Lucano (I.Re.L), Dipartimento Regionale di Reumatologia, AOR San Carlo di Potenza, 85100 Potenza, Italy;
- Correspondence: ; Tel.: +39-0971-613072 or +39-0971-613577
| | - Enrico Tirri
- UOSD di Reumatologia, Ospedale San Giovanni Bosco, 80144 Napoli, Italy; (E.T.); (D.C.)
| | | | - Marco Mattucci-Cerinic
- A.O. Careggi Università, 50134 Firenze, Italy;
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Leonardo Santo
- U.O.S. Reumatologia ASL BT—DSS 4, 76121 Barletta, Italy;
| | - Francesco Ciccia
- AOU Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy;
| | - Bruno Frediani
- UOC di Reumatologia, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy;
| | - Marcello Govoni
- AOU S. Anna di Ferrara, UOC Reumatologia, Dipartimento di Scienze Mediche, Università di Ferrara, 44121 Ferrara, Italy;
| | | | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Dipartimento di Scienze della Salute, Università degli studi “Magna Graecia” di Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Delle Sedie
- U.O. Reumatologia Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Rita Mulè
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, UO Reumatologia, 40138 Bologna, Italy;
| | | | - Rosario Foti
- A.O.U. Policlinico G. Rodolico-S. Marco, U.O di Reumatologia, 95123 Catania, Italy;
| | - Elisa Gremese
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Paola Conigliaro
- UOC Reumatologia, Dipartimento di Medicina dei Sistemi, Università di Roma “Tor Vergata”, 00133 Rome, Italy;
| | - Fausto Salaffi
- Clinica Reumatologica, Ospedale “C. Urbani” Università Politecnica delle Marche, 60035 Ancona, Italy;
| | - Ombretta Viapiana
- Ospedale Borgo Roma Policlinico G.B. Rossi, U.O.C. Reumatologia, 37126 Verona, Italy;
| | - Alberto Cauli
- Azienda Osped/Universitaria Policlinico Monserrato, 09124 Cagliari, Italy;
| | - Roberto Giacomelli
- UOC ImmunoReumatologia, Università CampusBio Medico di Roma, 00128 Rome, Italy; (R.G.); (L.A.)
| | - Luisa Arcarese
- UOC ImmunoReumatologia, Università CampusBio Medico di Roma, 00128 Rome, Italy; (R.G.); (L.A.)
| | - Giuliana Guggino
- PROMISE Department, University of Palermo, 90133 Palermo, Italy;
| | - Romualdo Russo
- AORN, A. Cardarelli U.O.S. Reumatologia, 80131 Napoli, Italy;
| | - Amy Puenpatom
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ 07033, USA;
| | - Domenico Capocotta
- UOSD di Reumatologia, Ospedale San Giovanni Bosco, 80144 Napoli, Italy; (E.T.); (D.C.)
| | - Francesca Nacci
- Department of Experimental and Clinical Medicine, Divisions of Rheumatology AOUC, University of Florence, 50134 Florence, Italy;
| | - Maria Grazia Anelli
- Rheumatology Unit, DETO, University of Bari, 70124 Bari, Italy; (M.G.A.); (F.I.)
| | - Valentina Picerno
- Istituto Reumatologico Lucano (I.Re.L), Dipartimento Regionale di Reumatologia, AOR San Carlo di Potenza, 85100 Potenza, Italy;
| | - Corrado Binetti
- Medical Affairs MSD Italia S.r.l., 00189 Rome, Italy; (A.M.G.); (C.B.)
| | - Florenzo Iannone
- Rheumatology Unit, DETO, University of Bari, 70124 Bari, Italy; (M.G.A.); (F.I.)
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11
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Gremese E, Ciccia F, Selmi C, Cuomo G, Foti R, Matucci-Cerinic M, Conti F, Fusaro E, Guggino G, Iannone F, Delle Sedie A, Perricone R, Idolazzi L, Moscato P, Theander E, Noël W, Bergmans P, Marelli S, Gossec L, Smolen JS. Persistence, effectiveness and safety of ustekinumab compared to TNF inhibitors in psoriatic arthritis within the Italian PsABio cohort. Clin Exp Rheumatol 2022; 41:735-743. [PMID: 36226614 DOI: 10.55563/clinexprheumatol/j33pjt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare real-world persistence, effectiveness and tolerability of ustekinumab versus TNF inhibitors (TNFi) in psoriatic arthritis (PsA). METHODS One-year data from Italian subjects enrolled in the PsABio study (PsA patients receiving 1st- to 3rd-line treatment with ustekinumab or TNFi) were evaluated. Treatment persistence was analysed using Kaplan-Meier curves; hazard ratios (HR) of stopping treatment, and the corresponding 95% confidence intervals (CI), were computed through Cox regression models. Proportions of patients reaching clinical effectiveness endpoints were analysed using logistic regression, including propensity score (PS) adjustment for imbalanced baseline covariates, and non-response imputation if treatment was stopped/switched. RESULTS Among 222 participants with follow-up data (effectiveness set), 101 received ustekinumab and 121 TNFi. In the ustekinumab group, 74.3% continued treatment up to 12±3 months compared to 63.6% in the TNFi group. Ustekinumab showed better persistence than TNFi, overall and in specific subgroups (females, monotherapy without methotrexate, BMI <25 or >30 kg/m2, patients receiving ustekinumab as 2nd-line treatment instead of a second TNFi). Overall, the PS-adjusted HR of treatment discontinuation was 0.46 (95% CI: 0.26-0.82) for ustekinumab vs. TNFi. cDAPSA LDA/remission was achieved in 43.5% of ustekinumab and 43.6% of TNFi-treated patients, while MDA was achieved in 24.2% and 28.0% of patients, respectively. After PS adjustment, odds ratios of clinical effectiveness did not differ significantly. Both treatments showed an acceptable safety profile. CONCLUSIONS This prospective, real-life study found a better persistence of ustekinumab than TNFi in PsA patients. At 1 year, both treatments showed similar effectiveness.
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Affiliation(s)
- Elisa Gremese
- Fondazione Policlinico A Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, and IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Rosario Foti
- Presidio Ospedaliero San Marco, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Marco Matucci-Cerinic
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, and Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabrizio Conti
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Italy
| | - Enrico Fusaro
- AOU Città della Salute e della Scienza di Torino, Italy
| | | | | | | | - Roberto Perricone
- Università degli Studi di Roma Tor Vergata e Policlinico Tor Vergata, Rome, Italy
| | - Luca Idolazzi
- Unità di Reumatologia, Dipartimento di Medicina, Università degli Studi di Verona, Italy
| | - Paolo Moscato
- AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | | | - Wim Noël
- Janssen Pharmaceutica NV, Beerse, The Netherlands
| | | | | | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, and Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne Université, Paris, France
| | - Josef S. Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Austria
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12
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Hughes M, Bruni C, Cuomo G, Delle Sedie A, Gargani L, Gutierrez M, Lepri G, Ruaro B, Santiago T, Suliman Y, Watanabe S, Iagnocco A, Furst D, Bellando-Randone S. The role of ultrasound in systemic sclerosis: On the cutting edge to foster clinical and research advancement. J Scleroderma Relat Disord 2021; 6:123-132. [PMID: 35386740 PMCID: PMC8892934 DOI: 10.1177/2397198320970394] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/05/2020] [Indexed: 09/29/2023]
Abstract
Ultrasound has been widely explored in systemic sclerosis in the clinical and research settings. Ultrasound allows a non-invasive and ionising radiation-free 'window' into this complex disease and is well-suited to repeated examinations. Ultrasound provides novel insights into the pathogenesis and measurement of disease in systemic sclerosis, including early (preclinical) internal organ involvement. The purpose of this review is to describe the role of ultrasound to foster clinical and research advancements in systemic sclerosis relating to (1) musculoskeletal, (2) digital ulcer, (3) lung disease and (4) skin disease. We also highlight unmet needs which much be addressed for ultrasound to assume a central role in systemic sclerosis clinical care and research.
