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Sobral D, Fernandes AF, Mashayekhi Sardoo A, Bernardes M, Pinto P, Santos H, Gomes JL, Tavares-Costa J, Silva J, Madruga Dias J, Bernardo A, Gaillard J, Armengaud J, Benes V, Pinheiro Torres R, Domingues L, Maia S, Branco J, Coelho AV, Pimentel dos Santos F. POS0359 MOLECULAR PROFILING OF RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS PATIENTS REVEALS AN ASSOCIATION BETWEEN INNATE AND ADAPTIVE CELL POPULATIONS AND THERAPEUTIC RESPONSE TO ADALIMUMAB. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3683] [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: 11/04/2022]
Abstract
Background:The response to treatment in spondylarthropaties is heterogeneous, due to factors yet to be better described. For that reason, it is important to find tools that might help clinicians to decide what is the best available therapeutic option for each patient.Objectives:The goal of this study is to use comprehensive molecular profiling to characterize clinical response to therapy in a real-world setting. Specifically, to identify molecular biomarkers differentiating good responders and non-responders to TNF inhibitors (TNFi) treatment, using adalimumab, in radiographic axial spondyloarthritis | ankylosing spondylitis (r-axSpA|AS) patients context.Methods:Whole-blood mRNA and plasma proteins were measured in a cohort of biologic naïve r-axSpA|AS patients (n = 35) from the Bioefficacy study (Biomarkers identification of anti-TNF alpha agent efficacy in AS patients using RNA sequencing and mass spectrometry), pre and post (14 weeks) TNFi treatment using adalimumab. Response to treatment was categorized according to ASAS20. Results of differential expression analysis were used to identify the most enriched pathways and in predictive models to distinguish responses to TNFi.Results:A treatment-related signature, independent of the type of response, suggests a reduction in inflammatory disease activity. We found genes and proteins robustly differentially expressed between baseline and week 14 in responders, including the GWAS AS-associated genes TNFRSF1A, FCGR2A, TYK2, TBKBP1, IL1R1, IL6R, ICOSLG, IL7R, HHAT and LTBR. Moreover, CRP and HP proteins showed strong and early decrease in the plasma of AS patients, while a cluster of apolipoproteins (APO1, APO2, APO3) showed an increased expression at week 14. Good responders to TNFi treatment tend to have higher expression of innate immunity genes at baseline, and lower expression of markers associated with adaptive immunity, particularly B-cells. A logistic regression model incorporating ASDAS-CRP, gender and Gene x, the top differentially expressed gene at baseline between responders and non-responders, enabled an accurate prediction of response to adalimumab in our cohort (AUC=0.97).Conclusion:Differences in disease activity and/or innate/adaptive immune cell type composition at baseline may be a major contributor to response to adalimumab in r-axSpA|AS. Alternatively, a model including clinical and gene expression variables could be considered, particularly in patients with mild disease activity.Disclosure of Interests:None declared
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Pinheiro Torres R, Fernandes Lourenco MH, Neto A, Pimentel Dos Santos F, Silva I, Mourão AF, Donato H, Costa M, Branco J. AB0747 MATERNAL AND FETAL OUTCOMES IN PREGNANT WOMEN WITH JUVENILE IDIOPATHIC ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3647] [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: 11/04/2022]
Abstract
Background:Juvenile idiopathic arthritis (JIA), one of the most common chronic diseases in children, can be classified in seven different categories according to its onset presentation. Concerns about pregnancy outcomes play a secondary role in disease approach. However, recent data showed an increased risk of pre-term birth in women with JIA instead the small patient samples analysed.Objectives:In this review, our aim is to describe the current available knowledge on JIA adverse, maternal and fetal, outcomes.Methods:A systematic literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases. The search was limited to articles in English language, presenting a comparator group (healthy individuals or patients without known auto-immune rheumatic diseases) and at least one clinical outcome of interest. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility.Results:Ten observational studies out of 1560 references, fulfilled the inclusion criteria, of which, 9 were retrospective and 1 prospective. A total of 6.214 women with JIA (with 6.811 pregnancies) and 18.659.513 healthy controls (with 21.339.194 pregnancies) were included in this review.Concerning maternal outcomes, delivery by caesarian section (CS) was more frequent among JIA women (in 4 out of 6 studies). Pre-eclampsia was referred in 3 out of 6 studies and a higher risk of vaginal bleeding and placenta previa in one additional study. No study found an increased risk for gestational diabetes or hypertension in pregnant women with JIA.Regarding fetal outcomes, 8 studies revealed significantly increased of pre-term birth (only in first births in one study) but one study didn’t show any increased risk. Two studies showed a higher risk of small gestational age (SGA) and in another 2, increased risk for low birth weight (LBW). No evidence of increased risk of major congenital malformations.Conclusion:This systematic review suggests an increased risk for pre-eclampsia, preterm birth, delivery by CS, SGA and LBW, among pregnant women with JIA. Conclusions should be carefully interpreted, giving the heterogeneity of studied populations regarding demography, disease type, disease activity, and prescribed medication.Disclosure of Interests:None declared
