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Dreher M, Witte T, Hoeper K, Assmann G, Proft F, Poddubnyy D, Murawski N, Triantafyllias K, Grodd M, Graf E, Fichtner UA, Binder H, Zeidler J, Hoeper JR, Callhoff J, Karberg K, Trautwein A, Tibyampansha D, Wojnowski L, Schmidt RE, Schwarting A. Rheuma-VOR study: optimising healthcare of rheumatic diseases by multiprofessional coordinating centres. Ann Rheum Dis 2024; 83:184-193. [PMID: 37890976 PMCID: PMC10850684 DOI: 10.1136/ard-2023-224205] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES Early diagnosis of inflammatory arthritis is critical to prevent joint damage and functional incapacities. However, the discrepancy between recommendations of early diagnosis and reality is remarkable. The Rheuma-VOR study aimed to improve the time to diagnosis of patients with early arthritis by coordinating cooperation between primary care physicians, specialists and patients in Germany. METHODS This prospective non-randomised multicentre study involved 2340 primary care physicians, 72 rheumatologists, 4 university hospitals and 4 rheumatology centres in 4 German Federal States. The two coprimary endpoints (time to diagnosis and screening performance of primary care physicians) were evaluated for early versus late implementation phase. Additionally, time to diagnosis and secondary endpoints (decrease of disease activity, increase in quality of life and overall well-being, improvement of fatigue, depression, functional ability, and work ability, reduction in drug and medical costs and hospitalisation) were compared with a reference cohort of the German Rheumatism Research Centre (DRFZ) reflecting standard care. RESULTS A total of 7049 patients were enrolled in the coordination centres and 1537 patients were diagnosed with a rheumatic disease and consented to further participation. A follow-up consultation after 1 year was realised in 592 patients. The time to diagnosis endpoint and the secondary endpoints were met. In addition, the calculation of cost-effectiveness shows that Rheuma-VOR has a dominant cost-benefit ratio compared with standard care. DISCUSSION Rheuma-VOR has shown an improvement in rheumatological care, patient-reported outcome parameters and cost savings by coordinating the cooperation of primary care physicians, rheumatologists and patients, in a nationwide approach.
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Affiliation(s)
- Matthias Dreher
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Torsten Witte
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Kirsten Hoeper
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Center for Rheumatology Lower Saxony, Hannover, Germany
| | - Gunter Assmann
- Center of Rheumatology and Clinical Immunology, RUB-University Hospital Minden JWK, Minden, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Niels Murawski
- Internal Medicine I Oncology, Haematology, Clinical Immunology and Clinical Rheumatology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Konstantinos Triantafyllias
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Center for Rheumatology Rhineland-Palatinate, Bad Kreuznach, Germany
| | - Marlon Grodd
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Urs A Fichtner
- Institute of Medical Biometry and Statistics, Section of Healthcare Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universitat Hannover, Hannover, Germany
| | - Juliana Rachel Hoeper
- Center for Health Economics Research Hannover (CHERH), Leibniz Universitat Hannover, Hannover, Germany
| | - Johanna Callhoff
- Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Anna Trautwein
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dativa Tibyampansha
- Department of Pharmacolgy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Leszek Wojnowski
- Department of Pharmacolgy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Reinhold E Schmidt
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Andreas Schwarting
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Center for Rheumatology Rhineland-Palatinate, Bad Kreuznach, Germany
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2
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Dand N, Stuart PE, Bowes J, Ellinghaus D, Nititham J, Saklatvala JR, Teder-Laving M, Thomas LF, Traks T, Uebe S, Assmann G, Baudry D, Behrens F, Billi AC, Brown MA, Burkhardt H, Capon F, Chung R, Curtis CJ, Duckworth M, Ellinghaus E, FitzGerald O, Gerdes S, Griffiths CEM, Gulliver S, Helliwell P, Ho P, Hoffmann P, Holmen OL, Huang ZM, Hveem K, Jadon D, Köhm M, Kraus C, Lamacchia C, Lee SH, Ma F, Mahil SK, McHugh N, McManus R, Modalsli EH, Nissen MJ, Nöthen M, Oji V, Oksenberg JR, Patrick MT, Perez-White BE, Ramming A, Rech J, Rosen C, Sarkar MK, Schett G, Schmidt B, Tejasvi T, Traupe H, Voorhees JJ, Wacker EM, Warren RB, Wasikowski R, Weidinger S, Wen X, Zhang Z, Barton A, Chandran V, Esko T, Foerster J, Franke A, Gladman DD, Gudjonsson JE, Gulliver W, Hüffmeier U, Kingo K, Kõks S, Liao W, Løset M, Mägi R, Nair RP, Rahman P, Reis A, Smith CH, Di Meglio P, Barker JN, Tsoi LC, Simpson MA, Elder JT. GWAS meta-analysis of psoriasis identifies new susceptibility alleles impacting disease mechanisms and therapeutic targets. medRxiv 2023:2023.10.04.23296543. [PMID: 37873414 PMCID: PMC10593001 DOI: 10.1101/2023.10.04.23296543] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Psoriasis is a common, debilitating immune-mediated skin disease. Genetic studies have identified biological mechanisms of psoriasis risk, including those targeted by effective therapies. However, the genetic liability to psoriasis is not fully explained by variation at robustly identified risk loci. To move towards a saturation map of psoriasis susceptibility we meta-analysed 18 GWAS comprising 36,466 cases and 458,078 controls and identified 109 distinct psoriasis susceptibility loci, including 45 that have not been previously reported. These include susceptibility variants at loci in which the therapeutic targets IL17RA and AHR are encoded, and deleterious coding variants supporting potential new drug targets (including in STAP2, CPVL and POU2F3). We conducted a transcriptome-wide association study to identify regulatory effects of psoriasis susceptibility variants and cross-referenced these against single cell expression profiles in psoriasis-affected skin, highlighting roles for the transcriptional regulation of haematopoietic cell development and epigenetic modulation of interferon signalling in psoriasis pathobiology.
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Affiliation(s)
- Nick Dand
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Health Data Research UK, London, UK
| | - Philip E Stuart
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Joanne Nititham
- Deparment of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Jake R Saklatvala
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Laurent F Thomas
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- BioCore - Bioinformatics Core Facility, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tanel Traks
- Department of Dermatology and Venereology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Steffen Uebe
- Institute of Human Genetics, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Gunter Assmann
- RUB University Hospital JWK Minden, Department of Rheumatology, Minden, Germany
- Jose-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg, Germany
| | - David Baudry
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Frank Behrens
- Division of Translational Rheumatology, Immunology - Inflammation Medicine, University Hospital, Goethe University, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
- Division of Rheumatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Allison C Billi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew A Brown
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Genomics England, Canary Wharf, London, UK
| | - Harald Burkhardt
- Division of Rheumatology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Francesca Capon
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Raymond Chung
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Charles J Curtis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Michael Duckworth
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Oliver FitzGerald
- UCD School of Medicine and Medical Sciences and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
| | - Sascha Gerdes
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christopher E M Griffiths
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Philip Helliwell
- National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, UK
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, UK
| | - Pauline Ho
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Oddgeir L Holmen
- HUNT Research Centre, Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Zhi-Ming Huang
- Deparment of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Michaela Köhm
- Division of Translational Rheumatology, Immunology - Inflammation Medicine, University Hospital, Goethe University, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
- Division of Rheumatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Cornelia Kraus
- Institute of Human Genetics, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Céline Lamacchia
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Sang Hyuck Lee
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Feiyang Ma
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Satveer K Mahil
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- St John's Institute of Dermatology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases and Dept Pharmacy and Pharmacology, University of Bath, UK
| | - Ross McManus
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Ellen H Modalsli
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Dermatology, Clinic of Orthopedy, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Michael J Nissen
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Markus Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Vinzenz Oji
- Department of Dermatology, University of Münster, Münster, Germany
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Matthew T Patrick
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Cheryl Rosen
- Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mrinal K Sarkar
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
- Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI, USA
| | - Heiko Traupe
- Department of Dermatology, University of Münster, Münster, Germany
| | - John J Voorhees
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Eike Matthias Wacker
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Richard B Warren
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
- Centre for Dermatology Research, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
| | - Rachael Wasikowski
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephan Weidinger
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Xiaoquan Wen
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Zhaolin Zhang
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vinod Chandran
- Schroeder Arthritis Institute, Krembil Research Institute, and Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Tõnu Esko
- Institute of Genomics, University of Tartu, Tartu, Estonia
| | - John Foerster
- College of Medicine, Dentistry, and Nursing, University of Dundee, Dundee, UK
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Dafna D Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, and Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Wayne Gulliver
- Newlab Clinical Research Inc, St. John's, NL, Canada
- Department of Dermatology, Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ulrike Hüffmeier
- Institute of Human Genetics, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Külli Kingo
- Department of Dermatology and Venereology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Dermatology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Perth, WA 6150, Australia
| | - Wilson Liao
- Deparment of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mari Løset
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Dermatology, Clinic of Orthopedy, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Rajan P Nair
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Proton Rahman
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - André Reis
- Institute of Human Genetics, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Catherine H Smith
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- St John's Institute of Dermatology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - Paola Di Meglio