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Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Royal
Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust,
Sheffield, UK
| | - Cosimo Bruni
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanna Cuomo
- Department of Medicine of
Precision, University of Naples L. Vanvitelli, Naples, Italy
| | - Andrea Delle Sedie
- Rheumatology Unit, Department of
Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology,
National Research Council, Pisa, Italy
| | - Marwin Gutierrez
- Division of Musculoskeletal and
Rheumatic Diseases, National Institute of Rehabilitation, Mexico City,
Mexico
- Rheumatology Center of Excellence,
Mexico City, Mexico
| | - Gemma Lepri
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Ruaro
- Pulmonology Department, University
Hospital of Cattinara, Trieste, Italy
| | - Tania Santiago
- Rheumatology Department, Centro
Hospitalar e Universitáro de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University
of Coimbra, Portugal
| | - Yossra Suliman
- Rheumatology and Rehabilitation
Department, Assiut University Hospital, Assiut, Egypt
| | - Shinji Watanabe
- Department of Allergy and
Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Annamaria Iagnocco
- Academic Rheumatology Centre,
Università degli Studi di Torino, Turin, Italy
| | - Daniel Furst
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
- Department of Medicine, Division
of Rheumatology, University of California Los Angeles, Los Angeles, CA,
USA
- University of Washington,
Seattle, WA, USA
| | - Silvia Bellando-Randone
- Department of Experimental and
Clinical Medicine, University of Florence, Florence, Italy
- Department of Geriatric
Medicine, Division of Rheumatology, Careggi University Hospital, Florence,
Italy
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13
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Christiansen SN, Filippou G, Scirè CA, Balint PV, Bruyn GA, Dalbeth N, Dejaco C, Sedie AD, Filippucci E, Hammer HB, Iagnocco A, Keen HI, Kissin EY, Koski J, Mandl P, Martin J, Miguel ED, Möller I, Naredo E, Pineda C, Schmidt WA, Stewart S, Antonietta D'Agostino M, Terslev L. Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise. Semin Arthritis Rheum 2021; 51:644-649. [PMID: 33468347 DOI: 10.1016/j.semarthrit.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to develop (1) a new ultrasound definition for aggregates and (2) a semi-quantitative ultrasound scoring system (0-3) for tophus, double contour and aggregates. Furthermore, the intra- and inter-reader reliabilities of both the re-defined aggregates and the semi-quantitative scoring system were assessed using static image exercises. METHODS Thirty-seven rheumatologists were invited. A Delphi process was used for re-defining aggregates and for selecting a semi-quantitative scoring system with >75% agreement obligate for reaching consensus. Subsequently, a web-based exercise on static ultrasound images was conducted in order to assess the reliability of both the re-defined aggregates and the semi-quantitative scoring system. RESULTS Twenty rheumatologists contributed to all rounds of the Delphi and image exercises. A consensual re-definition of aggregates was obtained after three Delphi rounds but needed an overarching principle for scoring aggregates in patients. A consensus-based semi-quantitative ultrasound scoring system for gout lesions was developed after two Delphi rounds. The re-definition of aggregates showed good intra- and inter-reader reliability (κ-values 0.71 and 0.61). The reliabilities of the scoring system were good for all lesions with slightly higher intra-reader (κ-values 0.74-0.80) than inter-reader reliabilities (κ-values 0.61-0.67). CONCLUSION A re-definition of aggregates was obtained with a good reliability when assessing static images. The first consensus-based semi-quantitative ultrasound scoring system for gout-specific lesions was developed with good inter- and intra-reader reliability for all lesions when tested in static images. The next step is to assess the reliabilities when scoring lesions in patients.
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Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy; Rheumatology Unit, Luigi Sacco University Hospital of Milan, Milan, Italy
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George Aw Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - Nicola Dalbeth
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria and Hospital of Brunico (SABES-ASDAA), Department of Rheumatology, Brunico, Italy
| | | | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Hilde B Hammer
- Rheumatology Department, Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, DSCB Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | | | - Juhani Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Julia Martin
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz and Universidad Autónoma de Madrid. Madrid, Spain
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Berlin, Germany
| | - Sarah Stewart
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Ambroise Pare´ Hospital, and Versailles Saint-Quentin-en-Yvelines University, Boulogne-Billancourt, France
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Paramalingam S, Morgan K, Becce F, Diederichsen LP, Ikeda K, Mandl P, Ohrndorf S, Sedie AD, Sharp V, Tan AL, Terslev L, Wakefield RJ, Bruyn GAW, D'Agostino MA, Keen HI. Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: A systematic review by the OMERACT ultrasound group. Semin Arthritis Rheum 2020; 51:661-676. [PMID: 33386164 DOI: 10.1016/j.semarthrit.2020.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
AIMS To analyze whether there is sufficient data from published literature to demonstrate that ultrasound, including elastography, present good metric properties (truth, discrimination and feasibility) in autoimmune myositis (AIM). METHODS A population, intervention, comparator and outcome-structured (PICO) search was performed in Medline, Cochrane Library and Embase database from 01/01/1973 to 08/05/2019. The inclusion criteria required original research involving adult humans, reported in English, assessing ultrasound and elastography in patients with an AIM. Conference abstracts and computer-assisted diagnostics that focused on technique and not ultrasound domains were excluded. RESULTS Approximately 2670 articles were identified. Forty-one full-text articles were included in the final analysis. There were 551 AIM patients studied. Eighteen studies (43.9%) had a control group, of which 15 (63.3%) were healthy controls. The age of participants (including controls) varied from 18 to 86 years, and most were females (59%). Diagnosis of AIM was largely biopsy-proven, although some were derived through clinical presentation, positive clinical imaging (ultrasound or otherwise) and/or electromyography and steroid responsiveness. The features examined with ultrasound in the 41 included articles consisted of: muscle echogenicity, bulk, atrophy, architecture, power Doppler, perfusion characteristics, shear wave modulus, shear wave velocity, elasticity index and fasciculations. Twelve studies (29.2%) used quantitative methods to assess these characteristics, whilst others used semi-quantitative, dichotomous/binary and descriptive scoring systems. Criterion validity was met in 14 studies (12/14, 85.7%) and construct validity in 22 studies (22/25, 88.0%). Most published articles reported Level 3b to Level 5 evidence with varying degrees of bias. There was only one longitudinal study examining discrimination. Reliability and feasibility were under-reported. CONCLUSION This is the first systematic review studying the utility of ultrasound, including elastography, in AIM. There is some evidence for criterion and construct validity, suggesting that ultrasound may be a promising outcome measurement instrument in AIM. Agreement on the standardization of acquisition, and the definitions of target domains, is required. Additionally, further validation studies are required to determine discrimination, reliability and feasibility.
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Affiliation(s)
- Shereen Paramalingam
- Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australia 6150, Australia; University of Notre Dame Australia, Western Australia, Australia.
| | - Kelly Morgan
- Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australia 6150, Australia
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Switzerland; University of Lausanne, Lausanne, Switzerland
| | | | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Peter Mandl
- Medical Department III, Rheumatology, Medical University Vienna, Vienna, Austria
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Veronika Sharp
- Santa Clara Valley Medical Center, San Jose, CA 94025, USA
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Richard J Wakefield
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - George A W Bruyn
- Department of Rheumatology, MC Hospital Group, Lelystad, the Netherlands
| | - Maria-Antonietta D'Agostino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, 78180 Montigny-Le-Bretonneux, France; Rheumatology Department, Ambroise Paré Hospital, AP-HP-Paris Saclay, 92100 Boulogne-Billancourt, France
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15
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Sakellariou G, Scirè CA, Adinolfi A, Batticciotto A, Bortoluzzi A, Delle Sedie A, De Lucia O, Dejaco C, Epis OM, Filippucci E, Idolazzi L, Picchianti Diamanti A, Zabotti A, Iagnocco A, Filippou G. Differential Diagnosis of Inflammatory Arthropathies by Musculoskeletal Ultrasonography: A Systematic Literature Review. Front Med (Lausanne) 2020; 7:141. [PMID: 32457913 PMCID: PMC7221062 DOI: 10.3389/fmed.2020.00141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Differential diagnosis in early arthritis is challenging, especially early after symptom onset. Several studies applied musculoskeletal ultrasound in this setting, however, its role in helping diagnosis has yet to be clearly defined. The purpose of this work is to systematically assess the diagnostic applications of ultrasonography in early arthritis in order to summarize the available evidence and highlight possible gaps in knowledge. Methods: In December 2017, existing systematic literature reviews (SLR) on rheumatoid arthritis (RA), osteoarthritis (OA), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR), calcium pyrophosphate deposition disease (CPPD), and gout were retrieved. Studies on ultrasound to diagnose the target conditions and detecting elementary lesions (such as synovitis, tenosynovitis, enthesitis, bone erosions, osteophytes) were extracted from the SLRs. The searches of the previous reviews were updated and data from new studies fulfilling the inclusion criteria extracted. Groups of reviewers worked separately for each disease, when possible diagnostic accuracy (sensitivities, specificities) was calculated from primary studies. When available, the reliability of ultrasound to detect elementary lesions was extracted. Results: For all the examined disease, recent SLRs were available. The new searches identified 27 eligible articles, with 87 articles included from the previous SLRs. The diagnostic performance of ultrasound in identifying diseases was addressed by 75 studies; in most of them, a single elementary lesion was used to define diagnosis, except for PMR. Only studies on RA included consecutive patients with new onset of arthritis, while studies on gout and CPPD often focused on subjects with mono-arthritis. Most of the remaining studies enrolled patients with a defined diagnosis. Synovitis was the most frequently detected lesion; clinical diagnosis was the most common reference standard. The diagnostic performance of ultrasound across different conditions was extremely variable. Ultrasound to identify elementary lesions was assessed in 38 studies in OA, gout and CPPD. Its performance in OA was very variable, with better results in CPPD and gout. The reliability of ultrasound was moderate to good for most lesions. Conclusions: Although a consistent amount of literature investigated the diagnostic application of ultrasound, in only a minority of cases its additional value over clinical diagnosis was tested. This SLR underlines the need for studies with a pragmatic design to identify the placement of ultrasound in the diagnostic pathway of new-onset arthritis.