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Pinheiro Torres R, Pimentel Dos Santos F, Branco J. AB0014 METHOTREXATE - IMPLICATIONS OF PHARMACOGENETICS IN THE TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3749] [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: 11/04/2022]
Abstract
Background:Methotrexate (MTX) is an anti-folate drug with anti-proliferative and anti-inflammatory effects. MTX proved to be the most highly effective, fast-acting disease modifying anti-rheumatic drug (DMARD), being widely used for the treatment of rheumatoid arthritis (RA) (1).Objectives:This review aims to describe the main genetic variants identified concerning proteins that play a role in methotrexate’s kinetics and efficiency profile.Methods:A literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases, employing the following MeSH terms: methotrexate, pharmacogenetics, pharmacokinetics and rheumatoid arthritis. The search was limited to articles in English language. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility. A total of 48 articles matched the research criteria and were analysed.Results:Genetic variants of four main proteins, with different functions, have been consistently described.Reduced folate carrier 1 (RFC1), a constitutively expressed folate transport protein that has high affinity for MTX is responsible, almost exclusively, for the transport of folate and MTX into the cell. The most commonly studied variant of the gene is the 80G > A variant (rs1051266), mapped within exon 2, on chromosome 21. It seems to improve RA responses to MTX, clinical efficacy with long disease remission (2).ABC transporters are involved in the eflux of MTX from cells. An increased expression and function of these transporters should decrease MTX concentrations in target cells, resulting in lack of therapeutic response. ABCB1 3435 C/T (rs1045642) is a high frequency polymorphism, significantly associated with RA good responses, symptom remission and reduced adverse events, due to MTX treatment (3).Thymidylate synthase (TYMS) is involved in thymidine synthesis. MTX decreases TYMS activity by inhibition and decreasing the access to tetrahydrofolate (THF) cofactors (1). The most common genetic variant of the TYMS gene consists of a 28 bp tandem repeat (rs34743033), with double and triple number of repeats (2R and 3R). The 3R allele genotype was associated with decreased efficacy and increased toxicity (4).The 5,10-methylenetetrahydrofolate reductase (MTHFR) enzyme is indirectly inhibited by MTX. The most common SNPs of the MTHFR gene are C677T (rs1801133) and A1298C (rs1801131). Both are associated with a decreased efficacy and an increased toxicity of MTX (5).Conclusion:MTX response is affected by many gene variants; the effect of each variant separately is likely to be small. Additionally, gene-gene interaction, enhancing the potential role of linkage disequilibrium. This shows the emerging need for a better gene characterization and to improve the knowledge about variants distribution according to ethnicity, to explain different responses to MTX at an individual level.References:[1]Song, G. et al. Association of the MTHFR C677T and A1298C polymorphisms with methotrexate toxicity in rheumatoid arthritis: a meta-analysis. Clin Rheumatol33, 1715–1724 (2014).[2]Hayashi H. et al. A single nucleotide polymorphism of reduced folate carrier 1 predicts methotrexate efficacy in Japanese patients with rheumatoid arthritis. Drug Metab Pharmacokinet. 2013;28(2):164-8.[3]Zhu H. et al. Pharmacogenetics and pharmacogenomics for rheumatoid arthritis responsiveness to methotrexate treatment: the 2013 update. Pharmacogenomics. 2014 Mar;15(4):551-66.[4]Owen SA. et al. Genetic polymorphisms in key methotrexate pathway genes are associated with response to treatment in rheumatoid arthritis patients. Pharm J. 2013;13:227–34.[5]Hughes LB. et al. Racial or ethnic differences in allele frequencies of single-nucleotide polymorphisms in the methylenetetrahydrofolate reductase gene and their influence on response to methotrexate in rheumatoid arthritis. Ann Rheum Dis. 2006;65:1213–8.Disclosure of Interests:None declared