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jonathan N Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- St John's Institute of Dermatology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Michael A Simpson
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - James T Elder
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
- Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI, USA
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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Haskamp S, Horowitz JS, Oji V, Philipp S, Sticherling M, Schäkel K, Schuhmann S, Prinz JC, Burkhardt H, Behrens F, Böhm B, Köhm M, Rech J, Simon D, Schett G, Morrison K, Gerdes S, Assmann G, Nimeh A, Schuster V, Jacobi A, Weyergraf A, Reis A, Uebe S, Wilsmann-Theis D, Mößner R, Hüffmeier U. Genetic Analysis of MPO Variants in Four Psoriasis Subtypes in Patients from Germany. J Invest Dermatol 2021; 141:2079-2083. [PMID: 33609556 DOI: 10.1016/j.jid.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Stefan Haskamp
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Joseph Simon Horowitz
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Vinzenz Oji
- Department of Dermatology, University of Münster, Münster, Germany
| | - Sandra Philipp
- Department of Dermatology, University of Berlin, Berlin, Germany
| | - Michael Sticherling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Knut Schäkel
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Sarah Schuhmann
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg C Prinz
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Harald Burkhardt
- Division of Rheumatology, Goethe University, Frankfurt am Main, Germany; Fraunhofer Project Group Translational Medicine and Pharmacology, IME, Goethe University, Frankfurt am Main, Germany
| | - Frank Behrens
- Division of Rheumatology, Goethe University, Frankfurt am Main, Germany; Fraunhofer Project Group Translational Medicine and Pharmacology, IME, Goethe University, Frankfurt am Main, Germany
| | - Beate Böhm
- Division of Rheumatology, Goethe University, Frankfurt am Main, Germany; Fraunhofer Project Group Translational Medicine and Pharmacology, IME, Goethe University, Frankfurt am Main, Germany
| | - Michaela Köhm
- Division of Rheumatology, Goethe University, Frankfurt am Main, Germany; Fraunhofer Project Group Translational Medicine and Pharmacology, IME, Goethe University, Frankfurt am Main, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Sascha Gerdes
- Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gunter Assmann
- Department of Internal Medicine I, Jose-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg, Germany
| | - Ali Nimeh
- Department of Rheumatology, Fachklinik Bad Bentheim, Bad Bentheim, Germany
| | - Volker Schuster
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Arnd Jacobi
- Ophthalmology and Dermatology Center, Practice Dr Jacobi, Nuremberg, Germany; Institute for Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar Weyergraf
- Department of Dermatology, Fachklinik Bad Bentheim, Bad Bentheim, Germany
| | - André Reis
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Steffen Uebe
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Rotraut Mößner
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Ulrike Hüffmeier
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Kaddu-Mulindwa D, Rosolowski M, Ziepert M, Regitz E, Assmann G, Bewarder M, Held G, Pfreundschuh M, Bittenbring JT. VEGFR2 and VEGFA polymorphisms are not associated with an inferior prognosis in Caucasian patients with aggressive B-cell lymphoma. Eur J Haematol 2020; 106:100-104. [PMID: 32997825 DOI: 10.1111/ejh.13526] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Previous published data showed an impact of single-nucleotide polymorphisms in the VEGF A and VEGFR2 genes on the survival of patients with various malignancies, among others diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS We investigated the role of four VEGF-A and two VEGFR-2 gene polymorphisms on the outcome of 273 patients with diffuse large B-cell lymphoma who were treated with R-CHOP within a prospective, randomized trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). The genomic DNA samples were analyzed using commercial DNA Probes (Applied Biosystems, USA) to detect single-nucleotide polymorphisms in the VEGF A rs699947, rs1570360, rs2010963, rs3025039 and rs1870377, and rs2305948 in the VEGFR2 receptor. Hundred healthy blood donors served as a control. RESULTS There was no difference between the SNP allele frequencies in lymphoma patients compared to the control group for all investigated SNPs. None of the investigated SNPs was significantly associated with EFS or OS. After adjusting for the International Prognostic Index risk factors in a multivariate analysis, these results could be confirmed. CONCLUSION Single-nucleotide polymorphisms of the VEGF and VEGFR2 were not associated with a worse outcome in Caucasian patients with DLBCL.
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Affiliation(s)
- Dominic Kaddu-Mulindwa
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Maciej Rosolowski
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Evi Regitz
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Gunter Assmann
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Moritz Bewarder
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Gerhard Held
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Michael Pfreundschuh
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
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Dreher M, Schmidt RE, Witte T, Assmann G, Hoeper K, Triantafyllias K, Zeidler J, Binder H, Schwarting A. AB1298-HPR RHEUMA-VOR: A PROOF-OF-CONCEPT NETWORK STUDY FOR THE IMPROVEMENT OF RHEUMATOLOGICAL HEALTH CARE THROUGH COORDINATED COOPERATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Rheumatoid arthritis (RA), psoriasis arthritis (PsA) and spondyloarthritis (SpA) are the most common chronic inflammatory rheumatic diseases. For all three diseases, the so-called “window of opportunity” [1,2,4] has been identified as the decisive factor affecting the outcome.Objectives:The aim of the prospective study is to improve the early diagnosis of RA, PsA and SpA and thus positively impact the quality of care for patients with the support of coordinating centers.Methods:Primary care providers are given access to screening questionnaires to document potential early cases of RA, PsA, and SpA, based on characteristic symptoms. These are evaluated by multidisciplinary teams at the regional coordinating centers. If they fulfill the criteria for referral, patients get an appointment at a cooperating rheumatology specialist within weeks. If a rheumatic disease is diagnosed, physicians and patients receive questionnaires about sociodemographic, physilogical and psychological parameters.In order to increase the quality of referrals, a 15-minute rheumatological consultation at the ACURA Rheumatology Center was implemented for all patients from Rhineland-Palatinate whose suspected diagnosis was confirmed by the coordination centre. In course of this, the Rheuma-VOR Screening-App will also be developed and optimized. The cooperating partners and additional information are already published [5].Results:Preliminary data (31 Dec 2019) are presented. In Rhineland-Palatinate, Saarland and Lower Saxony, 4942 suspected diagnoses of 1526 different referring physicians have now been reported. A total of 2578 patients were referred by the three coordination centres to one of the 49 participating rheumatological specialists. 1004 patients were diagnosed with one of the three diseases. About 306 patients have already taken the follow-up appointment after one year.In course of a screening consultation 736 patients have been screened to date. The patients have to wait in average about 42 days from the suspected diagnosis to the rejected or confirmed rheumatological diagnosis.Conclusion:Although the average waiting time for all three diseases is currently almost twice as long as the 23.9 days in the Rhineland-Palatinate predecessor project ADAPTHERA which just focuses on RA, the current results are very positive compared to the national average [3]. The aim is to further increase the screening quality and screening numbers, especially in the 1-year follow-up.Current data will be presented at the conference.References:[1]Boehncke WH, Menter A (2013) Burden of disease: psoriasis and psoriatic arthritis. Am J Clin Dermatol 14:377-388[2]Claudepierre P (2014) Spondyloarthritis: a window of opportunity? Joint Bone Spine 81:197-199[3]Lauter A, Triantafyllias K, Leiß R et al. (2019) ADAPTHERA—Statewide cross-sectoral care network for patients with early rheumatoid arthritis shows sustained remission in standard care. ZRheumatol. 78 (7): 660–669[4]O’dell JR (2002) Treating rheumatoid arthritis early: a window of opportunity? Arthritis Rheum 46:283-285[5]Schwarting A (2018) From ADAPTHERA to Rheuma-VOR: Concept of Coordinated Cooperation to Improve the Quality of Rheumatology Care Akt Rheumatol 43 (05): 406-409Acknowledgments:The authors thank all partners and participants of Rheuma-VORDisclosure of Interests:Matthias Dreher: None declared, Reinhold E. Schmidt: None declared, Torsten Witte: None declared, Gunter Assmann: None declared, Kirsten Hoeper Consultant of: AbbVie, Celgene,, Speakers bureau: Abbvie, Chugai, Novartis, Lilly, Celgene, Sandoz Hexal, Konstantinos Triantafyllias: None declared, Jan Zeidler: None declared, Harald Binder: None declared, Andreas Schwarting: None declared
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Assmann G, Köhm M, Schuster V, Behrens F, Mössner R, Magnolo N, Oji V, Burkhardt H, Hüffmeier U. Genetic variants in FBLIM1 gene do not contribute to SAPHO syndrome and chronic recurrent multifocal osteomyelitis in typical patient groups. BMC Med Genet 2020; 21:102. [PMID: 32397996 PMCID: PMC7216525 DOI: 10.1186/s12881-020-01037-7] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Abstract
Background Syndrome of synovitis acne pustulosis hyperostosis osteitis (SAPHO) and chronic recurrent multifocal osteomyelitis (CRMO) present two diseases of a dermatologic and rheumatologic spectrum that are variable in manifestation und therapeutic response. Genetic risk factors have long been assumed in both diseases, but no single reliable factor has been identified yet. Therefore, we aimed to clinically characterize a patient group with syndrome of synovitis acne pustulosis hyperostosis osteitis (SAPHO) (n = 47) and chronic recurrent multifocal osteomyelitis (CRMO)/ chronic non-bacterial osteomyelitis (CNO) (n = 9) and analyze a CRMO candidate gene. Methods Clinical data of all patients were collected and assessed for different combinations of clinical symptoms. SAPHO patients were grouped into categories according to the acronym; disease-contribution by pathogens was evaluated. We sequenced coding exons of FBLIM1. Results Palmoplantar pustular psoriasis (PPP) was the most common skin manifestation in CRMO/CNO and SAPHO patients; most SAPHO patients had sterno-costo-clavicular hyperostosis. The most common clinical category of the acronym was S_PHO (n = 26). Lack of pathogen detection from bone biopsies was more common than microbial isolation. We did not identify autosomal-recessive FBLIM1 variants. Conclusions S_PHO is the most common combination of symptoms of its acronym. Genetic analyses of FBLIM1 did not provide evidence that this gene is relevant in our patient group. Our study indicates the need to elucidate SAPHO’s and CRMO/CNO’s pathogenesis.
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Affiliation(s)
- Gunter Assmann
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, /Saar, Homburg, Germany
| | - Michaela Köhm
- Division of Rheumatology and IME, Fraunhofer Institute, Branch for Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Volker Schuster
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Frank Behrens
- Division of Rheumatology and IME, Fraunhofer Institute, Branch for Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Rotraut Mössner
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Nina Magnolo
- Department of Dermatology, University of Münster, Münster, Germany
| | - Vinzenz Oji
- Department of Dermatology, University of Münster, Münster, Germany
| | - Harald Burkhardt
- Division of Rheumatology and IME, Fraunhofer Institute, Branch for Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Ulrike Hüffmeier
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 10, 91054, Erlangen, Germany.