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Affiliation(s)
- Garifallia Sakellariou
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Carlo Alberto Scirè
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy.,Società Italiana di Reumatologia, Unità Epidemiologica, Milan, Italy
| | | | - Alberto Batticciotto
- Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi, "Ospedale di Circolo - Fondazione Macchi", Varese, Italy
| | - Alessandra Bortoluzzi
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | | | - Orazio De Lucia
- Unit of Clinical Rheumatology, Department of Rheumatology and Clinical Sciences, ASST Centro Traumatologico Ortopedico G. Pini - CTO, Milan, Italy
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria.,Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Carlo Urbani Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Luca Idolazzi
- Rheumatology Unit, Ospedale Civile Maggiore, University of Verona, Verona, Italy
| | - Andrea Picchianti Diamanti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome, Italy
| | - Alen Zabotti
- Department of Medical and Biological Science, Rheumatology Clinic, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - Georgios Filippou
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
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16
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Gargani L, Bruni C, Romei C, Frumento P, Moreo A, Agoston G, Guiducci S, Bellando-Randone S, Lepri G, Belloli L, Della Rossa A, Delle Sedie A, Stagnaro C, De Nes M, Salvadori S, Mosca M, Falaschi F, Epis O, Picano E, Matucci-Cerinic M. Prognostic Value of Lung Ultrasound B-Lines in Systemic Sclerosis. Chest 2020; 158:1515-1525. [PMID: 32360727 DOI: 10.1016/j.chest.2020.03.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A high percentage of systemic sclerosis (SSc) patients experience interstitial lung disease (ILD) during the disease course. Recent data have shown that lung ultrasound (LUS) can assess ILD by the evaluation of B-lines, the sonographic sign of pulmonary interstitial involvement. RESEARCH QUESTION To establish the prognostic value of B-lines in a large number of patients with SSc. STUDY DESIGN AND METHODS A total of 396 consecutive patients with SSc, who were enrolled at three Rheumatology Departments, underwent a comprehensive LUS examination on the anterolateral and posterior chest for a total of 58 scanning sites. All available clinical, imaging, and functional data were recorded. Patients were followed after enrolment to establish the prognostic role of LUS. RESULTS The median number of B-lines was higher in patients with the diffuse cutaneous subset (44 vs 17 B-lines; P < .0001), topoisomerase I autoantibodies (39 vs 16 B-lines; P < .0001), and the presence of ILD at chest high-resolution CT (45 vs 9 B-lines; P < .0001). At multivariable analysis, the number of posterior B-lines ≥5 was associated with new development or worsening ILD (hazard ratio, 3.378; 95% CI, 1.137-9.994; P = .028), with additional value over topoisomerase I positivity. The prognostic value was further confirmed in the subgroup of patients with known ILD at baseline (hazard ratio, 1.010; 95% CI, 1.003-1.018; P = .008). INTERPRETATION Lung ultrasound B-lines are associated with worsening or development of pulmonary deterioration. In the near future, LUS might become part of the diagnostic and prognostic armamentarium in patients with SSc, which would allow a more sustainable and user-friendly approach to this very fragile population.
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Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Chiara Romei
- 2nd Radiology Unit, Azienda Ospedaliero Universitaria Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Antonella Moreo
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Gergely Agoston
- Cardiology and Rheumatology Department, Niguarda Hospital, Milan, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Laura Belloli
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Alessandra Della Rossa
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Andrea Delle Sedie
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Michele De Nes
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marta Mosca
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Fabio Falaschi
- 2nd Radiology Unit, Azienda Ospedaliero Universitaria Pisa, Italy
| | - Oscar Epis
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
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17
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D'Angelo S, Cantini F, Ramonda R, Cantarini L, Carletto A, Chimenti MS, Delle Sedie A, Foti R, Gerli R, Lomater C, Lubrano E, Marchesoni A, Zabotti A, Salvarani C, Scrivo R, Scarpa R, Tramontano G, Nannini C, Lorenzin M, Fabbroni M, Martinis F, Perricone R, Carli L, Visalli E, Rovera G, Perrotta FM, Quartuccio L, Altobelli A, Costa L, Niccoli L, Ortolan A, Caso F. Effectiveness of Adalimumab for the Treatment of Psoriatic Arthritis: An Italian Real-Life Retrospective Study. Front Pharmacol 2019; 10:1497. [PMID: 31920675 PMCID: PMC6923751 DOI: 10.3389/fphar.2019.01497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Few studies have evaluated the effectiveness of adalimumab in the real-life setting in psoriatic arthritis (PsA). Objective: To evaluate the 2-year retention rate of adalimumab in PsA patients. Potential baseline parameters influencing persistence on treatment were also evaluated. Methods: PsA patients from 16 Italian Rheumatology Units treated with adalimumab as first- or second-line biological therapy were retrospectively evaluated. Adalimumab retention rate was evaluated at 12 and 24 months. Logistic regression was used to evaluate the association between predictor variables and adalimumab retention rate. Results: From 424 patients (53.5% male, aged 48.3 ± 12.8 years) who started treatment with adalimumab, 367 (86.6%) maintained treatment for 12 months and 313 (73.8%) for 2 years. At 24-months, Disease Activity in PsA (DAPSA) remission (defined as ≤4) and Low Disease Activity (LDA) (≤14) were achieved in 22.8% and 44.4% of patients, respectively. Adalimumab treatment significantly decreased the number of tender (7.0 ± 5.7 at baseline vs. 2.3 ± 3.5 at 24 months, p < 0.001) and swollen joints (2.7 ± 2.8 at baseline vs. 0.4 ± 0.9 at 24 months, p < 0.001), DAPSA (25.5 ± 10.9 at baseline vs. 11.0 ± 8.4 at 24 months, p < 0.001), PASI (5.3 ± 5.7 at baseline vs. 2.7 ± 2.8 at 24 months, p < 0.001) and CRP (3.8 ± 6.3 at baseline vs. 1.2 ± 1.7 at 24 months, p < 0.001). Among a range of laboratory and clinical variables, only female gender was associated with improved adalimumab persistence at 24 months (OR: 1.98, 95% CI: 1.2–3.2, p = 0.005). Conclusions: Independent of a range of predictor variables, adalimumab was shown to be effective, while maintaining a high retention rate after 2 years in PsA patients.
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Affiliation(s)
- Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), Potenza, Italy.,Basilicata Ricerca Biomedica (BRB), Potenza, Italy
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Delle Sedie
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosario Foti
- Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute, Università degli studi del Molise, Campobasso, Italy
| | - Antonio Marchesoni
- Department of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Deptartment of Internal Medicine, Azienda USL-IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.,University of Modena and Reggio Emilia, Modena, Italy
| | - Rossana Scrivo
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, Rome, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppina Tramontano
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), Potenza, Italy
| | | | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Marta Fabbroni
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Visalli
- Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Guido Rovera
- Rheumatology Unit, Ospedale Mauriziano, Torino, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute, Università degli studi del Molise, Campobasso, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Alessio Altobelli
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, Rome, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Laura Niccoli
- Department of Rheumatology, Hospital of Prato, Prato, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Wong PC, Lee G, Delle Sedie A, Hanova P, Inanc N, Jousse-Joulin S, Ohrndorf S, Stoenoiu MS, Keen HI, Terslev L, D'Agostino MA, Bruyn GA. Musculoskeletal Ultrasound in Systemic Lupus Erythematosus: Systematic Literature Review by the Lupus Task Force of the OMERACT Ultrasound Working Group. J Rheumatol 2019; 46:1379-1387. [PMID: 31203213 DOI: 10.3899/jrheum.181087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify and synthesize the best available evidence on the application of musculoskeletal (MSK) ultrasound (US) in patients with systemic lupus erythematosus (SLE) and to present the measurement properties of US in different elementary lesions and pathologies. METHODS A systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Original articles were included that were published in English between August 1, 2014, and December 31, 2018, reporting US, Doppler, synovitis, joint effusion, bone erosion, tenosynovitis, and enthesitis in patients with SLE. Data extraction focused on the definition and quantification of US-detected synovitis, joint effusion, bone erosion, tenosynovitis, enthesitis, and the measurement properties of US according to the OMERACT Filter 2.1 instruments selection. RESULTS Of the 143 identified articles, 15 were included. Most articles were cross-sectional studies (14/15, 93%). The majority of the studies used the OMERACT definitions for ultrasonographic pathology. Regarding the measurement properties of US in different elementary lesions and pathologies, all studies dealt with face validity, content validity, and feasibility. Most studies achieved construct validity. Concerning the reliability of image reading, 1 study (1/15, 7%) assessed both intraobserver and interobserver reliability. For image acquisition, 4 studies (4/15, 27%) evaluated interobserver reliability and none had evaluated intraobserver reliability. Criterion validity was assessed in 1 study (1/15, 7%). Responsiveness was not considered in any of the studies. CONCLUSION This literature review demonstrates the need for further research and validation work to define the involvement of US as an outcome measurement instrument for the MSK manifestations in patients with SLE.
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Affiliation(s)
- Priscilla C Wong
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands.