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Jácome C, Almeida R, Pereira AM, Araújo L, Correia MA, Pereira M, Couto M, Lopes C, Chaves Loureiro C, Catarata MJ, Santos LM, Ramos B, Mendes A, Pedro E, Cidrais Rodrigues JC, Oliveira G, Aguiar AP, Arrobas AM, Costa J, Dias J, Todo Bom A, Azevedo J, Ribeiro C, Alves M, Pinto PL, Neuparth N, Palhinha A, Marques JG, Martins P, Trincão D, Neves A, Todo Bom F, Santos MA, Branco J, Loyoza C, Costa A, Silva Neto A, Silva D, Vasconcelos MJ, Teixeira MF, Ferreira-Magalhães M, Taborda Barata L, Carvalhal C, Santos N, Sofia Pinto C, Rodrigues Alves R, Moreira AS, Morais Silva P, Fernandes R, Ferreira R, Alves C, Câmara R, Ferraz de Oliveira J, Bordalo D, Calix MJ, Marques A, Nunes C, Menezes F, Gomes R, Almeida Fonseca J. Asthma App Use and Interest Among Patients With Asthma: A Multicenter Study. J Investig Allergol Clin Immunol 2021; 30:137-140. [PMID: 32327403 DOI: 10.18176/jiaci.0456] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - R Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - A M Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - L Araújo
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - M A Correia
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - M Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - M Couto
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - C Lopes
- Unidade de Imunoalergologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - C Chaves Loureiro
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M J Catarata
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L M Santos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Ramos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - E Pedro
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - J C Cidrais Rodrigues
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - G Oliveira
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - A P Aguiar
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - A M Arrobas
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Costa
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Dias
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Azevedo
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Ribeiro
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Alves
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - P L Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - N Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - A Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - J G Marques
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - P Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - D Trincão
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - A Neves
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - F Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - M A Santos
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - J Branco
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - C Loyoza
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - A Costa
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Silva Neto
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - D Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M J Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M F Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M Ferreira-Magalhães
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - L Taborda Barata
- Serviço de Imunoalergologia, Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - C Carvalhal
- Serviço de Imunoalergologia, Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - N Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - C Sofia Pinto
- Serviço de Pneumologia, Hospital São Pedro de Vila Real, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Rodrigues Alves
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - A S Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | | | - R Fernandes
- Serviço de Pediatria, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - R Ferreira
- Serviço de Pediatria, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - C Alves
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - R Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | | | - D Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - M J Calix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - A Marques
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - C Nunes
- Imunoalergologia, Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - F Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - R Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - J Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
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Gonçalves N, Domingues L, Mashayekhi Sardoo A, Radu L, Rodrigues-Manica S, Neto A, Torres R, Marona J, Branco J, Mendes C, Matias R, Pimentel Dos Santos F. AB0688 GAIT PATTERN DIFFERENCES BETWEEN PATIENTS WITH RADIOGRAPHIC AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS, THE MyoSpA STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5632] [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: 11/04/2022]
Abstract
Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory disease classified as radiographic (r-axSpA) or non-radiographic (nr-axSpA). Defining the gait patterns associated with these two groups can improve its detection and promote early intervention. In normal walking, body segments move around the joints as struts of an inverted pendulum. The resultant cyclic rotations contribute to the forward translation of the body, while minimizing muscle work and maintaining stability. Recent literature describes a decline in this pendulum-like mechanism associated with aging and some neurological diseases (Parkinson and multiple sclerosis).Objectives:The aim was to compare the 3D gait kinematics of patients with r-axSpA and nr-axSpA.Methods:A cross-sectional study was conducted on 54 participants (18-50 years old), 27 patients with axSpA (according to ASAS criteria, with less than 10 years since symptoms onset) and 27 healthy controls, matched by gender, age and level of physical activity. A sub-analysis was performed involving the whole group of patients classified as r-axSpA (n=14) and nr-axSpA (n=6). Subjects movement was reconstructed using a 3D full-body kinematic model (Kinetikos, Coimbra, Portugal) fed by 15 inertial sensors placed in the head, arms, trunk, pelvis, thighs, shanks and feet. 3D gait kinematics was characterised based on variables that analyse the body movement as a whole (e.g. center of mass displacement, speed), conventional spatiotemporal parameters (e.g. stance/swing time, step length) and joints kinematics time-normalized to 101 points, comprising the gait cycle from 0 to 100%. Nonparametric statistical tests were used.Results:In the r-axSpA group, 71,4% were male, with a mean age of 34.43±7.84 years and a BASDAI of 2.84±2.39, whereas in the nr-axSpA, 50% were male, with a mean age of 41.83±6.27 years and a BASDAI of 2.99±0.58. A statistically significant difference was observed in the displacement of the center of mass (with respect to the pelvis local coordinate system) along the anteroposterior axis between the two studied groups (H = 4.96, p = 0.03), with a mean rank displacement of 8.6 for r-axSpA and 15.00 for nr-axSpa, corresponding to a reduction in displacement of 38% (mean 0.00986 vs 0.01579m), in the r-axSpa group.Conclusion:Our preliminary results in r-axSpA subjects show a reduction of the pendulum mechanism. Although no significant segmental (kinematics) changes were observed, the sum of all studied variables result in a clear different gait pattern between the two groups. The observed decline can be an early sign of the inefficiency of the r-axSpA group to minimise the cost of transport of the center of mass during walking (i.e. increased instability). This study shows the potential of gait analysis to identify subjects who may benefit from early physiotherapy intervention.Disclosure of Interests:Nuno Gonçalves: None declared, Lúcia Domingues: None declared, Atlas Mashayekhi Sardoo: None declared, Lucian Radu: None declared, Santiago Rodrigues-Manica Speakers bureau: Jansse, MSD, Novartis, Agna Neto: None declared, Rita Torres: None declared, José Marona: None declared, Jaime Branco Speakers bureau: Vitoria, César Mendes: None declared, Ricardo Matias: None declared, Fernando Pimentel dos Santos Speakers bureau: Novartis, Pfizer, Biogen, Vitoria,
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Rodrigues-Manica S, Sepriano A, Pimentel Dos Santos F, Gouveia N, Barcelos A, Branco J, Bernardes M, Ferreira R, Vieira-Sousa E, Barreira SC, Vinagre F, Roque R, Santos H, Madeira N, Rovisco J, Daniel A, Ramiro S. FRI0293 EFFECTIVENESS OF SWITCHING BETWEEN TNF INHIBITORS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: IS THE REASON TO SWITCH RELEVANT? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.539] [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:It has been common practice to start a second TNF inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) who discontinue their first TNFi. It remains unclear if the reason for discontinuation of the first TNFi influences the response to the second.Objectives:To assess if the reason of discontinuation of the first TNFi influences the response to the second TNFi.Methods:Patients with axSpA from the ReumaPt registry, who discontinued their first TNFi and started a second TNFi and who had complete data on Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at baseline, 3 and 6 months for their first TNFi were included. Then, they were followed every 6 months up to 12 years. The main outcome was the ASDAS clinically important improvement (ASDAS CII). Secondary outcomes were ASDAS major important improvement (ASDAS MI); ASDAS low disease activity (ASDAS LDA); ASDAS inactive disease (ASDAS ID) and BASDAI 50. The reason for discontinuation of the first TNFi was defined as: i) Primary failure, ASDAS CII was not achieved at 3 or 6 months; ii) Secondary failure, ASDAS CII achieved at 3 or 6 months but lost in ≥1 follow-up visit; iii) Adverse events; iv) Other (e.g. pregnancy, surgery). The response to the first TNFi at 3 and 6 months was compared to the response to the