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Assmann G, Zinke S, Gerling M, Bittenbring JT, Preuss KD, Thurner L. Progranulin-autoantibodies in sera of rheumatoid arthritis patients negative for rheumatoid factor and anti-citrullinated peptide antibodies. Clin Exp Rheumatol 2020; 38:94-98. [PMID: 31074725] [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: 01/19/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Previously we discovered antibodies against progranulin (PGRN-abs) in a protein array-based screening of sera from various rheumatic diseases. Here we conducted a study to evaluate the prevalence of PGRN-abs in seropositive and seronegative rheumatoid arthritis (RA). METHODS PGRN-abs were determined in the sera from 257 RA patients being seropositive for RF-IgM and/or ACPA-IgG and from 224 seronegative RA patients who were prospectively included in this study (total RA cohort n=481). All serum samples from the included participants were tested for RF-IgM as well as for ACPA-IgG, and PGRN-abs were determined using a previously described ELISA. Statistics was performed using the χ2 test for evaluating differences in clinical data; to evaluate independent statistical effects on the frequency of PGRN-abs status a logistic regression model with Wald-test was performed. RESULTS PGRN-abs were detected in 25.3% from seropositive RA and in 21.0% from RF- and ACPA-negative RA resulting in a prevalence of 23.7% for both cohorts together. Comparing mean DAS28 values in the PGRN-abs positive cohort with the PGRN-abs negative cohort, the DAS28 value was significantly higher in PGRN-abs positive RA patients (3.81 vs. 3.50, p=0.038). A trend for higher frequencies of PGRN-abs in sera of RA patients with unfavourable characteristics such as erosive disease or requiring TNFi medication was observed. CONCLUSIONS These data suggest that the determination of PGRN-abs in seronegative RA patients may reduce their seronegative status. Further studies are required to evaluate PGRN-abs as a potential diagnostic marker in RA.
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Affiliation(s)
- Gunter Assmann
- Department of Internal Medicine I, José Carreras Center for Immuno- and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany.
| | - Silke Zinke
- Outpatient Rheumatology Center Berlin-Lichtenberg, Berlin, Germany
| | - Moritz Gerling
- Department of Internal Medicine, Klinikum Bremerhaven, Germany
| | - Joerg Thomas Bittenbring
- Department of Internal Medicine I, José Carreras Center for Immuno- and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany
| | - Klaus Dieter Preuss
- Department of Internal Medicine I, José Carreras Center for Immuno- and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany
| | - Lorenz Thurner
- Department of Internal Medicine I, José Carreras Center for Immuno- and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany
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Benesova K, Lorenz HM, Lion V, Voigt A, Krause A, Sander O, Schneider M, Feuchtenberger M, Nigg A, Leipe J, Briem S, Tiessen E, Haas F, Rihl M, Meyer-Olson D, Baraliakos X, Braun J, Schwarting A, Dreher M, Witte T, Assmann G, Hoeper K, Schmidt RE, Bartz-Bazzanella P, Gaubitz M, Specker C. [Early recognition and screening consultation: a necessary way to improve early detection and treatment in rheumatology? : Overview of the early recognition and screening consultation models for rheumatic and musculoskeletal diseases in Germany]. Z Rheumatol 2019; 78:722-742. [PMID: 31468170 DOI: 10.1007/s00393-019-0683-y] [Citation(s) in RCA: 15] [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] [Indexed: 12/22/2022]
Abstract
In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.
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Affiliation(s)
- K Benesova
- Sektion Rheumatologie, Innere Medizin V, Universitätsklinik Heidelberg, Heidelberg, Deutschland.
| | - H-M Lorenz
- Sektion Rheumatologie, Innere Medizin V, Universitätsklinik Heidelberg, Heidelberg, Deutschland.,ACURA Rheumazentrum Baden-Baden, Baden-Baden, Deutschland
| | - V Lion
- Sektion Rheumatologie, Innere Medizin V, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - A Voigt
- Abteilung Rheumatologie, klinische Immunologie und Osteologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - A Krause
- Abteilung Rheumatologie, klinische Immunologie und Osteologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - O Sander
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | | | - A Nigg
- MVZ MED
- BAYERN OST Altötting·Burghausen, Burghausen, Deutschland
| | - J Leipe
- Sektion Rheumatologie, V. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
| | - S Briem
- Innere Medizin und Rheumatologie, Alb-Donau Klinikum Langenau, Langenau, Deutschland
| | - E Tiessen
- Innere Medizin und Rheumatologie, Alb-Donau Klinikum Langenau, Langenau, Deutschland
| | - F Haas
- Rheumatologische Facharztpraxis, Tübingen, Deutschland
| | - M Rihl
- Rheumatologische Schwerpunktpraxis, Traunstein, Deutschland
| | - D Meyer-Olson
- m&i Fachklinik Bad Pyrmont und MVZ Weserbergland, Bad Pyrmont, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Bochum, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Bochum, Deutschland
| | - A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland.,ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T Witte
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - G Assmann
- Rheumatologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - K Hoeper
- Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - R E Schmidt
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - P Bartz-Bazzanella
- Klinik für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Deutschland
| | - M Gaubitz
- Interdisziplinäre Diagnostik und Therapie - Akademie für Manuelle Medizin, WWU Münster, Münster, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Evang. Krankenhaus Essen-Werden, Kliniken Essen-Mitte, Essen, Deutschland
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10
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Lesan V, Schmit D, Bewarder M, Assmann G, Stilgenbauer S. Chemotherapy associated hyponatremia in hematological malignancies: A retrospective study of 189 patients treated in a single medical center. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz251.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Klemm P, Assmann G, Preuss KD, Fadle N, Regitz E, Martin T, Pfreundschuh M, Thurner L. Progranulin autoantibodies in systemic sclerosis and autoimmune connective tissue disorders: A preliminary study. Immun Inflamm Dis 2019; 7:271-275. [PMID: 31502765 PMCID: PMC6842819 DOI: 10.1002/iid3.270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The present study aimed to investigate progranulin autoantibodies in systemic sclerosis and autoimmune connective tissue disorders. Progranulin is a physiologic tumor necrosis factor (TNF) antagonist. Progranulin antibodies decrease progranulin levels. METHODS Serum samples of 123 patients with systemic sclerosis and various autoimmune connective tissue disorders (Sjoegren's syndrome [SjS], mixed connective tissue disorder, polymyositis [PM] and dermatomyositis [DM], antiphospholipid syndrome [APLS], and undifferentiated connective tissue disease [UCTD]) were tested for progranulin antibodies using enzyme-linked immunosorbent assay. RESULTS Progranulin antibodies were found in 34 of 123 (27.6%) patients at least once during their disease. In detail, 2 of 8 (25%) patients with limited cutaneous systemic sclerosis, 10 of 31 (32.3%) patients with diffuse cutaneous systemic sclerosis, 9 of 22 (40.9%) patients with SjS, 1 of 3 (33.33%) patients with mixed connective tissue disease, 4 of 33 (12.1%) patients with DM or PM, 6 of 15 (40%) patients with APLS, and 2 of 11 (18.2%) patients with UCTD were positive for progranulin antibodies during the course of disease. CONCLUSIONS Progranulin antibodies are frequently present in patients with systemic sclerosis and other autoimmune connective tissue disorders. Despite the lack of specificity for a given autoimmune disease, progranulin antibodies might not only indicate a potential subtype but also play a pathogenic role in patients with autoimmune connective disorders. Given the important role of TNF-α in inflammatory processes in autoimmune connective tissue disorders, progranulin antibodies might support the proinflammatory environment by neutralizing the TNF blocker progranulin.
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Affiliation(s)
- Philipp Klemm
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Homburg/Saar, Germany.,Department of Rheumatology and Immunology, Justus Liebig University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Gunter Assmann
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Homburg/Saar, Germany
| | - Klaus-Dieter Preuss
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Homburg/Saar, Germany
| | - Natalie Fadle
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Homburg/Saar, Germany
| | - Evi Regitz
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Homburg/Saar, Germany
| | - Thierry Martin
- CNRS, UPR3572, IBMC, Hopitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Michael Pfreundschuh
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Homburg/Saar, Germany
| | - Lorenz Thurner
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Homburg/Saar, Germany
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12
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Abstract
Rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis are the most common chronic autoimmune rheumatic diseases. For all three diseases an early diagnosis and initiation of treatment is crucial. The proof of concept network study "Rheuma-VOR" is a further developed version of the predecessor project ADAPTHERA and was extended to several federal states. The aim of this prospective study is to improve the early diagnosis of rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis and thus positively impact the quality of care for patients with the help of multidisciplinary coordinating centers. To date 3710 disease-specific questionnaires from patients with the suspected diagnosis of rheumatoid arthritis, psoriatic arthritis or axial spondylarthritis from 1298 different primary care providers were registered in the multidisciplinary coordination centers. A total of 1958 appointments were made with 1 of the 53 participating rheumatology specialists. In 876 patients, 1 of the 3 rheumatic diseases was diagnosed in an early stage. The waiting period was on average 42.5 days depending on the federal state, which is well below the nationwide average. It should also be noted that the coordinated cooperation and risk stratification of the Rheuma-VOR coordination centers relieved the capacity of rheumatology specialists by 1281 appointments (34.5%). In addition, the 2‑week Rheuma Bus Tour and the accompanying initiatives in Rhineland-Palatinate (Rheuma-VOR screening app and the triage consultation) are showing first promising positive results.
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Affiliation(s)
- A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland. .,ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland.