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep.
| | - Gavin Lee
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Andrea Delle Sedie
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Petra Hanova
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Nevsun Inanc
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Sandrine Jousse-Joulin
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Sarah Ohrndorf
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Maria S Stoenoiu
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Helen I Keen
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Lene Terslev
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Maria-Antonietta D'Agostino
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - George A Bruyn
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
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Gutierrez M, Soto-Fajardo C, Pineda C, Alfaro-Rodriguez A, Terslev L, Bruyn G, Iagnocco A, Bertolazzi C, D'Agostino MA, Delle Sedie A. Ultrasound in the Assessment of Interstitial Lung Disease in Systemic Sclerosis: A Systematic Literature Review by the OMERACT Ultrasound Group. J Rheumatol 2019; 47:991-1000. [PMID: 31263075 DOI: 10.3899/jrheum.180940] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide an overview of the role of lung ultrasound (LUS) in the assessment of interstitial lung disease (ILD) in systemic sclerosis (SSc) and to discuss the state of validation supporting its clinical relevance and application in daily clinical practice. METHODS Original articles published between January 1997 and October 2017 were included. To identify all available studies, a detailed search pertaining to the topic of review was conducted according to guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). A systematic search was performed in PubMed and EMBASE. The quality assessment of retrieved articles was performed according to the Oxford Center for Evidence-based Medicine. The methodological quality of the studies was assessed using the Cochrane Handbook for Systematic Reviews and the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS From 300 papers identified, 12 were included for the analysis. LUS passed the filter of face, content validity, and feasibility. However, there is insufficient evidence to support criterion validity, reliability, and sensitivity to change. CONCLUSION Despite a great deal of work supporting the potential role of LUS for the assessment of ILD-SSc, much remains to be done before validating its use as an outcome measure in ILD-SSc.
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Affiliation(s)
- Marwin Gutierrez
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy. .,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa.
| | - Carina Soto-Fajardo
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Carlos Pineda
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Alfonso Alfaro-Rodriguez
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Lene Terslev
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - George Bruyn
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Annamaria Iagnocco
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Chiara Bertolazzi
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Maria Antonietta D'Agostino
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
| | - Andrea Delle Sedie
- From the Division of Musculoskeletal and Rheumatic Disorders, and the Division of Neurosciences, Instituto Nacional de Rehabilitacion, Mexico City; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana, Iztapalapa, México City, Mexico; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy; Université Versailles Saint-Quentin en Yvelines, Paris, France; Rheumatology Unit, University of Pisa, Pisa, Italy.,M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, and Doctorado en Ciencias Biológicas y de la Salud, Universidad Autonoma Metropolitana; C. Soto-Fajardo, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; C. Pineda, MD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; A. Alfaro-Rodriguez, MD, Division of Neurosciences, Instituto Nacional de Rehabilitacion; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet; G. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; A. Iagnocco, MD, PhD, Academic Rheumatology Center, Università degli Studi di Torino; C. Bertolazzi, MD, PhD, Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion; M.A. D'Agostino, MD, PhD, Université Versailles Saint-Quentin en Yvelines; A. Delle Sedie, MD, PhD, Rheumatology Unit, University of Pisa
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20
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Marchesoni A, D'Angelo S, Anzidei M, Bortolotti R, Cantini F, Caramella D, Carotti M, Chimenti MS, Delle Sedie A, Egan CG, Fabbroni M, Frediani B, Fusaro E, Galeazzi M, Gallazzi MB, Gentileschi S, Gentili F, Gerli R, Gilio M, Iannone F, La Paglia E, Lubrano E, Macarini L, Olivieri I, Pellerito R, Ramonda R, Salvarani C, Scarano E, Scarpa R, Spaggiari L, Spanò A, Zawaideh JP, Mazzei MA. Radiologist-rheumatologist multidisciplinary approach in the management of axial spondyloarthritis: a Delphi consensus statement. Clin Exp Rheumatol 2019; 37:575-584. [PMID: 30557127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this study was to develop a Delphi consensus statement between rheumatologists and radiologists for the diagnosis and monitoring of axial spondyloarthritis (axial-SpA). METHODS Following an extensive literature search to identify unmet needs and potential goals for a multidisciplinary approach, a scientific board comprising 28 Italian hospital-based rheumatologists (n=19) and radiologists (n=9) identified 8 "starting points", resulting in the development of 23 consensus statements covering issues from current practice guidelines to specific MRI protocols for the assessment of axial-SpA. Each participant anonymously expressed a level of agreement for each statement using a 5-point Likert scale (1="strongly disagree"; 5="strongly agree") via an online Delphi method.Total cumulative agreement (TCA) was defined as the sum of the percentage of response to items 4 ("agree") and 5 ("absolutely agree"). Consensus was defined as ≥80% total cumulative agreement for each statement. RESULTS After the first round of voting (28 participants), positive consensus was reached for 28/31 (90.3%) statements. Statements without consensus (n=3) were discussed in a face-to-face plenary session prior to the second vote (28 participants). After the second round voting, positive consensus was attained for all 31 statements, with mean final TCA of 95.5% (range 82.1-100%). CONCLUSIONS This Delphi consensus statement provides an aid to rheumatologists and radiologists for the diagnosis and monitoring of axial-SpA.
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Affiliation(s)
- Antonio Marchesoni
- Department of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
| | - Salvatore D'Angelo
- Istituto Reumatologico Lucano (IReL), Potenza, and Basilicata Ricerca Biomedica (BRB) Foundation, Potenza, Italy
| | - Michele Anzidei
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | | | | | - Davide Caramella
- Division of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Italy
| | - Marina Carotti
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | | | | | - Marta Fabbroni
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Enrico Fusaro
- A.O.U. 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Mauro Galeazzi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Mauro Battista Gallazzi
- Department of Radiology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Stefano Gentileschi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Francesco Gentili
- Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine University of Perugia, Italy
| | - Michele Gilio
- Istituto Reumatologico Lucano (IReL), Potenza, and Basilicata Ricerca Biomedica (BRB) Foundation, Potenza, and Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro, Italy
| | | | - Ernesto La Paglia
- Department of Hospital Services, SS. Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute 'Vincenzo Tiberio', Università degli Studi del Molise, Campobasso, Italy
| | - Luca Macarini
- Department of Radiology, University of Foggia, Italy
| | - Ignazio Olivieri
- Istituto Reumatologico Lucano (IReL), Potenza, and Basilicata Ricerca Biomedica (BRB) Foundation, Potenza, Italy
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, and University of Modena and Reggio Emilia, Italy
| | - Enrico Scarano
- Radiology Department, San Carlo Hospital, Potenza, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lucia Spaggiari
- Department of Radiology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Angelo Spanò
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Jeries Paolo Zawaideh
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Italy
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Zabotti A, Filippou G, Canzoni M, Adinolfi A, Picerno V, Carrara G, Balint P, Bruyn G, D'Agostino MA, Damjanov N, Delle Sedie A, Filippucci E, Gonzalez Fernandez ML, Hammer HB, Karim Z, Mandl P, Moller I, Morales Lozano MR, Naredo E, Porta F, Sakellariou G, Terslev L, Scirè CA, Iagnocco A. OMERACT agreement and reliability study of ultrasonographic elementary lesions in osteoarthritis of the foot. RMD Open 2019; 5:e000795. [PMID: 30997148 PMCID: PMC6443136 DOI: 10.1136/rmdopen-2018-000795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/22/2019] [Accepted: 02/08/2019] [Indexed: 01/15/2023] Open
Abstract
Objective To evaluate the level of agreement on ultrasonographic (US) lesions among highly experienced sonographers as well as the intraobserver and interobserver reliability of inflammatory and structural US lesions in patients with osteoarthritis (OA) of the foot. Methods After a systematic literature review, a Delphi survey was performed to test definitions of US lesions in OA of the foot, including inflammatory lesions (ie, synovial hypertrophy [SH], joint effusion [JE], power Doppler signal [PD]), and structural abnormalities (ie, cartilage damage [CD] and osteophytes). Subsequently, the reliability of US in assessing the aforementioned lesions was tested on static images as well as during a live exercise. Reliability was assessed by kappa analyses and prevalence-adjusted bias-adjusted kappa (PABAK) on a dichotomous and an ordinal scale. Results Intraobserver and interobserver reliability for SH and JE evaluated by binary scoring was good for both components, while the intraobserver reliability for semiquantitative scoring of SH ranged from moderate in the web-based exercise (PABAK 0.49) to good (PABAK 0.8) in the live exercise. Reliability for CD and PD assessments were respectively good and excellent in all exercises (ranged from PABAK 0.61 to 0.79 for CD and 0.88 to 0.95 for PD). The interobserver reliability for the semiquantitative scoring of osteophytes was fair in the live exercise (PABAK 0.36) and moderate in the static exercise (PABAK 0.60). Conclusions Consensual US definitions were found to be reliable for assessing inflammatory lesions in OA of the foot, while the use of US to assess structural damage requires further studies.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Georgios Filippou
- Dipartimento di Scienze Mediche, Università degli studi di Ferrara, Clinica di Reumatologia, Ferrara, Italy
| | | | - Antonella Adinolfi
- Department of Clinical Medicine and Immunology, Rheumatology Section, University of Siena, Siena, Italy
| | - Valentina Picerno
- Rheumatology Department of Lucania, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Peter Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George Bruyn
- Rheumatology, Medisch Centrum Leeuwarden, Sneek, Netherlands
| | - Maria Antonietta D'Agostino
- Rheumatology, Ambroise Paré Hospital, APHP, Université Versailles-Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | | | | | | | | | - Zunaid Karim
- Department of Rheumatology, Midyorkshire NHS Trust, Midyorkshire, UK
| | - Peter Mandl
- Internal Medicine III, Department of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Ingrid Moller
- Reumatologia, Instituto Poal de Reumatologia, Barcelona, Spain
| | | | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Garifallia Sakellariou
- Chair and Division of Rheumatology, Universityof Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Disease, Rigshospitalet-Glostrup, Copenaghen, Denmark
| | - Carlo Alberto Scirè
- Dipartimento di Scienze Mediche, Università degli studi di Ferrara, Clinica di Reumatologia, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Rome, Italy
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22
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Bruyn GAW, Siddle HJ, Hanova P, Costantino F, Iagnocco A, Delle Sedie A, Gutierrez M, Hammer HB, Jernberg E, Loeille D, Micu MC, Moller I, Pineda C, Richards B, Stoenoiu MS, Suzuki T, Terslev L, Vlad V, Wonink R, d'Agostino MA, Wakefield RJ. Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions. J Rheumatol 2019; 46:351-359. [PMID: 30385707 DOI: 10.3899/jrheum.171490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA). METHODS Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively. CONCLUSION Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.