second TNFi at the same visits, adjusting for age, gender and C-reactive protein (CRP). The association between the reason of discontinuation of the first TNFi and response the second TNFi over time was tested in generalized estimating equations (GEE) models, adjusted for age, gender and CRP.Results:In total, 193 patients (53% male, mean age 45 (SD:11) years) were included, with a median follow-up time on the second TNFi of 1.5 years. Patients had a lower response to the second TNFi compared to the first TNFi according to the main outcome (ASDAS CII) at 3 months (41% vs 51%) and 6 months (35% vs 56%). There was an association between the reason to discontinue the first TNFi and response to the second TNFi as defined by the most stringent outcomes (ASDAS MI and ASDAS ID), but not for ASDAS CII (Table). Compared to patients who discontinued their first TNFi due to primary failure, patients were more likely to achieve ASDAS ID with the second TNFi when they discontinued their first TNFi due to secondary failure (OR: 7.3 [(95%CI: 1.9; 27.7]), adverse events (OR: 9.1 [2.5; 33.3]), or other reasons (OR: 7.7 [1.6; 37.9]).Conclusion:In axSpA, response to the second TNFi is worse compared to the first TNFi. Patients with a secondary failure to the first TNFi have a better response to the second TNFi compared to those discontinuing the first TNFi due to primary failure, particularly for most stringent outcomes.Table.Association between the reason for discontinuation of the first TNFi and response to the second TNFiReason to discontinue first TNFi*Outcome for the second TNFiOR (95% CI)ASDAS-CII (N=135)ASDAS-MII (N=135)ASDAS-LDA (N=166)ASDAS-ID (N=166)BASDAI50 (N=147)(ref Primary failure) -Secondary failure1.9 (0.7;4.8)4.8 (1.3;18.2)1.2 (0.6;2.4)7.3 (1.9;27.7)1.4 (0.6;3.0) -Adverse events1.5 (0.6;3.5)2.4 (0.6;9.6)0.9 (0.5;1.7)9.1 (2.5;33.3)1.1 (0.5;2.3) -Other1.0 (0.3;3.8)1.7 (0.1;19.4)1.0 (0.4;2.4)7.7 (1.6;37.9)0.5 (0.1;1.7)*GEE models with the reason of discontinuation of the first TNFi as predictor (reference category: primary failure); all models adjusted for age, gender and C-reactive protein. OR in bold are statistically significant (p<0.05).Disclosure of Interests:Santiago Rodrigues-Manica Speakers bureau: Jansse, MSD, Novartis, Alexandre Sepriano: None declared, Fernando Pimentel dos Santos Speakers bureau: Novartis, Pfizer, Biogen, Vitoria,, Nélia Gouveia: None declared, Anabela Barcelos Speakers bureau: Bene, Eli-Lilly, Pfizer, MSD, Novartis, Jaime Branco Speakers bureau: Vitoria, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Raquel Ferreira: None declared, Elsa Vieira-Sousa: None declared, Sofia C Barreira: None declared, Filipe Vinagre: None declared, Raquel Roque: None declared, Helena Santos Speakers bureau: AbbVie, Eli-Lilly, Janssen, Pfizer, Novartis, Nathalie Madeira: None declared, João Rovisco: None declared, Alexandra Daniel: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis
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Mashayekhi Sardoo A, Leo P, Santos M, Costa T, Almeida SF, Maia S, Benes V, Brown M, Branco J, Pimentel Dos Santos F. AB0015 IDENTIFICATION OF KEY GENES TO SUPPORT SYSTEMIC LUPUS ERYTHEMATOSUS, RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS DIAGNOSIS BY TRANSCRIPTOMIC APPROACH. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5456] [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: 11/04/2022]
Abstract
Background:Early diagnosis of inflammatory rheumatic diseases (IRD), as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA) and axial Spondyloarthritis (axSpA) represents in our days a major clinical challenge. Increasing evidence has determined that early diagnosis, prompt treatment initiation and early achievement of remission are the best predictors of long-term clinical, functional and radiographic outcomes. Therefore, identification of sensitive biomarkers to support an early diagnosis to enable early therapy is of utmost importance [1,2].Objectives:This study aims to identify novel genes that may improve the current clinical diagnosis approach for early SLE, RA and axSpA.Methods:A cross-sectional study was conducted on 44 participants, 12 with axSpA (according to ASAS criteria), 11 with RA (according to ACR/EULAR criteria for RA), 10 with SLE (according to ACR classification criteria for SLE) and 11 Healthy Controls (HC), gender and age matched. Patients with co-occurrence of other IRD or having received biological therapies were excluded. Peripheral blood samples were collected into PAXgene tubes and stored in -80°C. mRNA profiling by RNA-seq was performed. Unpaired t-tests with multivariate permutation correction were applied to identify differentially expressed genes (DEGs) between patients and HC for each disease and within diseases. Enrichment analysis, Gene ontology (GO) and Kyoto Enrichment of Genes and Genomes (KEGG) analysis were also performed. DEGs that allow to distinguish each disease from HC and between diseases. The top DEGs (axSpA n=2, RA n=2, SLE n=3) identified were confirmed by quantitative