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - G Assmann
- Rheumatologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T Witte
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Hoeper
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - R E Schmidt
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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13
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Löhr S, Ekici AB, Uebe S, Büttner C, Köhm M, Behrens F, Böhm B, Sticherling M, Schett G, Simon D, Mössner R, Nimeh A, Oji V, Assmann G, Rech J, Holmdahl R, Burkhardt H, Reis A, Hüffmeier U. Analyses of association of psoriatic arthritis and psoriasis vulgaris with functional NCF1 variants. Rheumatology (Oxford) 2019; 58:915-917. [DOI: 10.1093/rheumatology/key448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sabine Löhr
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Steffen Uebe
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Christian Büttner
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Michaela Köhm
- Division of Rheumatology and IME, Fraunhofer Project Group Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main
| | - Frank Behrens
- Division of Rheumatology and IME, Fraunhofer Project Group Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main
| | - Beate Böhm
- Division of Rheumatology and IME, Fraunhofer Project Group Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main
| | | | - Georg Schett
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen
| | - David Simon
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen
| | - Rotraut Mössner
- Department of Dermatology, Georg-August-University Göttingen, Göttingen
| | - Ali Nimeh
- Department of Rheumatology, Fachklinik Bad Bentheim, Bad Bentheim
| | - Vinzenz Oji
- Department of Dermatology, University of Münster, Münster
| | - Gunter Assmann
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen
| | - Rikard Holmdahl
- Division of Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Harald Burkhardt
- Division of Rheumatology and IME, Fraunhofer Project Group Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main
| | - André Reis
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Ulrike Hüffmeier
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
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14
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Schub D, Assmann G, Sester U, Sester M, Schmidt T. VZV-specific T-cell levels in patients with rheumatic diseases are reduced and differentially influenced by antirheumatic drugs. Arthritis Res Ther 2018; 20:252. [PMID: 30413189 PMCID: PMC6235212 DOI: 10.1186/s13075-018-1742-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/25/2018] [Accepted: 10/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Varicella zoster virus (VZV)-specific cellular immunity is essential for viral control, and the incidence of VZV reactivation is increased in patients with rheumatic diseases. Because knowledge of the influence of antirheumatic drugs on specific cellular immunity is limited, we analyzed VZV-specific T cells in patients with rheumatoid arthritis (RA) and seronegative spondylarthritis (SpA), and we assessed how their levels and functionality were impacted by disease-modifying antirheumatic drugs (DMARDs). A polyclonal stimulation was carried out to analyze effects on general effector T cells. METHODS CD4 T cells in 98 blood samples of patients with RA (n = 78) or SpA (n = 20) were quantified by flow cytometry after stimulation with VZV antigen and the polyclonal stimulus Staphylococcus aureus enterotoxin B (SEB), and they were characterized for expression of cytokines (interferon-γ, tumor necrosis factor [TNF]-α, interleukin [IL]-2) and markers for activation (CD69), differentiation (CD127), or functional anergy programmed death 1 molecule [PD-1], cytotoxic T-lymphocyte antigen 4 [CTLA-4]. Results of patients with RA were stratified into subgroups receiving different antirheumatic drugs and compared with samples of 39 healthy control subjects. Moreover, direct effects of biological DMARDs on cytokine expression and proliferation of specific T cells were analyzed in vitro. RESULTS Unlike patients with SpA, patients with RA showed significantly lower percentages of VZV-specific CD4 T cells (median 0.03%, IQR 0.05%) than control subjects (median 0.09%, IQR 0.16%; p < 0.001). Likewise, SEB-reactive CD4 T-cell levels were lower in patients (median 2.35%, IQR 2.85%) than in control subjects (median 3.96%, IQR 4.38%; p < 0.05); however, expression of cytokines and cell surface markers of VZV-specific T cells did not differ in patients and control subjects, whereas SEB-reactive effector T cells of patients showed signs of functional impairment. Among antirheumatic drugs, biological DMARDs had the most pronounced impact on cellular immunity. Specifically, VZV-specific CD4 T-cell levels were significantly reduced in patients receiving TNF-α antagonists or IL-6 receptor-blocking therapy (p < 0.05 and p < 0.01, respectively), whereas SEB-reactive T-cell levels were reduced in patients receiving B-cell-depleting or IL-6 receptor-blocking drugs (both p < 0.05). CONCLUSIONS Despite absence of clinical symptoms, patients with RA showed signs of impaired cellular immunity that affected both VZV-specific and general effector T cells. Strongest effects on cellular immunity were observed in patients treated with biological DMARDs. These findings may contribute to the increased susceptibility of patients with RA to VZV reactivation.
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Affiliation(s)
- David Schub
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Gunter Assmann
- Department of Internal Medicine I, Saarland University, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany.
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15
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Balleisen L, Assmann G, Bailey J, Epping PH, Schulte H, van de Loo J. Epidemiological Study on Factor VII, Factor VIII and Fibrinogen in an Industrial Population - II. Baseline Data on the Relation to Blood Pressure, Blood Glucose, Uric Acid, and Lipid Fractions. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1660106] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn a preceding paper the baseline data in the Munster Arteriosclerosis Study (PROCAM study) of the levels of fibrinogen, factor VIIc and factor VIIIc were described, and their correlation of age, body weight, smoking, alcohol, pill-using and menopause discussed. In this part the relationship of these coagulation factors to blood pressure, blood glucose, uric acid and lipid parameters, which were examined in 4186 apparently healthy individuals, is presented. The correlations are described using two different statistical models, first the Pearson correlation coefficients after allowing each clotting factor for the effects of age, cigarette and alcohol consumption, body weight, menopausal state, pill using and the other clotting factors, and secondly by a multiple regression analysis. The data suggest that there are multiple interrelationships between hemostatic factors and the variables under consideration. The most striking positive correlations were found for factor VII c to blood glucose and triglycerides in men and women and to HDDcholesterol in women.
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Affiliation(s)
- L Balleisen
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - G Assmann
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - J Bailey
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - P-H Epping
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - H Schulte
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - J van de Loo
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
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16
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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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17
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Olsson AG, Angelin B, Assmann G, Binder CJ, Björkhem I, Cedazo-Minguez A, Cohen J, von Eckardstein A, Farinaro E, Müller-Wieland D, Parhofer KG, Parini P, Rosenson RS, Starup-Linde J, Tikkanen MJ, Yvan-Charvet L. Can LDL cholesterol be too low? Possible risks of extremely low levels. J Intern Med 2017; 281:534-553. [PMID: 28295777 DOI: 10.1111/joim.12614] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Following the continuous accumulation of evidence supporting the beneficial role of reducing low-density lipoprotein cholesterol (LDL-C) levels in the treatment and prevention of atherosclerotic cardiovascular disease and its complications, therapeutic possibilities now exist to lower LDL-C to very low levels, similar to or even lower than those seen in newborns and nonhuman species. In addition to the important task of evaluating potential side effects of such treatments, the question arises whether extremely low LDL-C levels per se may provoke adverse effects in humans. In this review, we summarize information from studies of human cellular and organ physiology, phenotypic characterization of rare genetic diseases of lipid metabolism, and experience from clinical trials. Specifically, we emphasize the importance of the robustness of the regulatory systems that maintain balanced fluxes and levels of cholesterol at both cellular and organismal levels. Even at extremely low LDL-C levels, critical capacities of steroid hormone and bile acid production are preserved, and the presence of a cholesterol blood-brain barrier protects cells in the central nervous system. Apparent relationships sometimes reported between less pronounced low LDL-C levels and disease states such as cancer, depression, infectious disease and others can generally be explained as secondary phenomena. Drug-related side effects including an increased propensity for development of type 2 diabetes occur during statin treatment, whilst further evaluation of more potent LDL-lowering treatments such as PCSK9 inhibitors is needed. Experience from the recently reported and ongoing large event-driven trials are of great interest, and further evaluation including careful analysis of cognitive functions will be important.
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Affiliation(s)
- A G Olsson
- Department of Medicine and Health, Linköping University, Linköping, Sweden
| | - B Angelin
- Metabolism Unit, Department of Endocrinology, Metabolism and Diabetes, and KI/AZ Integrated CardioMetabolic Center, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - G Assmann
- University of Münster, Münster, Germany
| | - C J Binder
- Medical University of Vienna & Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - I Björkhem
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A Cedazo-Minguez
- Division of Neurogeriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet Huddinge, Stockholm, Sweden
| | - J Cohen
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - D Müller-Wieland
- Klinik II und Poliklinik für Innere Medizin der Universität zu Köln, Köln, Germany
| | - K G Parhofer
- Ludwig-Maximilians-University of Munich, Munich, Germany
| | - P Parini
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
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18
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Wehrfritz H, Trudzinski F, Assmann G, Zewinger S, Kamp A, Tauchnitz M, Seiler F, Alqudrah M, Tsitouras K, Bals R, Lepper PM. Extrakorporale Membranoxygenierung bei einem Patienten mit schwerem ARDS infolge einer Granulomatose mit Polyangiitis. Pneumologie 2017. [DOI: 10.1055/s-0037-1598323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H Wehrfritz
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - F Trudzinski
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - G Assmann
- Hämatologie, Klin. Immunologie und Rheumatologie, Universitätsklinikum des Saarlandes
| | - S Zewinger
- Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes
| | - A Kamp
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - M Tauchnitz
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - F Seiler
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - M Alqudrah
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - K Tsitouras
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - R Bals
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
| | - PM Lepper
- Klinik für Innere Medizin V, Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes
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Assmann G, Zinke S, Gerling M, Fadle N, Preuss D, Pfreundschuh M, Thurner L. SAT0062 Test for Serum Progranulin Autoantibodies Can Reduce The Seronegative Status in Rheumatoid Arthritis by One Third. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kubuschok B, Preuss KD, Baier-Thoenes K, Regitz E, Thurner L, Assmann G, Pfreundschuh M. Autoantibodies against lamin C, NA14 and CK15 in primary vasculitides or autoimmune diseases with secondary vasculitis. Clin Exp Rheumatol 2016; 34:S60-S69. [PMID: 27214601] [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: 01/14/2015] [Accepted: 10/09/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Autoantibodies may play a role in the pathogenesis of primary vasculitides (PVs) like giant cell arteritis (GCA). We recently identified 3 cytoskeletal proteins (lamin C [laC], nuclear autoantigen of 14kD [NA14] and cytokeratin 15 [CK15]) as autoantigens in GCA and postulated a frequent autoantibody response against these antigens in PVs. METHODS To test this hypothesis we studied a cohort of patients with PVs (n=61) and healthy individuals (n=27) for the presence of these autoantibodies using a recombinant cDNA expression library. To define their specifity for PV, we also examined patients with other autoimmune diseases such as rheumatoid arthritis (RA) and connective tissue diseases (CTD). RESULTS We found no statistically significant differences in autoantibody responses between patients with PV and healthy controls, although there was a trend for an association between PVs and the occurrence of antibodies against laC and CK15. However, in patients with RA (n=33) or Sjögren's syndrome (SS, n=11) with vasculitides we observed more frequently autoantibodies against NA14, laC and CK15 compared to healthy controls. In patients with systemic lupus erythematosus (SLE, n=23) autoantibodies against laC were more frequent. The presence of autoantibodies in RA, SS and SLE was associated with systemic secondary vasculitis (SSV). In RA, laC- and NA14-seropositive patients were in a more advanced disease stage than seronegative patients with more frequent extraarticular manifestations (p=0.004). In SLE laC-autoantibody-positive patients had a higher SLE activity index (p<0.001). CONCLUSIONS Serum autoantibodies against laC and NA14 are frequent in patients with RA and CTD and are associated with extensive disease and SSV. The potential pathogenic and prognostic role of these antibodies should be further investigated.