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Affiliation(s)
- George A W Bruyn
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands.
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work.
| | - Heidi J Siddle
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Petra Hanova
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Félicie Costantino
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Annamaria Iagnocco
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Andrea Delle Sedie
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Marwin Gutierrez
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Hilde B Hammer
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Elizabeth Jernberg
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Damien Loeille
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Mihaela C Micu
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Ingrid Moller
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Carlos Pineda
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Bethan Richards
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Maria S Stoenoiu
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Takeshi Suzuki
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Lene Terslev
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Violeta Vlad
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Robert Wonink
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Maria-Antonietta d'Agostino
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Richard J Wakefield
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
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Tani C, Carli L, Stagnaro C, Elefante E, Signorini V, Balestri F, Delle Sedie A, Mosca M. Imaging of joints in systemic lupus erythematosus. Clin Exp Rheumatol 2018; 36 Suppl 114:68-73. [PMID: 30296972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
Musculoskeletal symptoms are among the most common manifestations in patients with systemic lupus erythematosus (SLE), being reported in up to 95% of patients; joint and tendon involvement can range from arthralgia to severe deforming arthropathy; while myositis a rare manifestation, comorbid fibromyalgia is reported in up to 40% of SLE patients. All these manifestations have a significant impact on the patients' quality of life, possibly leading to disability and functional impairment in daily living activities. In recent years, thanks to the availability of new imaging techniques for the assessment of tendon and joint pathologies, the approach to the definition and characterisation of these manifestations in SLE is constantly evolving. In this review we will therefore illustrate the state of the art of imaging techniques in the assessment of joint involvement in SLE, focusing on ultrasounds (US) and magnetic resonance (MRI), discussing their advantages, drawbacks and possible future developments. The main findings that emerge from the recent literature is that imaging studies may allow a more accurate definition of disease subtypes revealing an unexpected higher prevalence of joint and tendon involvement with respect to what known by clinical evaluation and standard radiography. Indeed, US and MRI also made possible the identification of joints and tendons pathologies in patients with no or very mild clinical symptoms. On the other hand, the interpretation of some findings remains uncertain, as well as the validity and feasibility of this analysis in clinical practice. Thus, further studies should clarify the clinical meaning of subclinical abnormalities detected in US and MRI scans and their impact on the long-term outcomes.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Stagnaro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Viola Signorini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesca Balestri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Andrea Delle Sedie
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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24
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Ferro F, Delle Sedie A. The use of ultrasound for assessing interstitial lung involvement in connective tissue diseases. Clin Exp Rheumatol 2018; 36 Suppl 114:165-170. [PMID: 30296990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
Interstitial lung disease (ILD) is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality. Recently, lung ultrasound examination has appeared as a useful, feasible, non-invasive, radiation-free imaging technique with high sensitivity and specificity for the diagnosis of CTD-associated ILD. In this review, we discuss the literature concerning lung ultrasound findings (B-lines and pleural irregularities) in systemic sclerosis. We also examine the possible utility and potential limitations of lung ultrasound in other CTDs including: inflammatory myopathies, mixed connective tissue disease, and Sjögren's syndrome. Specifically, we compare the diagnostic accuracy of lung ultrasound with traditional imaging techniques and pulmonary functional tests.
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Affiliation(s)
- Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Andrea Delle Sedie
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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25
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Filippou G, Scirè CA, Adinolfi A, Damjanov NS, Carrara G, Bruyn GAW, Cazenave T, D'Agostino MA, Delle Sedie A, Di Sabatino V, Diaz Cortes ME, Filippucci E, Gandjbakhch F, Gutierrez M, Maccarter DK, Micu M, Möller Parera I, Mouterde G, Mortada MA, Naredo E, Pineda C, Porta F, Reginato AM, Satulu I, Schmidt WA, Serban T, Terslev L, Vlad V, Vreju FA, Zufferey P, Bozios P, Toscano C, Picerno V, Iagnocco A. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis 2018. [PMID: 29535120 DOI: 10.1136/annrheumdis-2017-212542] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. METHODS A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. RESULTS The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification. CONCLUSIONS Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.
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Affiliation(s)
- Georgios Filippou
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy
| | - Carlo Alberto Scirè
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy
| | | | - Nemanja S Damjanov
- University of Belgrade, Belgrade, Serbia.,SIR Epidemiology Unit, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Mihaela Micu
- Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
| | | | - Gaël Mouterde
- Rheumatology department, Lapeyronie Hospital & EA 2415, Montpellier, France
| | - Mohamed Atia Mortada
- Department of Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Carlos Pineda
- Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - Anthony M Reginato
- Division of Rheumatology, The Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Iulia Satulu
- Department of Rheumatology, Internal Medicine Clinic, Kalmar County Hospital, Kalmar, Sweden
| | | | | | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | | | - Panagiotis Bozios
- Department of Rheumatology, University of Ioannina, Ioannina, Greece
| | | | - Valentina Picerno
- Rheumatology Department of Lucania, "San Carlo" Hospital of Potenza and "Madonna delle Grazie" Hospital of Matera, Potenza, Italy
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26
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Delle Sedie A, Riente L, Maggiorini L, Pratesi F, Tavoni A, Migliorini P, Puxeddu I. Potential biomarkers in patients with systemic sclerosis. Int J Rheum Dis 2017; 21:261-265. [DOI: 10.1111/1756-185x.13196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Andrea Delle Sedie
- Rheumatology Unit; Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Lucrezia Riente
- Rheumatology Unit; Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Lavinia Maggiorini
- Immunology and Allergology Unit; Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Federico Pratesi
- Immunology and Allergology Unit; Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Antonio Tavoni
- Immunology and Allergology Unit; Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Paola Migliorini
- Immunology and Allergology Unit; Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Ilaria Puxeddu
- Immunology and Allergology Unit; Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
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27
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Filippou G, Scirè CA, Damjanov N, Adinolfi A, Carrara G, Picerno V, Toscano C, Bruyn GA, D'Agostino MA, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Möller I, Naredo E, Pineda C, Porta F, Schmidt WA, Terslev L, Vlad V, Zufferey P, Iagnocco A. Definition and Reliability Assessment of Elementary Ultrasonographic Findings in Calcium Pyrophosphate Deposition Disease: A Study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. J Rheumatol 2017; 44:1744-1749. [PMID: 28250136 DOI: 10.3899/jrheum.161057] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To define the ultrasonographic characteristics of calcium pyrophosphate crystal (CPP) deposits in joints and periarticular tissues and to evaluate the intra- and interobserver reliability of expert ultrasonographers in the assessment of CPP deposition disease (CPPD) according to the new definitions. METHODS After a systematic literature review, a Delphi survey was circulated among a group of expert ultrasonographers, who were members of the CPPD Ultrasound (US) Outcome Measures in Rheumatology (OMERACT) subtask force, to obtain definitions of the US characteristics of CPPD at the level of fibrocartilage (FC), hyaline cartilage (HC), tendon, and synovial fluid (SF). Subsequently, the reliability of US in assessing CPPD at knee and wrist levels according to the agreed definitions was tested in static images and in patients with CPPD. Cohen's κ was used for statistical analysis. RESULTS HC and FC of the knee yielded the highest interobserver κ values among all the structures examined, in both the Web-based (0.73 for HC and 0.58 for FC) and patient-based exercises (0.55 for the HC and 0.64 for the FC). Kappa values for the other structures were lower, ranging from 0.28 in tendons to 0.50 in SF in the static exercise and from 0.09 (proximal patellar tendon) to 0.27 (triangular FC of the wrist) in the patient-based exercise. CONCLUSION The new OMERACT definitions for the US identification of CPPD proved to be reliable at the level of the HC and FC of the knee. Further studies are needed to better define the US characteristics of CPPD and optimize the scanning technique in other anatomical sites.