RT-PCR.Results:For axSpA, genes involved in negative regulation of cytokines by JAK/STAT pathway and in osteoblast differentiation through STAT3 pathway, were confirmed. In SLE, genes involved in trap for immune complexes in peripheral blood and involved in nucleosome regulation, were also confirmed. Regarding RA, no genes were confirmed.Conclusion:Our work provides new insights into IRD pathogenesis, and discloses new biomarkers, which may be useful as either predictive biomarkers for diagnosis or therapeutic targets to improve IRD approach.Further validation are needed in different cohorts.References:[1]Monti, S. et al. (2015) ‘Rheumatoid arthritis treatment: The earlier the better to prevent joint damage’, RMD Open, 1(Suppl 1), pp. 1–5. doi: 10.1136/rmdopen-2015-000057.[2]Oglesby, A. et al. (2014) ‘Impact of early versus late systemic lupus erythematosus diagnosis on clinical and economic outcomes.’, Applied health economics and health policy, 12(2), pp. 179–90. doi: 10.1007/s40258-014-0085-x.Acknowledgments:To all patients and healthy controls who participated in the studyDisclosure of Interests:Atlas Mashayekhi Sardoo: None declared, Paul Leo: None declared, Mariana Santos: None declared, Tiago Costa: None declared, Sergio Fernandes Almeida: None declared, Sara Maia: None declared, Vladimir Benes: None declared, Mattew Brown Speakers bureau: MSD, Pfizer, Novartis, Jaime Branco Speakers bureau: Vitoria, Fernando Pimentel dos Santos Speakers bureau: Novartis, Pfizer, Biogen, Vitoria,
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Mashayekhi Sardoo A, Sobral D, Domingues L, Rodrigues-Manica S, Pinheiro Torres R, Neto A, Alves P, Costa J, Grosso AR, Branco J, Pimentel Dos Santos F. THU0021 IDENTIFICATION OF MUSCLE ASSOCIATED KEY GENES TO SUPPORT AXIAL SPONDYLOARTHRITIS DIAGNOSIS BY TRANSCRIPTOMIC APPROACH, THE MYOSPA STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5331] [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: 11/04/2022]
Abstract
Background:Early diagnosis of axial Spondyloarthritis (axSpA) represents a major clinical challenge nowadays. Increasing evidence has determined that early diagnosis, prompt treatment initiation and early achievement of remission are the best predictors of long-term clinical, functional and radiographic outcomes. New tools to support the diagnosis are needed.Objectives:This study aims to identify differentially expressed genes that may improve the current clinical diagnosis approach for early axSpA.Methods:A cross-sectional study was conducted on 50 participants, 25 patients with axSpA (according to ASAS criteria) and 25 Healthy Controls, matched by gender, age and levels of physical activity. Peripheral blood samples were collected and RNA-Seq technology was performed. Normalization of raw data, and identification of differentially expressed genes was obtained using edgeR and limma-voom R packages. Gene Set Enrichment Analysis (GSEA) and Functional Enrichment analysis using Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) annotations were also performed. A number of Differently Expressed Genes were highlighted.Results:311 genes were identified as being significantly differentially expressed between patients and controls. In details, 129 downregulated (7 genes have fold change more than 1) and 182 upregulated genes (3 genes have fold change more than 1) are highlighted. These genes are mostly involved in Myogenesis, Innate Immune Signalling and JAK/STAT pathways. Several genes with functions of skeletal muscle development and muscle contraction were identified.Conclusion:The evidence disclosed that regulation of muscle development and contraction may be also engaged in physiopathology mechanisms of axSpA. These new cues open new perspectives for diagnosis and therapeutic approaches in axSpA.Acknowledgments:To all patients and healthy people who participate in MyoSpA studyDisclosure of Interests:Atlas Mashayekhi Sardoo: None declared, Daniel Sobral: None declared, Lucia Domingues: None declared, Santiago Rodrigues-Manica Speakers bureau: Jansse, MSD, Novartis, Rita Pinheiro Torres: None declared, Agna Neto: None declared, Patricia Alves: None declared, Julia Costa: None declared, Ana Rita Grosso: None declared, Jaime Branco Speakers bureau: Vitoria, Fernando Pimentel dos Santos Speakers bureau: Novartis, Pfizer, Biogen, Vitoria,
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Fuggle NR, Cooper C, Oreffo ROC, Price AJ, Kaux JF, Maheu E, Cutolo M, Honvo G, Conaghan PG, Berenbaum F, Branco J, Brandi ML, Cortet B, Veronese N, Kurth AA, Matijevic R, Roth R, Pelletier JP, Martel-Pelletier J, Vlaskovska M, Thomas T, Lems WF, Al-Daghri N, Bruyère O, Rizzoli R, Kanis JA, Reginster JY. Alternative and complementary therapies in osteoarthritis and cartilage repair. Aging Clin Exp Res 2020; 32:547-560. [PMID: 32170710 PMCID: PMC7170824 DOI: 10.1007/s40520-020-01515-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/14/2020] [Indexed: 12/28/2022]
Abstract
Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.