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Affiliation(s)
- Boris Kubuschok
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany.
| | - Klaus-Dieter Preuss
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
| | - Kerstin Baier-Thoenes
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
| | - Evi Regitz
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
| | - Lorenz Thurner
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
| | - Gunter Assmann
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
| | - Michael Pfreundschuh
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, Homburg/Saar, Germany
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Kasch R, Assmann G, Merk S, Barz T, Melloh M, Hofer A, Merk H, Flessa S. Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department? BMC Musculoskelet Disord 2016; 17:112. [PMID: 26932453 PMCID: PMC4774180 DOI: 10.1186/s12891-016-0962-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/23/2016] [Indexed: 02/02/2023] Open
Abstract
Background The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Methods Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department’s point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. Results The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable. Conclusions This is the first detailed analysis of the hospital department’s cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.
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Affiliation(s)
- R Kasch
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.
| | - G Assmann
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.,Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - S Merk
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - T Barz
- Department of Orthopedics and Trauma Surgery, Asklepios Hospital Uckermark, Schwedt, Germany
| | - M Melloh
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.,Center for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - A Hofer
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - H Merk
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - S Flessa
- Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Greifswald, Germany
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Schub D, Assmann G, Sester M, Schmidt T. AB0031 Restricted T-Cell Frequencies and Function in Patients with Rheumatoid Arthritis Revealed by a Whole Blood Stimulation Assay Using Polyclonal and Varicella Zoster Virus-Specific Stimuli. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Assmann G, Zinke S, Gerling M, Ong M, Fadle N, Preuss K, Thurner L, Pfreundschuh M. THU0098 Serum Progranulin Autoantibodies in Rheumatoid Arthritis Associated with Higher Disease Activity: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Thurner L, Fadle N, Regitz E, Kemele M, Klemm P, Zaks M, Stöger E, Bette B, Carbon G, Zimmer V, Assmann G, Murawski N, Kubuschok B, Held G, Preuss KD, Pfreundschuh M. The molecular basis for development of proinflammatory autoantibodies to progranulin. J Autoimmun 2015; 61:17-28. [PMID: 26005049 DOI: 10.1016/j.jaut.2015.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/07/2014] [Revised: 04/27/2015] [Accepted: 05/03/2015] [Indexed: 11/17/2022]
Abstract
Recently we identified in a wide spectrum of autoimmune diseases frequently occurring proinflammatory autoantibodies directed against progranulin, a direct inhibitor of TNFR1 & 2 and of DR3. In the present study we investigated the mechanisms for the breakdown of self-tolerance against progranulin. Isoelectric focusing identified a second, differentially electrically charged progranulin isoform exclusively present in progranulin-antibody-positive patients. Alkaline phosphatase treatment revealed this additional progranulin isoform to be hyperphosphorylated. Subsequently Ser81, which is located within the epitope region of progranulin-antibodies, was identified as hyperphosphorylated serine residue by site directed mutagenesis of candidate phosphorylation sites. Hyperphosphorylated progranulin was detected exclusively in progranulin-antibody-positive patients during the courses of their diseases. The occurrence of hyperphosphorylated progranulin preceded seroconversions of progranulin-antibodies, indicating adaptive immune response. Utilizing panels of kinase and phosphatase inhibitors, PKCβ1 was identified as the relevant kinase and PP1 as the relevant phosphatase for phosphorylation and dephosphorylation of Ser81. In contrast to normal progranulin, hyperphosphorylated progranulin interacted exclusively with inactivated (pThr320) PP1, suggesting inactivated PP1 to cause the detectable occurrence of phosphorylated Ser81 PGRN. Investigation of possible functional alterations of PGRN due to Ser81 phosphorylation revealed, that hyperphosphorylation prevents the interaction and thus direct inhibition of TNFR1, TNFR2 and DR3, representing an additional direct proinflammatory effect. Finally phosphorylation of Ser81 PGRN alters the conversion pattern of PGRN. In conclusion, inactivated PP1 induces hyperphosphorylation of progranulin in a wide spectrum of autoimmune diseases. This hyperphosphorylation prevents direct inhibition of TNFR1, TNFR2 and DR3 by PGRN, alters the conversion of PGRN, and is strongly associated with the occurrence of neutralizing, proinflammatory PGRN-antibodies, indicating immunogenicity of this alternative secondary modification.
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MESH Headings
- Animals
- Autoantibodies/genetics
- Autoantibodies/immunology
- Autoantibodies/metabolism
- Binding Sites/genetics
- Blotting, Western
- Cell Line
- Cell Line, Tumor
- Flow Cytometry
- HEK293 Cells
- Humans
- Intercellular Signaling Peptides and Proteins/genetics
- Intercellular Signaling Peptides and Proteins/immunology
- Intercellular Signaling Peptides and Proteins/metabolism
- Mutagenesis, Site-Directed
- Phosphorylation
- Progranulins
- Protein Isoforms/genetics
- Protein Isoforms/immunology
- Protein Isoforms/metabolism
- Protein Kinase C beta/genetics
- Protein Kinase C beta/immunology
- Protein Kinase C beta/metabolism
- Protein Precursors/genetics
- Protein Precursors/immunology
- Protein Precursors/metabolism
- Receptors, Tumor Necrosis Factor, Member 25/immunology
- Receptors, Tumor Necrosis Factor, Member 25/metabolism
- Receptors, Tumor Necrosis Factor, Type I/immunology
- Receptors, Tumor Necrosis Factor, Type I/metabolism
- Receptors, Tumor Necrosis Factor, Type II/immunology
- Receptors, Tumor Necrosis Factor, Type II/metabolism
- Serine/genetics
- Serine/immunology
- Serine/metabolism
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Affiliation(s)
- Lorenz Thurner
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany.
| | - Natalie Fadle
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Evi Regitz
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Maria Kemele
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Philipp Klemm
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Marina Zaks
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Elisabeth Stöger
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Birgit Bette
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Gabi Carbon
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Vincent Zimmer
- Department of Internal Medicine II, Saarland University Medical Center, Homburg, Saar, Germany
| | - Gunter Assmann
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Niels Murawski
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Boris Kubuschok
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Gerhard Held
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Klaus-Dieter Preuss
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany
| | - Michael Pfreundschuh
- Saarland University Medical School, José Carreras Center for Immuno- and Gene Therapy, Internal Medicine I, Homburg, Saar, Germany.
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Assmann G, Buono P, Daniele A, Della Valle E, Farinaro E, Ferns G, Krogh V, Kromhout D, Masana L, Merino J, Misciagna G, Panico S, Riccardi G, Rivellese AA, Rozza F, Salvatore F, Salvatore V, Stranges S, Trevisan M, Trimarco B, Vetrani C. Functional foods and cardiometabolic diseases* International Task Force for Prevention of Cardiometabolic Diseases. Nutr Metab Cardiovasc Dis 2014; 24:1272-1300. [PMID: 25467217 DOI: 10.1016/j.numecd.2014.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/20/2014] [Indexed: 12/14/2022]
Abstract
Mounting evidence supports the hypothesis that functional foods containing physiologically-active components may be healthful. Longitudinal cohort studies have shown that some food classes and dietary patterns are beneficial in primary prevention, and this has led to the identification of putative functional foods. This field, however, is at its very beginning, and additional research is necessary to substantiate the potential health benefit of foods for which the diet-health relationships are not yet scientifically validated. It appears essential, however, that before health claims are made for particular foods, in vivo randomized, double-blind, placebo controlled trials of clinical end-points are necessary to establish clinical efficacy. Since there is need for research work aimed at devising personalized diet based on genetic make-up, it seems more than reasonable the latter be modeled, at present, on the Mediterranean diet, given the large body of evidence of its healthful effects. The Mediterranean diet is a nutritional model whose origins go back to the traditional dietadopted in European countries bordering the Mediterranean sea, namely central and southern Italy, Greece and Spain; these populations have a lower incidence of cardiovascular diseases than the North American ones, whose diet is characterized by high intake of animal fat. The meeting in Naples and this document both aim to focus on the changes in time in these two different models of dietary habits and their fall out on public health.