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Affiliation(s)
- Georgios Filippou
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland. .,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino.
| | - Carlo A Scirè
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Nemanja Damjanov
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Antonella Adinolfi
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Greta Carrara
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Valentina Picerno
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Carmela Toscano
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - George A Bruyn
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Maria Antonietta D'Agostino
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Andrea Delle Sedie
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Emilio Filippucci
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Marwin Gutierrez
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Mihaela Micu
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Ingrid Möller
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Esperanza Naredo
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Carlos Pineda
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Francesco Porta
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Wolfgang A Schmidt
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Lene Terslev
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Violeta Vlad
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Pascal Zufferey
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Annamaria Iagnocco
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
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Fallahi P, Ferrari SM, Ruffilli I, Elia G, Miccoli M, Sedie AD, Riente L, Antonelli A. Increased incidence of autoimmune thyroid disorders in patients with psoriatic arthritis: a longitudinal follow-up study. Immunol Res 2017; 65:681-686. [DOI: 10.1007/s12026-017-8900-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Terslev L, Gutierrez M, Christensen R, Balint PV, Bruyn GA, Delle Sedie A, Filippucci E, Garrido J, Hammer HB, Iagnocco A, Kane D, Kaeley GS, Keen H, Mandl P, Naredo E, Pineda C, Schicke B, Thiele R, D'Agostino MA, Schmidt WA. Assessing Elementary Lesions in Gout by Ultrasound: Results of an OMERACT Patient-based Agreement and Reliability Exercise. J Rheumatol 2015; 42:2149-54. [PMID: 26472419 DOI: 10.3899/jrheum.150366] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To test the reliability of the consensus-based ultrasound (US) definitions of elementary gout lesions in patients. METHODS Eight patients with microscopically proven gout were evaluated by 16 sonographers for signs of double contour (DC), aggregates, erosions, and tophi in the first metatarsophalangeal joint and the knee bilaterally. The patients were examined twice using B-mode US to test agreement and inter- and intraobserver reliability of the elementary components. RESULTS The prevalence of the lesions were DC 52.8%, tophus 61.1%, aggregates 29.8%, and erosions 32.4%. The intraobserver reliability was good for all lesions except DC, where it was moderate. The best reliability per lesion was seen for tophus (κ 0.73, 95% CI 0.61-0.85) and lowest for DC (κ 0.53, 95% CI 0.38-0.67). The interobserver reliability was good for tophus and erosions, but fair to moderate for aggregates and DC, respectively. The best reliability was seen for erosions (κ 0.74, 95% CI 0.65-0.81) and lowest for aggregates (κ 0.21, 95% CI 0.04-0.37). CONCLUSION This is the first step to test consensus-based US definitions on elementary lesions in patients with gout. High intraobserver reliability was found when applying the definition in patients on all elementary lesions while interobserver reliability was moderate to low. Further studies are needed to improve the interobserver reliability, particularly for DC and aggregates.
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Delle Sedie A, Riente L. Psoriatic arthritis: what ultrasound can provide us. Clin Exp Rheumatol 2015; 33:S60-S65. [PMID: 26470747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Abstract
Ultrasound (US) is a valuable imaging technique for detection and characterisation of the inflammatory process in arthritides. US has widely been applied to psoriatic arthritis (PsA) in both clinical and research fields, especially focusing on enthesitis. US has proven to be useful to establish a diagnosis of PsA, to recognise subclinical involvement, (such as enthesis abnormalities in patients with PsA, and in patients with only clinically apparent skin psoriasis despite the absence of clinical symptoms of arthritis), to estimate disease activity, and to allow therapy monitoring showing structural and inflammatory changes (not only in joints and tendons, but also in domains not assessed in usual rheumatology care, such as the skin and nails).
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Terslev L, Gutierrez M, Schmidt WA, Keen HI, Filippucci E, Kane D, Thiele R, Kaeley G, Balint P, Mandl P, Delle Sedie A, Hammer HB, Christensen R, Möller I, Pineda C, Kissin E, Bruyn GA, Iagnocco A, Naredo E, D'Agostino MA. Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group. J Rheumatol 2015; 42:2177-81. [PMID: 26329333 DOI: 10.3899/jrheum.141294] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group on the validation of US as a potential outcome measure in gout. METHODS Based on the lack of definitions, highlighted in a recent literature review on US as an outcome tool in gout, a series of iterative exercises were carried out to obtain consensus-based definitions on US elementary components in gout using a Delphi exercise and subsequently testing these definitions in static images and in patients with proven gout. Cohen's κ was used to test agreement, and values of 0-0.20 were considered poor, 0.20-0.40 fair, 0.40-0.60 moderate, 0.60-0.80 good, and 0.80-1 excellent. RESULTS With an agreement of > 80%, consensus-based definitions were obtained for the 4 elementary lesions highlighted in the literature review: tophi, aggregates, erosions, and double contour (DC). In static images interobserver reliability ranged from moderate to almost perfect, and similar results were found for the intrareader reliability. In patients the intraobserver agreement was good for all lesions except DC (moderate). The interobserver agreement was poor for aggregates and DC but moderate for the other components. CONCLUSION These first steps in evaluating the validity of US as an outcome measure for gout show that the reliability of the definitions ranged from moderate to excellent in static images and somewhat lower in patients, indicating that a standardized scanning technique may be needed, before testing the responsiveness of those definitions in a composite US score.
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Gutierrez M, Schmidt WA, Thiele RG, Keen HI, Kaeley GS, Naredo E, Iagnocco A, Bruyn GA, Balint PV, Filippucci E, Mandl P, Kane D, Pineda C, Delle Sedie A, Hammer HB, Christensen R, D'Agostino MA, Terslev L. International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology (Oxford) 2015; 54:1797-805. [PMID: 25972391 DOI: 10.1093/rheumatology/kev112] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To produce consensus-based definitions of the US elementary lesions in gout and to test their reliability in a web-based exercise. METHODS The process consisted of two steps. In the first step a written Delphi questionnaire was developed from a systematic literature review and expert international consensus. This collated information resulted in four statements defining US elementary lesions: double contour (DC), tophus, aggregates and erosion. The Delphi questionnaire was sent to 35 rheumatology experts in US, asking them to rate their level of agreement or disagreement with each statement. The second step tested the reliability by a web-exercise. US images of both normal and gouty elementary lesions were collected by the participants. A facilitator then constructed an electronic database of 110 images. The database was sent to the participants, who evaluated the presence/absence of US elementary lesions. A group of 20 images was displayed twice to evaluate intra-reader reliability. RESULTS A total of 32 participants responded to the questionnaires. Good agreement (>80%) was obtained for US definitions on DC, tophus, aggregates and erosion in the Delphi exercise after three rounds. The reliability on images showed inter-reader κ values for DC, tophus, aggregates, erosion findings of 0.98, 0.71, 0.54 and 0.85, respectively. The mean intra-reader κ values were also acceptable: 0.93, 0.78, 0.65 and 0.78, respectively. CONCLUSION This, the first consensus-based US definition of elementary lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies.
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Affiliation(s)
- Marwin Gutierrez
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy,
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus, Medical Centre for Rheumatology, Berlin, Germany
| | - Ralf G Thiele
- Department of Medicine, Allergy/Immunology and Rheumatology Division, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | - Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Esperanza Naredo
- Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Annamaria Iagnocco
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome
| | - George A Bruyn
- Rheumatology Department, MC Groep Hospitals, Lelystad, Netherlands
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - David Kane
- Rheumatology Department, Trinity College, Dublin, Ireland
| | - Carlos Pineda
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | | | | | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Maria Antonietta D'Agostino
- INSERM U1173, Rheumatology Department, Laboratoire d'excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France and
| | - Lene Terslev
- Rheumatology Department, Center for Rheumatology and Spine diseases, Copenhagen University Hospital, Copenhagen, Denmark
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Tani C, D'Aniello D, Possemato N, Delle Sedie A, Caramella D, Bombardieri S, Mosca M. Erratum to: MRI pattern of arthritis in systemic lupus erythematosus: a comparative study with rheumatoid arthritis and healthy subjects. Skeletal Radiol 2015; 44:267. [PMID: 25391417 DOI: 10.1007/s00256-014-2054-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy,
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Sakellariou G, Iagnocco A, Delle Sedie A, Riente L, Filippucci E, Montecucco C. Ultrasonographic evaluation of entheses in patients with spondyloarthritis: a systematic literature review. Clin Exp Rheumatol 2014; 32:969-978. [PMID: 25496747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Enthesitis represents a characteristic features of spondyloarthritis (SpA) and, in the context of the early management of the disease, its reliable assessment has emerged as a central issue. Musculoskeletal ultrasonography (US) has proven to be of value in the assessment of peripheral entheses. Our aim was to systematically review the literature from 2010 to 2013 in order to summarise the evidence on the evaluation of entheses by US in patients with diagnosed or suspected SpA. METHODS PubMed and Embase were searched developing a search strategy based on terms related to SpA and US. The target population were patients with SpA or suspected SpA, the intervention was entheseal US, the outcomes were the prevalence of US abnormalities, the reliability, the diagnostic accuracy, the sensitivity to change. The possible comparators were clinical evaluation and other imaging techniques. Cohort studies (cross-sectional or longitudinal), case-control studies, diagnostic accuracy studies, systematic literature reviews and meta-analyses were eligible for inclusion. RESULTS Out of 3368 retrieved references, 34 papers were finally included. 22 of which reported information on the prevalence of US findings, yielding highly variable results. US was sufficiently reliable, as reported in 6 papers. A minority of studies reported data on sensitivity to change, which was good, and on the application of US for differential diagnosis and diagnosis of SpA, thus demonstrating the value of US also in this context. CONCLUSIONS US confirms its validity and reliability in the assessment of entheseal involvement in patients with SpA. Further application in the help of diagnosis will be provided by future research.