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Affiliation(s)
- N R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| | - R O C Oreffo
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J F Kaux
- Department of Physical and Rehabilitation Medicine & Sports Traumatology, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University Hospital and University of Liège, Liege, Belgium
| | - E Maheu
- Rheumatology Department, AP-HP, Saint-Antoine Hospital, 4 Blvd. Beaumarchais, Paris, France
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - G Honvo
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - F Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Saint-Antoine Hospital, Paris, France
| | - J Branco
- Centro Hospitalar de Lisboa Ocidental- Hospital Egas Moniz, Lisbon, Portugal
- CEDOC / NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - M L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - B Cortet
- Department of Rheumatology and EA 4490, Lille University Hospital, Lille, France
| | - N Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - A A Kurth
- Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Ratingen, Germany
| | - R Matijevic
- Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - R Roth
- Institute of Outdoor Sports and Environmental Science, German Sport University, Cologne, Germany
| | - J P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - M Vlaskovska
- Medical Faculty, Department of Pharmacology, Medical University Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria
| | - T Thomas
- Department of Rheumatology, Hôpital Nord, CHU de Saint-Etienne, Saint-Étienne, France
- INSERM U1059, Université de Lyon, Saint-Étienne, France
| | - W F Lems
- Location VU Medical Center, Department of Rheumatology and Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - N Al-Daghri
- Chair for Biomarkers Research, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - J Y Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
- Chair for Biomarkers Research, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liege, Belgium
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Branco J, Santos J, Silva J, Felizardo M, Calvinho P, Furtado S. P21 Outcomes of Lung Cancer Surgical Patients in a District Hospital. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.060] [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: 11/28/2022]
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Reis C, Rodrigues A, Dias S, Sousa R, Branco J, Canhão H, Paiva T. Lifestyles associated to sleep duration. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.460] [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: 10/28/2022] Open
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Branco J, Pinheiro J. S100β protein as a predictor of post-stroke functional outcome: A prospective study. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.064] [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: 11/25/2022]
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Schramm U, Bussmann M, Irman A, Siebold M, Zeil K, Albach D, Bernert C, Bock S, Brack F, Branco J, Couperus JP, Cowan TE, Debus A, Eisenmann C, Garten M, Gebhardt R, Grams S, Helbig U, Huebl A, Kluge T, Köhler A, Krämer JM, Kraft S, Kroll F, Kuntzsch M, Lehnert U, Loeser M, Metzkes J, Michel P, Obst L, Pausch R, Rehwald M, Sauerbrey R, Schlenvoigt HP, Steiniger K, Zarini O. First results with the novel petawatt laser acceleration facility in Dresden. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/874/1/012028] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Branco J, Ola M, Silva RM, Fonseca E, Gomes NC, Martins-Cruz C, Silva AP, Silva-Dias A, Pina-Vaz C, Erraught C, Brennan L, Rodrigues AG, Butler G, Miranda IM. Impact of ERG3 mutations and expression of ergosterol genes controlled by UPC2 and NDT80 in Candida parapsilosis azole resistance. Clin Microbiol Infect 2017; 23:575.e1-575.e8. [PMID: 28196695 DOI: 10.1016/j.cmi.2017.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Candida parapsilosis is a healthcare-related fungal pathogen particularly common among immunocompromised patients. Our understanding of antifungal resistance mechanisms in C. parapsilosis remains very limited. We previously described an azole-resistant strain of C. parapsilosis (BC014RPSC), obtained following exposure in vitro to posaconazole. Resistance was associated with overexpression of ergosterol biosynthetic genes (ERG genes), together with the transcription factors UPC2 (CPAR2-207280) and NDT80 (CPAR2-213640). The aim of this study was to identify the mechanisms underlying posaconazole resistance of the BC014RPSC strain. METHODS To identify the causative mutation, we sequenced the genomes of the susceptible (BC014S) and resistant (BC014RPSC) isolates, using Illumina technology. Ergosterol content was assessed in both strains by mass spectrometry. UPC2 and NDT80 genes were deleted in BC014RPSC strain. Mutants were characterized regarding their azole susceptibility profile and ERG gene expression. RESULTS One homozygous missense mutation (R135I) was found in ERG3 (CPAR2-105550) in the azole-resistant isolate. We show that Erg3 activity is completely impaired, resulting in a build up of sterol intermediates and a failure to generate ergosterol. Deleting UPC2 and NDT80 in BC014RPSC reduces the expression of ERG genes and restores susceptibility to azole drugs. CONCLUSIONS A missense mutation in the ERG3 gene results in azole resistance and up-regulation of ERG genes expression. We propose that this mutation prevents the formation of toxic intermediates when cells are treated with azoles. Resistance can be reversed by deleting Upc2 and Ndt80 transcription factors. UPC2 plays a stronger role in C. parapsilosis azole resistance than does NDT80.