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Thurner L, Zaks M, Preuss KD, Fadle N, Regitz E, Ong MF, Pfreundschuh M, Assmann G. Progranulin antibodies entertain a proinflammatory environment in a subgroup of patients with psoriatic arthritis. Arthritis Res Ther 2014; 15:R211. [PMID: 24321127 PMCID: PMC3978758 DOI: 10.1186/ar4406] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/22/2013] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a distinctive inflammatory arthritis which may typically develop in a subgroup of individuals suffering from psoriasis. We recently described progranulin autoantibodies (PGRN-Abs) in the sera of patients with different autoimmune diseases including seronegative polyarthritis. In the present study we investigated the occurrence of PGRN-Abs in PsA. METHODS PGRN-Abs were determined in 260 patients with PsA, 100 patients with psoriasis without arthritic manifestations (PsC) and 97 healthy controls using a recently described ELISA. PGRN plasma levels were determined from subgroups by a commercially available ELISA-kit. Possible functional effects of PGRN-antibodies were analysed in vitro by tumour necrosis factor (TNF)-α mediated cytotoxicity assays using WEHI-S and HT1080 cells. RESULTS PGRN-Abs were detected with relevant titres in 50/260 (19.23%) patients with PsA, but in 0/100 patients with psoriasis without arthritic manifestations (P = 0.0001). All PGRN-Abs belonged to immunoglobulin G (IgG). PGRN-Abs were significantly more frequent in PsA patients with enthesitis or dactylitis. PGRN-Abs were also more frequent in PsA patients receiving treatment with TNF-α-blockers than in patients treated without TNF-α-blockers (20.8% versus 17.4%; P = 0.016). PGRN plasma levels were significantly lower in PGRN-Ab-positive patients with PsA than in healthy controls and patients with psoriasis without arthritic manifestations (P < 0.001), indicating a neutralizing effect of PGRN-Abs. Moreover cytotoxicity assays comparing PGRN-antibody positive with negative sera from matched patients with PsA, clearly showed a proinflammatory effect of PGRN antibodies. CONCLUSION Neutralizing PGRN-Abs occur with relevant titres in a subgroup of patients with PsA, but not in patients without arthritic manifestations (PsC). PGRN-Ab-positive patients had more frequent enthesitis or dactylitis. TNF-α-induced cytotoxicity assays demonstrated that the protective effects of progranulin were inhibited by serum containing PGRN-Abs. This suggests that PGRN-Ab might not only be useful as a diagnostic and prognostic marker, but may provide a proinflammatory environment in a subgroup of patients with PsA.
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Affiliation(s)
- G Assmann
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - U Schmidt
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - M Drechsler
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - M Pfannkuche
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
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Heyne K, Conrad M, Dohmen D, Huwer J, Assmann G, Roemer K. Differential basal levels ofMDM-2transcription induced by p53-P72 and p53-R72. Cell Cycle 2014; 9:4028-30. [DOI: 10.4161/cc.9.19.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Schub D, Janssen E, Leyking S, Sester U, Assmann G, Hennes P, Smola S, Vogt T, Rohrer T, Sester M, Schmidt T. Altered phenotype and functionality of varicella zoster virus-specific cellular immunity in individuals with active infection. J Infect Dis 2014; 211:600-12. [PMID: 25180236 DOI: 10.1093/infdis/jiu500] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 11/12/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) establishes lifelong persistence and may reactivate in individuals with impaired immune function. To investigate immunologic correlates of protection and VZV reactivation, we characterized specific immunity in 207 nonsymptomatic immunocompetent and 132 immunocompromised individuals in comparison with patients with acute herpes zoster. METHODS VZV-specific CD4 T cells were quantified flow cytometrically after stimulation and characterized for expression of interferon-γ, interleukin 2, and tumor necrosis factor α and surface markers for differentiation (CD127) and anergy (cytotoxic T lymphocyte antigen 4 [CTLA-4] and programmed death [PD]-1). Immunoglobulin G and A levels were quantified using an enzyme-linked immunosorbent assay. RESULTS In healthy individuals, VZV-specific antibody and T-cell levels were age dependent, with the highest median VZV-specific CD4 T-cell frequencies of 0.108% (interquartile range, 0.121%) during adolescence. VZV-specific T-cell profiles were multifunctional with predominant expression of all 3 cytokines, CD127 positivity, and low expression of CTLA-4 and PD-1. Nonsymptomatic immunocompromised patients had similar VZV-specific immunologic properties except for lower T-cell frequencies (P<.001) and restricted cytokine expression. In contrast, significantly elevated antibody- and VZV-specific CD4 T-cell levels were found in patients with zoster. Their specific T cells showed a shift in cytokine expression toward interferon γ single positivity, an increase in CTLA-4 and PD-1, and a decrease in CD127 expression (all P<.001). This phenotype normalized after resolution of symptoms. CONCLUSIONS VZV-specific CD4-T cells in patients with zoster bear typical features of anergy. This phenotype is reversible and may serve as adjunct tool for monitoring VZV reactivations in high-risk patients.
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Affiliation(s)
- David Schub
- Department of Transplant and Infection Immunology
| | | | | | | | | | | | - Sigrun Smola
- Institute of Virology, Saarland University, Homburg, Germany
| | | | | | | | - Tina Schmidt
- Department of Transplant and Infection Immunology
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Assmann G, Molinger M, Pfreundschuh M, Bohle R, Zimmer V. Gastrointestinal perforation due to vasculitis at primary diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) despite a high dose glucocorticosteroids treatment. Springerplus 2014; 3:404. [PMID: 25133090 PMCID: PMC4132439 DOI: 10.1186/2193-1801-3-404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/06/2014] [Indexed: 12/13/2022]
Abstract
Background Eosinophilic granulomatosis with polyangiitis (EGPA) belongs to the systemic ANCA-associated vasculitides which may develop life-threatening major organ involvement, such as eosinophilic pulmonary infiltration, neuropathy, acute nephritis, myocarditis, and gastrointestinal (GI) tract involvement. Here, two cases of EGPA are presented developing perforation of the bowel at primary diagnosis after 7 respectively 10 days of initiation of high-dose glucocorticosteroides (GC) therapy. Findings Two male patients, aged 32 (case 1) and 36 years (case 2), were admitted to the hospital with the symptoms of dyspnea, fatigue, fever, and chest pain. The patients completed the previously published revised international Chapel Hill nomenclature of EGPA. The two patients (case 1 and 2) developed acute abdominal pain after 7 (case 1) and ten days (case 2) on GC treatment. Computed tomography followed by surgery detected acute perforation of the small intestine (middle part of jejunum, case 1) and colon transversum (case 2). The resected specimens disclosed bowel perforation with severe transmural inflammation, edema, hemorrhage and vasculitis typically of EGPA. On the first post-operative day, therapy with cyclophosphamide (according to the Austin protocol) with a dosage of 750 mg/qm every 3 weeks (for 8 cycles) was initiated with good response within three months of treatment. Conclusion The course of disease of the two presented EGPA patients suggest that very early initiation of intensified immunosuppressive treatment, preferentially with cyclophophomide or B cell depletion strategies, needs to be considered to avoid life-threatening complications of GI involvement.
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Affiliation(s)
- Gunter Assmann
- University Medical School of Saarland, Rheumatology and Oncology, Kirrberger Strasse 1, D-66421 Homburg, Saar Germany
| | - Marc Molinger
- University Medical School of Saarland, Rheumatology and Oncology, Kirrberger Strasse 1, D-66421 Homburg, Saar Germany
| | - Michael Pfreundschuh
- University Medical School of Saarland, Rheumatology and Oncology, Kirrberger Strasse 1, D-66421 Homburg, Saar Germany
| | - Rainer Bohle
- Department of Pathology, University Medical School of Saarland, Homburg, Saar Germany
| | - Vincent Zimmer
- Department of Medicine II Gastroenterology, University Medical School of Saarland, Homburg, Saar Germany
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Assmann G, Eggimann M, Pfreundschuh M, Roemer K, Heyne K. AB0096 MDM2 Knock-Down Reduces NfκB Expression in Rheumatoid Arthritis (RA) Synoviocytes. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Assmann G, Zinke S, Gerling M, Pfreundschuh M, Thurner L, Preuss K. AB0064 Progranulin Antibodies (PGRN-ABS) in Rheumatoid Arthritis More Frequent than in Psoriatic Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mollenhauer M, Assmann G, Zengel P, Guntinas-Lichius O, Ihrler S. [HPV-associated oropharyngeal carcinoma. Status quo and relationship with cancer of unknown primary]. Pathologe 2014; 35:127-40; quiz 141-2. [PMID: 24619523 DOI: 10.1007/s00292-013-1852-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Carcinomas of the oropharynx with association to high-risk types of human papillomavirus (HPV) have been identified as a new tumour entity with favourable prognosis, distinct from classical nicotine- and alcohol-associated carcinoma. They develop through oncogenic transformation of the basal cells of reticulated cryptal epithelium of the palatinal tonsils and the base of the tongue. Positivity for HPV strongly correlates with an atypical, non-keratinizing histological differentiation and cystic transformation of lymph node metastases. Strong immunohistological positivity for p16 reliably detects transcriptionally active infection with high-risk HPV. Hence, p16 staining has been regarded as an effectual diagnostic tool in the appropriate setting. Frequent nodal metastasation as well as considerable size of (cystic) metastases, and frequent small size as well as submucosal location of primary tumours all contribute to frequent initial manifestation of cervical cancer of unknown primary (CUP). In a situation of CUP diagnostic testing for HPV (in negative cases in addition to EBV) is recommended in lymph node metastases, due to the high predictive value for the localization of occult primary carcinomas. Intense clinicopathological cooperation is mandatory for improved detection of small, occult primary carcinomas. The relevance of this new carcinoma entity will increase, as the incidence continues to increase worldwide.
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Affiliation(s)
- M Mollenhauer
- Institut für Pathologie, Technische Universität München (TUM), Trogerstr. 18, 81675, München, Deutschland,
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Assmann G, Kasch R, Hofer A, Schulz AP, Kayser R, Lahm A, Merk H, Flessa S. An economic analysis of aseptic revision hip arthroplasty: calculation of partial hospital costs in relation to reimbursement. Arch Orthop Trauma Surg 2014; 134:413-20. [PMID: 24477287 DOI: 10.1007/s00402-014-1920-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Aseptic loosening is one of the most common intermediate and long-term complications after total hip replacement (THR). These complications cause suffering and require expensive revision surgery. Little concrete data on direct costs are available from the hospital's, moreover operating department's perspective. We here provide a detailed analysis of the costs of THR revision and relate them to reimbursement underlying the German diagnosis-related groups (DRG) system. MATERIALS AND METHODS Major cost parameters were identified using for orientation the cost matrix of the German Institute for Hospital Reimbursement (InEK GmbH). We then retrospectively analysed the major direct costs of aseptic revision THR in terms of contribution margins I and II. The analysis included a total of 114 patients who underwent aseptic revision from 1 January 2009 to 31 March 2012. Data were retrieved from the hospital information system and patient records. All costs of surgery, diagnostic tests, and other treatments were calculated as purchase prices in EUR. The comparative analysis of direct costs and reimbursements was done for DRG I46A and I46B from the hospital's, especially treating department's rather than the society or healthcare insurance's perspective. RESULTS The average direct cost incurred by the hospital for a THR revision was <euro>4,380.0. The largest share was accounted for surgical costs (62.7 % of total). Implant and staff costs were identified as the most important factors that can be influenced. The proportion of the daily contribution margin that was left to cover the hospital's indirect cost decreased with the relative cost weight of the DRG to which a patient was assigned. CONCLUSION Our study for the first time provides a detailed analysis of the major direct case costs of THR revision for aseptic loosening from the provider's perspective. Our findings suggest that these revision operations could be performed cost-beneficially by the operating unit. From an economic perspective, cases with higher cost weights are more favorable for a hospital. These results need to be confirmed in multicenter studies.