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Affiliation(s)
- Garifallia Sakellariou
- Chair and Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
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Delle Sedie A, Riente L, Bombardieri S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0046-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Delle Sedie A. A special Clinical and Experimental Rheumatology issue on ultrasound in rheumatology. Clin Exp Rheumatol 2014; 32:S1-S2. [PMID: 24529035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/08/2013] [Indexed: 06/03/2023]
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Delle Sedie A, Riente L. Ultrasound in connective tissue diseases. Clin Exp Rheumatol 2014; 32:S53-S60. [PMID: 24528598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/08/2013] [Indexed: 06/03/2023]
Abstract
Rheumatologists have been using ultrasound (US) for the evaluation of patients affected by rheumatic disease for a long time. Actually this approach is becoming more and more diffuse and US is used for multiple purposes: diagnosis, disease activity assessment, prognosis, and therapy monitoring. The real 'new' step for the rheumatologist has been moving from the 'usual' musculoskeletal US to other fields of US, such as the assessment of vascular involvement (both macro and micro), skin, lung and even nails. In this paper we review the published literature related to the use of musculoskeletal, skin and lung US in patients affected by connective tissue diseases.
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Riente L, Carli L, Delle Sedie A. Ultrasound imaging in psoriatic arthritis and ankylosing spondylitis. Clin Exp Rheumatol 2014; 32:S26-S33. [PMID: 24528804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
Abstract
Musculoskeletal ultrasound (US) is a reliable imaging technique which has a key role in the assessment of patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). US can help in the diagnosis of the disorder, in the evaluation of the extent of the joint and enthesis involvement and in therapy monitoring because it can reflect both morphostructural changes and inflammatory activity. Several studies have reported that US revealed pathological findings at joints and enthesis in a large number of PsA patients who do not complain of active pain and/or swelling at the time of the clinical examination and in psoriasis patients with no signs of musculoskeletal disease. The application of US in the evaluation of nail and skin involvement in patients affected by psoriasis, with or without arthritis, and the imaging of sacroiliac joints is an interesting approach. US has already become commonplace in both clinical and research fields, and improvements in US technology will offer further possibilities for future research.
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Affiliation(s)
- Lucrezia Riente
- Dipartimento di Medicina Clinica e Sperimentale Università di Pisa, Pisa, Italy.
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Iagnocco A, Naredo E, Wakefield R, Bruyn GA, Collado P, Jousse-Joulin S, Finzel S, Ohrndorf S, Delle Sedie A, Backhaus M, Berner-Hammer H, Gandjbakhch F, Kaeley G, Loeuille D, Moller I, Terslev L, Aegerter P, Aydin S, Balint PV, Filippucci E, Mandl P, Pineda C, Roth J, Magni-Manzoni S, Tzaribachev N, Schmidt WA, Conaghan PG, D’Agostino MA. Responsiveness in Rheumatoid Arthritis. A Report from the OMERACT 11 Ultrasound Workshop. J Rheumatol 2013; 41:379-82. [DOI: 10.3899/jrheum.131084] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Task Force on the validity of different US measures in rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) presented during the OMERACT 11 Workshop.Methods.The Task Force is an international group aiming to iteratively improve the role of US in arthritis clinical trials. Recently a major focus of the group has been the assessment of responsiveness of a person-level US synovitis score in RA: the US Global Synovitis Score (US-GLOSS) combines synovial hypertrophy and power Doppler signal in a composite score detected at joint level. Work has also commenced examining assessment of tenosynovitis in RA and the role of US in JIA.Results.The US-GLOSS was tested in a large RA cohort treated with biologic therapy. It showed early signs of improvement in synovitis starting at Day 7 and increasing to Month 6, and demonstrated sensitivity to change of the proposed grading. Subsequent voting questions concerning the application of the US-GLOSS were endorsed by > 80% of OMERACT delegates. A standardized US scoring system for detecting and grading severity of RA tenosynovitis and tendon damage has been developed, and acceptable reliability data were presented from a series of exercises. A preliminary consensus definition of US synovitis in pediatric arthritis has been developed and requires further testing.Conclusion.At OMERACT 11, consensus was achieved on the application of the US-GLOSS for evaluating synovitis in RA; and work continues on development of RA tenosynovitis scales as well as in JIA synovitis.
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Mosca M, Tani C, Filice ME, Carli L, Delle Sedie A, Vagnani S, Della Rossa A, Baldini C, Bombardieri S. TNF-alpha inhibitors in Systemic Lupus Erythematosus. A case report and a systematic literature review. Mod Rheumatol 2013; 25:642-5. [DOI: 10.3109/14397595.2013.844306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sakellariou G, Iagnocco A, Filippucci E, Ceccarelli F, Di Geso L, Carli L, Riente L, Delle Sedie A, Montecucco C. Ultrasound imaging for the rheumatologist XLVIII. Ultrasound of the shoulders of patients with rheumatoid arthritis. Clin Exp Rheumatol 2013; 31:837-842. [PMID: 24373322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate the prevalence of ultrasonographic (US) shoulder abnormalities in patients with rheumatoid arthritis (RA) and to investigate the relationship between US findings and demographic and clinical features. METHODS Consecutive patients attending the rheumatology units involved in this study were enrolled. Clinical and demographical data were recorded. US of bilateral shoulders was performed at the same time, examining tendons, bursae, gleno-humeral and acromion-clavicular joints. The presence of signs of inflammation, bone erosions or rotator cuff pathology was evaluated. RESULTS A total of one hundred patients were enrolled, mean age (SD) 59.6 (14.7) years, median disease duration (IQR) 56.5 (34.7, 96.5) months, 98% of them were on DMARDs and 22% on biologics. Shoulder tenderness was reported by 44% of patients. 34% of patients showed at least one sign of inflammatory involvement, and 25% of them presented with humeral head erosions. Signs of rotator cuff pathology were seen in 49% of patients. Agreement between the presence of spontaneous pain and US inflammatory abnormalities was moderate (kappa 0.501). Patients with inflammatory involvement of the shoulders had significantly higher DAS28, HAQ, VAS pain, acute phase reactants and disease duration compared to patient with no inflammatory signs, they were more frequently RF positive and reported more frequently spontaneous pain. CONCLUSIONS US assessment of the shoulder in RA patients can be considered of value, especially in patients with relevant indicators of disease activity and severity.
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Affiliation(s)
- Garifallia Sakellariou
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
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Bandinelli F, Delle Sedie A, Salvadorini G, Riente L, Candelieri A, Generini S, Bombardieri S. Reply to comment on 'Ankylosing spondylitis: how diagnostic and therapeutic delay have changed over the last six decades' E. Feldtkeller, A. Zeller, M. Rudwaleit. Clin Exp Rheumatol 2013; 31:993. [PMID: 24238323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/07/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Francesca Bandinelli
- Division of Rheumatology AOUC, University of Florence, Department of Internal Medicine, Florence, Italy.
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Baldini C, Delle Sedie A, Luciano N, Pepe P, Ferro F, Talarico R, Tani C, Mosca M. Vitamin D in “early” primary Sjögren’s syndrome: does it play a role in influencing disease phenotypes? Rheumatol Int 2013; 34:1159-64. [DOI: 10.1007/s00296-013-2872-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
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Filippucci E, Delle Sedie A, Riente L, Di Geso L, Carli L, Ceccarelli F, Sakellariou G, Iagnocco A, Grassi W. Ultrasound imaging for the rheumatologist. XLVII. Ultrasound of the shoulder in patients with gout and calcium pyrophosphate deposition disease. Clin Exp Rheumatol 2013; 31:659-664. [PMID: 24050142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/18/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES This study was aimed at determining the prevalence of ultrasound (US) morpho-structural changes in the shoulders of patients with crystal-related arthropathies, and at investigating the relationship between them and the clinical findings. METHODS Eighty-eight patients with a crystal proven diagnosis of gout or calcium pyrophosphate dihydrate (CPPD) disease attending the in-patient and the out-patient clinics of four Italian Rheumatology Departments were consecutively enrolled in this multi-centre study. All patients were clinically examined by an expert rheumatologist who recorded clinical and laboratory data in addition to the presence/absence of spontaneous shoulder pain and performed the Hawkins, Jobe, Patte, Gerber, and Speed tests. In each centre, US examinations were carried out by a rheumatologist expert in musculoskeletal US blinded to clinical data, using a MyLab TWICE XVG machine (Esaote SpA, Genoa, Italy) equipped with a linear probe operating at 4-13 MHz, and a Logiq 9 machine (General Electrics Medical Systems, Milwaukee, WI, USA) with a linear probe operating at 9-14 MHz. Shoulders were scanned to detect peri-articular inflammation, rotator cuff pathology and joint involvement, and to reveal US signs indicative of crystal deposits. RESULTS A total of 88 patients, 39 with gout, 46 with CPPD disease, and 3 with both gout and CPPD disease, were enrolled. In total, 176 shoulders were clinically assessed, of which 54/176 (30%) were painful and 74/176 (42%) were clinically normal shoulders. All US findings indicative of peri-articular synovial inflammation were more frequently detected in patients with CPPD disease than in gouty patients. In 50 out of 176 (28.4%) shoulders, US allowed the detection of at least one finding indicative of synovial inflammation. Chronic tendinopathy was a frequent US finding both in gout patients and in patients with CPPD disease and the supraspinatus tendon was the most frequently involved one. In CPPD disease the supraspinatus tendon was found ruptured in a number of shoulders seven times higher than in gouty patients. The osteophytes were found at acromion-clavicular joint in nearly 80% of the shoulders in CPPD disease and in 60% in the gouty patients. CONCLUSIONS The results of this study confirm the high specificity of US findings indicative of crystal deposits at hyaline cartilage level and indicate that the supraspinatus tendon and the fibrocartilage of the acromion-clavicular joint are the most frequently affected structures of the shoulders in patients with crystal-related arthropathies.