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Affiliation(s)
- G Assmann
- Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Friedrich-Loeffler-Straße 70, 17487, Greifswald, Germany,
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Deutsch MA, Huber B, Assmann G, Müller-Höcker J, Ott I, Franz WM. Human endothelial-colony forming cells enhance cardiac repair by increasing neovascularization and the pool of Sca1+ cardiac resident stem cells after myocardial infarction in SCID/beige mice. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muntoni S, Wiebusch H, Jansen-Rust M, Rust S, Schulte H, Berger K, Pisciotta L, Bertolini S, Funke H, Seedorf U, Assmann G. Heterozygosity for lysosomal acid lipase E8SJM mutation and serum lipid concentrations. Nutr Metab Cardiovasc Dis 2013; 23:732-736. [PMID: 22795295 DOI: 10.1016/j.numecd.2012.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/20/2012] [Accepted: 05/24/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIM The complete absence of the lysosomal acid lipase (LAL) enzyme function causes Wolman's Disease that is fatal within the first six months of life. Subtotal defects cause Cholesteryl ester storage disease (CESD), an autosomal recessive disorder leading to hepatic steatosis, fibrosis, micronodular cirrhosis, combined hyperlipidemia with low HDL-cholesterol, increased risk for atherosclerosis, premature death. Since the frequency of the Exon 8 splice junction mutation (c.894 G > A, E8SJM), the CESD leading mutation, is not rare in the general population (allele frequency 0.0025), we investigated the impact of this mutation on serum lipid profile in E8SJM carriers. METHODS AND RESULTS We collected E8SJM carriers both form genetic study-population analysis and from Outpatient Lipid Clinics and then we assessed their serum lipid profile. We found thirteen individuals heterozygote for E8SJM. Most of them were Germans, three Spanish and two Italian. We found a significant increase in total cholesterol levels in both sexes with E8SJM mutation, leading to a significant increase in LDL cholesterol in males. CONCLUSIONS Our results show that LAL E8SJM carriers have an alteration in lipid profile with a Polygenic Hypercholesterolemia phenotype, leading to an increase in cardiovascular risk profile.
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Affiliation(s)
- Sa Muntoni
- Department of Toxicology, Oncology and Molecular Pathology Unit, University of Cagliari, Italy.
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Assmann G, Zinke S, Ney JT, Ong MF, Neumann F, Nold S, Pfreundschuh M. SAT0286 Serum Immunoglobulin Free Light Chain Assessment in Psoriatic Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Assmann G, Zinke S, Zaks M, Pfoehler C, Preuss D, Pfreundschuh M, Thurner L. SAT0285 Progranulin-Neutralizing Autoantibodies in Psoriatic Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Assmann G, Shihadeh K, Ong M, Ziepert M, Poeschel V, Pfreundschuh M. AB1263 Higher prevalence of anti-citrullinated protein antibodies (ACPA) without impact on prognosis in patients with aggressive B-non-hodgkin lymphoma (DLCBL):. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Husmann CA, Holle JU, Moosig F, Mueller S, Wilde B, Cohen Tervaert JW, Harper L, Assmann G, Gross WL, Epplen JT, Wieczorek S. Genetics of toll like receptor 9 in ANCA associated vasculitides. Ann Rheum Dis 2013; 73:890-6. [PMID: 23592712 DOI: 10.1136/annrheumdis-2012-202803] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 01/21/2023]
Abstract
OBJECTIVES To investigate the contribution of genetic polymorphisms of toll like receptor (TLR) 9 and related genes on the susceptibility and clinical manifestation of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV). METHODS Four single nucleotide polymorphisms (SNPs) in TLR9 were genotyped in 863 German AAV cases and 1344 healthy controls. Significant results were replicated in a cohort of 426 Dutch and British AAV cases. 11 polymorphisms in TLR9 related genes were studied concomitantly. RESULTS A strong association of TLR9 genotypes and haplotypes with granulomatosis with polyangiitis was observed as well as a contrariwise association with microscopic polyangiitis. The association was confirmed when cases were compared according to ANCA status rather than to clinical entity. This was partly replicated in the second cohort leading to a striking overall difference in TLR9 allele/haplotype frequencies between proteinase 3 (PR3) ANCA+ and myeloperoxidase (MPO) ANCA+ cases (p=0.00000398, pc=0.000016, OR 1.68 (95% CI 1.35 to 2.1) for rs352140; p=0.000011, pc=0.000044, OR 1.64 (95% CI 1.31 to 2.04) for a 3-SNP haplotype). No significant association or epistatic effect was detected for TLR9 related genes: interleukin 6, interleukin 23 receptor, myeloid differentiation primary response 88, TNF receptor-associated factor 6, interleukin-1 receptor-associated kinase 4, discs large homolog 5 and nucleotide-binding oligomerisation domain containing 2. CONCLUSIONS We provide further evidence that PR3-ANCA+ AAV differs genetically from MPO-ANCA+ AAV. TLR9 signalling may be involved in disease pathology, favouring models of infectious agents triggering AAV development.
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Affiliation(s)
- C A Husmann
- Department of Human Genetics, Ruhr University, , Bochum, Germany
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Ney JT, Juhasz-Boess I, Gruenhage F, Graeber S, Bohle RM, Pfreundschuh M, Solomayer EF, Assmann G. Genetic polymorphism of the OPG gene associated with breast cancer. BMC Cancer 2013; 13:40. [PMID: 23369128 PMCID: PMC3563620 DOI: 10.1186/1471-2407-13-40] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 01/22/2013] [Indexed: 12/20/2022] Open
Abstract
Background The receptor activator of NF-κB (RANK), its ligand (RANKL) and osteoprotegerin (OPG) have been reported to play a role in the pathophysiological bone turnover and in the pathogenesis of breast cancer. Based on this we investigated the role of single nucleotide polymorphisms (SNPs) within RANK, RANKL and OPG and their possible association to breast cancer risk. Methods Genomic DNA was obtained from Caucasian participants consisting of 307 female breast cancer patients and 396 gender-matched healthy controls. We studied seven SNPs in the genes of OPG (rs3102735, rs2073618), RANK (rs1805034, rs35211496) and RANKL (rs9533156, rs2277438, rs1054016) using TaqMan genotyping assays. Statistical analyses were performed using the χ2-tests for 2 x 2 and 2 x 3 tables. Results The allelic frequencies (OR: 1.508 CI: 1.127-2.018, p=0.006) and the genotype distribution (p=0.019) of the OPG SNP rs3102735 differed significantly between breast cancer patients and healthy controls. The minor allele C and the corresponding homo- and heterozygous genotypes are more common in breast cancer patients (minor allele C: 18.4% vs. 13.0%; genotype CC: 3.3% vs. 1.3%; genotype CT: 30.3% vs. 23.5%). No significantly changed risk was detected in the other investigated SNPs. Additional analysis showed significant differences when comparing patients with invasive vs. non-invasive tumors (OPG rs2073618) as well as in terms of tumor localization (RANK rs35211496) and body mass index (RANKL rs9533156 and rs1054016). Conclusions This is the first study reporting a significant association of the SNP rs3102735 (OPG) with the susceptibility to develop breast cancer in the Caucasian population.
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Affiliation(s)
- Jasmin Teresa Ney
- Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421, Homburg/Saar, Saarland, Germany.