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Affiliation(s)
- Emilio Filippucci
- Rheumatology Clinic, Polytechnic University delle Marche, Jesi, Italy.
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Delle Sedie A, Riente L, Iagnocco A, Carli L, Ceccarelli F, Di Geso L, Filippucci E, Sakellariou G, Bombardieri S. Ultrasound imaging for the rheumatologist XLVI. Ultrasound guided injection in the shoulder: a descriptive literature review. Clin Exp Rheumatol 2013; 31:477-483. [PMID: 23899967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Abstract
Shoulder pain represents one of the most frequent clinical conditions in the general population and it can be generated by a large spectrum of pathologies. The most frequent approach of most rheumatologists to shoulder pain, in daily clinical practice, mainly based on their personal experience, is to locally inject drugs. Since the literature on this topic provides conflicting results due to the wide heterogeneity in the study designs, we decided to report the most relevant studies. Not enough data are available to assess whether US-guided injections are more efficient in controlling shoulder pain with respect to the landmark approach. However, it is likely that US-guided technique shows a more rapid improvement, possibly by providing a higher corticosteroid volume injected right where it is needed. When injecting hyaluronic acid, a more accurate localisation of the medicament might be useful to improve efficacy and avoid adverse effects (i.e. pain), however, there are no studies comparing the blind approach to the US-guided one. Finally, new treatments for shoulder pain have been used but they still need future validation in more appropriate RCTs.
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Riente L, Delle Sedie A, Filippucci E, Iagnocco A, Sakellariou G, Talarico R, Carli L, Di Geso L, Ceccarelli F, Bombardieri S. Ultrasound imaging for the rheumatologist XLV. Ultrasound of the shoulder in psoriatic arthritis. Clin Exp Rheumatol 2013; 31:329-333. [PMID: 23663744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the prevalence of ultrasound (US) pathologic abnormalities in the shoulders of psoriatic arthritis (PsA) patients and to compare them with the main clinical findings. METHODS Ninety-seven PsA patients were enrolled in the study. The subacromial/subdeltoid bursa, the sheath of the long biceps tendon, the glenohumeral joint and the acromion-clavicular joint were examined for the presence of synovial effusions and synovial hypertrophy. Rotator cuff tendons (supraspinatus, subscapularis, infraspinatus) were imaged for tendinosis, calcifications and total or partial tears, while deltoid enthesis were evaluated for local enthesitis and the lesser and greater tuberosity of the humerus for the presence of enthesophytes. RESULTS Tendinosis represented the most frequent abnormal finding. Supraspinatus tendinosis was detected more often than subscapularis and infraspinatus tendinosis. When considering tendon tear, supraspinatus was also the most frequently involved anatomical structure. Clinical examination frequently failed to detect abnormalities in patients in whom US examination showed pathological findings. This is particularly true for tendon involvement, i.e. effusion within the sheath of the biceps tendon was imaged in 43 shoulders but clinical assessment reported abnormalities only in 22 shoulders (p<0.0001). CONCLUSIONS US examination appears to be a useful and sensitive imaging technique, specifically in identifying joint and tendon involvement of the shoulder.
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Affiliation(s)
- Lucrezia Riente
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.
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Iagnocco A, Filippucci E, Sakellariou G, Ceccarelli F, Di Geso L, Carli L, Riente L, Delle Sedie A, Valesini G. Ultrasound imaging for the rheumatologist XLIV. Ultrasound of the shoulder in healthy individuals. Clin Exp Rheumatol 2013; 31:165-171. [PMID: 23484463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate the prevalence of shoulder ultrasound (US) detectable abnormalities in asymptomatic individuals of various ages and to correlate the US findings with clinical data. METHODS 97 healthy subjects were enrolled in the present study. They were subgrouped according to their age, as follows: group I (20-29 years); group II (30-39 years); group III (40-49 years); group IV (50-59 years); group V (>60 years). A physical examination of both shoulders, based on a series of provocative maneuvers, was carried out. The US assessment was performed by using a Logiq9 machine equipped with a multi-frequency linear probe working at 12MHz and included the study of a number of structures for the evaluation of local abnormalities, as follows: the long head of biceps tendon (synovial effusion (SE), synovial hypertrophy (SH), power Doppler (PD) signal); the subacromion-subdeltoid and sub-scapularis bursae (SE, SH, PD signal); the rotator cuff tendons (tendinosis, calcifications, tears, impingement); the acromionclavicular (ACJ) and gleno-humeral joints (SE, SH, PD signal, osteophytes, erosions, fibrocartilage calcifications, cartilage abnormalities, tophaceous deposits). In addition, deltoid, throchite and throchine enthesopathy were searched for. RESULTS 194 shoulders were studied in total. A low but variable percentage of joints of healthy individuals (3.1-13.4%) showed positive provocative maneuvers. 138 shoulders (71.1%) did not show any US abnormalities. The most frequent changes were SE of ACJ (25.5%), osteophytes of ACJ (23.3%), and supraspinatus tendinosis (20.6%). The prevalence of abnormalities progressively increased with age. Sub-clinical involvement was present in most cases, being provocative maneuvers positive only in a low percentage of joints. CONCLUSIONS The present study demonstrated the presence of a wide set of US-detectable changes in healthy subjects, that were more frequently present in elderly individuals. The absence of any clinical sign of local pathology cannot exclude the presence of local abnormalities.
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Affiliation(s)
- Annamaria Iagnocco
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy.
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Epis O, Filippucci E, Delle Sedie A, De Matthaeis A, Bruschi E. Clinical and ultrasound evaluation of the response to tocilizumab treatment in patients with rheumatoid arthritis: a case series. Rheumatol Int 2013; 34:737-42. [DOI: 10.1007/s00296-012-2638-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 12/15/2012] [Indexed: 10/27/2022]
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Sakellariou G, Iagnocco A, Riente L, Ceccarelli F, Carli L, Di Geso L, Delle Sedie A, Filippucci E, Montecucco C. Ultrasound imaging for the rheumatologist XLIII. Ultrasonographic evaluation of shoulders and hips in patients with polymyalgia rheumatica: a systematic literature review. Clin Exp Rheumatol 2013; 31:1-7. [PMID: 23369808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Musculoskeletal ultrasonography (US) has lately been applied to patients with polymyalgia rheumatica for the examination of shoulders and hip, and included in the 2012 PMR classification criteria. We aimed to perform a comprehensive overview of the literature on this topic with a systematic review. METHODS We searched PubMed, Embase, the Cochrane library and the proceedings from EULAR and ACR congresses (2011-2012). We included studies evaluating patients with confirmed or suspected PMR, undergoing US of shoulders and/or hips. The diagnosis of PMR could be based on expert opinion or diagnostic criteria. Cohort, case-control, diagnostic accuracy studies and case-series were eligible for inclusion. The features of the included studies were presented. When available, sensitivities and specificities were calculated for primary studies. RESULTS Out of 1736 papers identified by our search, 13 articles and 1 abstract were finally included in the review. Eight studies focused on shoulder US, 1 on hip US, 4 on both. Studies were extremely variable in terms of population, US examination, reference standard and control population. In general, at the shoulder, pathological bilateral US findings in most studies were more prevalent in patients with PMR compared to controls. When sensitivity and specificity could be calculated, bilateral findings were more sensitive. Notably, less information was available on hip US. CONCLUSIONS US (especially in shoulder examination) is confirmed to be a potentially useful instrument to integrate clinical information in the management of patients with PMR. Its additional value in conjunction with the new classification criteria should be further tested.
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Vitali S, Delle Sedie A, Filippucci E, Riente L, Iagnocco A, Sakellariou G, Meenagh G, Paolicchi A, Montecucco C, Valesini G, Grassi W, Bombardieri S, Caramella D. Ultrasound imaging for the rheumatologist. XLII. Assessment of hip pain in rheumatic patients: the radiologist's view. Clin Exp Rheumatol 2012; 30:817-824. [PMID: 23253630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 06/01/2023]
Abstract
Hip pain is a common complaint in daily practice and the identification of the underlying pathologic condition is the first step for an adequate treatment. In this review, we discuss the available evidence for the application of conventional radiography, computed tomography and magnetic resonance imaging in rheumatologic patients with painful hip, presenting the main imaging findings due to osteoarthritis, inflammatory arthritis (rheumatoid arthritis and spondyloarthritides), osteonecrosis and some other soft tissue involvement (bursitis and synovial cyst) that could be the cause of hip pain. Because different imaging techniques show different sensitivity and specificity, the choice of technique to use depends on the type and stage of the disease itself.
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Affiliation(s)
- Saverio Vitali
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.
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