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Assmann G, Juhasz-Boess I, Gruenhage F, Graeber S, Wieczorek S, Pfreundschuh M, Solomayer EF, Ney JT. Genetic polymorphisms of the OPG gene associated with breast cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1523 Background: The receptor activator of NfkappaB (RANK) and osteoprotegerin (OPG) cascade system have been reported to play a role in the pathogenesis of breast cancer (BC). Genetic variations in the genes coding for RANK, RANK ligand (RANKL), and OPG are supposed to play a role in the susceptibility of breast cancer. Methods: In the present case-control study genomic DNA was obtained from 307 BC patients (age: median 56) and 396 healthy female controls (healthy blood donors, HC; age median: 45). We studied six single nucleotide polymorphisms (SNPs) in the genes coding for RANK (2 SNPs, rs1805034, rs35211496), OPG (2 SNPs, rs3102735, rs2073618), and RANKL (2 SNPs, rs9533156, rs2277438) using TaqMan assay-guided PCR for the respective SNPs. The genotype and allelic frequencies comparing BC with HC were analyzed with χ2 test for 2x3 and 2x2 tables, respectively. Results: The genotype distributions as well as the allelic frequencies of the SNP rs3102735 in the OPG gene differed significantly (p=0.006 and p=0.019, respectively) between BC patients and HC; the genotypes containing the minor allele were more frequent in BC patients (table). In the OPG SNP rs2073618 the minor allele C was significantly less frequent in BC patients compared to HC (43.8 vs. 49.7%; OR: 0.788; p=0.031). In addition, BC patients carried less frequently the homozygous genotype of the minor allele compared to major allele (18.6 vs. 23.9%, p=0.083). No significant risk was detected for the other SNPs investigated in this study. Conclusions: This is the first study reporting a significant association of the SNP rs3102735 in the OPG gene with the susceptibility to develop BC in the Caucasian population. The minor allele C of OPG SNP rs2073618, however, seems to be protective against BC disease. The impact of the OPG SNP rs3102735 (location: 5`near region, chromosome 8q24) and of the OPG SNP rs2073618 (a missense SNP, leading to amino acid exchanges Leu3Asn) on the pathogenesis of BC are unclear. [Table: see text]
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Affiliation(s)
- Gunter Assmann
- University Medical School of Saarland and Jose Carreras Research Center, Homburg, Germany
| | - Ingolf Juhasz-Boess
- University Medical School of Saarland, Gynecology and Obstetrics, Homburg, Germany
| | - Frank Gruenhage
- University Medical School of Saarland, Medicine II, Homburg, Germany
| | - Stefan Graeber
- Medical Biometry and Statistics, University of Saarland, Homburg, Germany
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Jung J, Molinger M, Kohn D, Schreiber M, Pfreundschuh M, Assmann G. Intra-articular glucocorticosteroid injection into sternocostoclavicular joints in patients with SAPHO syndrome. Semin Arthritis Rheum 2012; 42:266-70. [PMID: 22560016 DOI: 10.1016/j.semarthrit.2012.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/15/2012] [Accepted: 03/18/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Painful swelling of the anterior chest wall caused by osteitis and hyperostosis in the sternocostoclavicular region are characteristically observed in patients suffering from SAPHO syndrome. Autoimmune triggering of inflammation and bacterial infection is hypothesized to be involved in the pathogenesis. Promising treatment modalities include antirheumatic and antibiotic medications. METHODS Ten patients with SAPHO syndrome and symptomatic osteitis in the sternocostoclavicular region were treated by a single instillation of glucocorticosteroids (20 mg triamcinolone) into the sternocostoclavicular joints. The disease activity was evaluated on the basis of a questionnaire asking for osteitis activity (quantified for complains on a scale of 0-6), by Health Assessment Questionnaire (HAQ) score, erythrocyte sedimentation rate, C-reactive protein, and magnet resonance imaging (MRI) scanning of the sternocostoclavicular region (osteitis scores quantified for inflammation on a scale of 0-2 by the radiologist) prior to injection and after 12 weeks. No changes of the preexisting antirheumatic therapy were allowed during the observation interval. RESULTS All patients continued the study during the follow-up. The osteitis score changed from 4.2 (mean; standard error (SE) ±0.3) to 3.2 (±0.4), [P = 0.062], the erythrocyte sedimentation rate from 19.0 (range from 12 to 30) to 19.9 (from 12 to 27), [P = 0.430], and the MRI score from 1.6 (±0.2) to 1.5 (±0.2) [P = 1.0]. One patient developed an increase of the clinical osteitis activity from 3 to 5 according the scoring system; only 2 patients showed a reduction of the MRI activity score from 2 to 1. CONCLUSIONS Intra-articular glucocorticosteroid instillation does not appear to reduce osteitis in the sternocostoclavicular region in patients with SAPHO syndrome.
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Affiliation(s)
- Jochen Jung
- University Saarland Medical School, Orthopedics, Kirrbergerstraße 1, Homburg, Germany
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Zimmer V, Höblinger A, Mihalache F, Assmann G, Acalovschi M, Lammert F. Potential genotype-specific single nucleotide polymorphism interaction of common variation in p53 and its negative regulator mdm2 in cholangiocarcinoma susceptibility. Oncol Lett 2012; 4:101-106. [PMID: 22807971 DOI: 10.3892/ol.2012.680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 03/14/2012] [Indexed: 12/31/2022] Open
Abstract
Aberrant cell cycle control and apoptosis deregulation are involved in biliary carcinogenesis. The tumor suppressor gene p53 and its key negative regulator murine double minute 2 (mdm2) cooperate in modulating these basic cell functions and germline p53 alteration promotes cholangiocarcinoma (CCA) formation in animal models. The potential association between common functional genetic variation in p53 (SNP72 G/C) and mdm2 (SNP309 T/G) and susceptibility to bile duct cancer, however, has not been studied. p53/SNP72 G/C (rs1042522) and mdm2/SNP309 T/G (rs2279744) were genotyped in 182 Caucasian CCA patients and 350 controls using TaqMan assays. Allelic and genotypic differences, including exploratory data analyses (according to gender, tumor localization, early onset and genotypic interactions) were compared in contingency tables using the χ(2) and Fisher's exact tests. The overall comparison of allele and genotype frequencies yielded no significant association between either SNP and CCA susceptibility. Similarly, gender- and localization-specific analyses did not reveal deviations in allelic or genotypic distributions. In carriers of the low-apoptotic p53 genotype CC, the mdm2 SNP309 T allele conferred borderline significant CCA risk [P=0.049; odds ratio (OR), 4.36; 95% CI, 0.92-20.77]. Power analysis confirmed adequate statistical power to exclude major SNP effects (each >97% for OR 1.7). Collectively, the results we obtained from the largest European CCA cohort do not support the hypothesis of a prominent role of common p53 and mdm2 variation in the genetic susceptibility to bile duct cancer. However, epistatic effects may modulate genetic CCA risk in individual subsets.
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Affiliation(s)
- Vincent Zimmer
- Department of Medicine II, Saarland University Hospital, Homburg
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Abstract
About 7-8% of all human cancers are thought to be related to infections with high-risk (HR) human papilloma virus (HPV). Besides cervical cancer, especially squamous cell carcinomas of the anogenital and oropharyngeal regions are associated with HR-HPV. Transmission of HPV is due to sexual activity. Harald zur Hausen was awarded in 2008 with the Nobel price in medicine for the establishment of a causal link between certain HPV infections and cervical cancer. Meanwhile potent prophylactic vaccines are available to prevent infections with HPV-16 and HPV-18, the two most frequently observed HR HPV types worldwide. On molecular grounds a persistent HPV infection is the central risk factor for the development of HPV-associated neoplasias. Continued expression of the viral E6 and E7 oncogenes disrupts cell cycle control mechanisms in infected cells, thereby gaining limitless proliferative capacity and resistance against apoptotic signals. However acquisition of mutations and genomic instability might cause malignant transformation in these cells.
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Affiliation(s)
- G Assmann
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Straße 36, 80337, München, Deutschland
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Simon P, Pfoehler C, Bergner R, Schreiber M, Pfreundschuh M, Assmann G. Swollen joint count in psoriatic arthritis is associated with progressive radiological damage in hands and feet. Clin Exp Rheumatol 2012; 30:45-50. [PMID: 22274638] [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: 03/02/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Psoriatic arthritis (PsA) may progress to joint damage. Determining clinical predictors of joint damage assessed by radiography is important. The aim of this study was to determine clinical factors as possible predictors for radiological damage in hands and feet of PsA patients with a 12-month follow-up. METHODS We conducted a retrospective study on 53 PsA patients who were taking disease-modifying anti-rheumatic drugs (DMARDs) and/or tumour necrosis factor (TNF)-alpha-blockers at a fixed dosage. The patients were observed in 118 follow-up visits (intervals of 12 months ± 3 months), according to a clinical and radiological protocol which included the documentation of the number of swollen and tender joints in hands and feet, the applied therapy, psoriasis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and global health assessment. Outcome was defined as radiographic damage of hands and feet (Ratingen score). For the statistical analysis the Chi-Square test for 2x2 crosstables (with Fisher's correction, as required) was used. RESULTS Progressive radiological damage was more frequent among patients with an increasing swollen joint count (8 of 26 visits; 30.8%) than among those with a stable or decreased number of swollen joints (5 of 89 visits; 5.6%; p=0.001). The analysis of the patients stratified into the different treatment modalities resulted in a significant higher rate of radiological progress (20.8%) in patients on DMARD therapy compared with TNF-alpha blocking agents (0%) (p=0.009). CONCLUSIONS During a 12-month follow-up of PsA patients, an increasing number of swollen joints heralds progression of radiological damage. TNF-alpha-blocker therapy appears to be superior to DMARDs in the protection from radiological progress.
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Affiliation(s)
- P Simon
- Department of Oncology and Rheumatology, Saarland University Medical School, D-66421 Homburg, Germany
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Assmann G, Schmitz G, Donath N, Lekim D. Phosphatidylcholine Substrate Specificity of Lecithin: Cholesterol Acyltransferase. Scandinavian Journal of Clinical and Laboratory Investigation 2011. [DOI: 10.1080/00365517809104894] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Assmann G, Schmitz G, Heckers H. The Role of High Density Lipoproteins in Lecithin: Cholesterol Acyltransferase Activity: Perspectives from Tangier Disease. Scandinavian Journal of Clinical and Laboratory Investigation 2011. [DOI: 10.1080/00365517809104907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Assmann G, Pfoehler C, Simon P, Pfreundschuh M, Tilgen W, Wieczorek S. Genetic variations in the genes encoding receptor activator nuclear factor κ B (RANK), receptor activator nuclear factor κ B ligand (RANKL) and osteoprotegerin (OPG) in patients with psoriasis and psoriatic arthritis: a case-control study. J Dermatol 2010; 38:519-23. [PMID: 21352301 DOI: 10.1111/j.1346-8138.2010.01055.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Psoriasis (Ps) and psoriatic arthritis (PsA) are diseases of unknown origin. However, the receptor activator nuclear factor κ B ligand (RANKL) might play a key role in the pathomechanisms of the disease. Our aim was to study seven single nucleotide polymorphisms (SNP) in the genes encoding for receptor activator nuclear factor κ B (RANK, two SNP), osteoprotegerin (OPG, two SNP) and RANKL (three SNP in patients with Ps and PsA). A case-control study with 156 Ps patients (45 with PsA) and 516 healthy blood donors was conducted to evaluate an association of the SNP with Ps and PsA by genotyping of DNA by polymerase chain reaction. None of the seven SNP showed any differences in the allelic or genotype frequencies between Ps patients and controls. Our study showed no significant association between the SNP in the genes encoding for RANK, OPG and RANKL with susceptibility of disease in Ps and PsA patients.
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Affiliation(s)
- Gunter Assmann
- Internal Medicine I and José Carreras Research Center, Department of Dermatology, University of Saarland Medical School, Homburg/Saar, Germany.
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