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Affiliation(s)
- J Branco
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Ola
- UCD School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin, Ireland
| | - R M Silva
- Department of Medical Sciences, iBiMED & IEETA, University of Aveiro, Aveiro, Portugal
| | - E Fonseca
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - N C Gomes
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - C Martins-Cruz
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A P Silva
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Silva-Dias
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - C Pina-Vaz
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - C Erraught
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - L Brennan
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - A G Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - G Butler
- UCD School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin, Ireland
| | - I M Miranda
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
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Harvey NC, Biver E, Kaufman JM, Bauer J, Branco J, Brandi ML, Bruyère O, Coxam V, Cruz-Jentoft A, Czerwinski E, Dimai H, Fardellone P, Landi F, Reginster JY, Dawson-Hughes B, Kanis JA, Rizzoli R, Cooper C. The role of calcium supplementation in healthy musculoskeletal ageing : An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF). Osteoporos Int 2017; 28:447-462. [PMID: 27761590 PMCID: PMC5274536 DOI: 10.1007/s00198-016-3773-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/11/2016] [Indexed: 12/27/2022]
Abstract
The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.
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Affiliation(s)
- N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Biver
- Service of Bone Diseases, University Hospitals Geneva, Geneva, Switzerland
| | - J-M Kaufman
- Department of Internal Medicine, section Endocrinology, Ghent University, Ghent, Belgium
| | - J Bauer
- Department of Geriatric Medicine, Klinikum, Carl von Ossietzky University, Ammerländer Heerstrasse 114-118, 26129, Oldenburg, Germany
| | - J Branco
- CEDOC - NOVA Medical School, UNL and Rheumatology Department, CHLO/Hospital Egas Moniz, Lisbon, Portugal
| | - M L Brandi
- Head, Bone and Mineral Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - V Coxam
- INRA, UMR 1019, UNH, CRNH Auvergne, F-63000, Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000, Clermont-Ferrand, France
| | - A Cruz-Jentoft
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis), Madrid, Spain
| | - E Czerwinski
- Department of Bone and Joint Diseases, Faculty of Health Sciences, Krakow Medical Centre, Jagiellonian University, Krakow, Poland
| | - H Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - P Fardellone
- CHU Amiens, Université Picardie - Jules Verne, INSERM U 1088, Amiens, France
| | - F Landi
- Geriatric Department, Catholic University of Sacred Heart, Milan, Italy
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
| | - R Rizzoli
- Service of Bone Diseases, University Hospitals Geneva, Geneva, Switzerland
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK.
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Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, Choy E, Kosek E, Amris K, Branco J, Dincer F, Leino-Arjas P, Longley K, McCarthy GM, Makri S, Perrot S, Sarzi-Puttini P, Taylor A, Jones GT. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2016; 76:318-328. [PMID: 27377815 DOI: 10.1136/annrheumdis-2016-209724] [Citation(s) in RCA: 678] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'. METHODS A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations. RESULTS 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability). CONCLUSIONS These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.
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Affiliation(s)
- G J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - C Kronisch
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Department of Rheumatology, Cantonal Hospital, Fribourg, Switzerland
| | - L E Dean
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - F Atzeni
- ICRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - W Häuser
- Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.,Department of Psychosomatic Medicine, Technische Universität München, München, Germany
| | - E Fluß
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - E Choy
- Section of Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - E Kosek
- Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Centre, Stockholm, Sweden
| | - K Amris
- Department of Rheumatology, Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Branco
- Rheumatology Department, CEDOC-NOVA Medical School, UNL, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | - F Dincer
- Hacettepe University Division of Internal Medicine, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
| | - P Leino-Arjas
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - G M McCarthy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Makri
- Patient Representative, Limassol, Cyprus
| | - S Perrot
- Centre de la Douleur, Hôpital Cochin-Hôtel Dieu, Université Paris Descartes, Paris, France
| | - P Sarzi-Puttini
- Rheumatology Unit, L. Sacco University Hospital, Milan, Italy
| | - A Taylor
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - G T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Sepriano A, Ramiro S, van der Heijde D, Άvila-Ribeiro P, Fonseca R, Borges J, Teixeira L, Carvalho P, Cerqueira M, Neves J, Meirinhos T, Barcelos A, Sequeira G, Salvador M, Canas da Silva J, Santos H, Bernardes M, Vieira-Sousa E, Canhão H, Branco J, Pimentel-Santos F, Landewé R. OP0112 Effect of Comedication with Conventional Synthetic Dmards on Tnf Inhibitors-Retention in Patients with Spondyloarthritis: A Prospective Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1654] [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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18
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Ljuhar R, Norman B, Ljuhar D, Haftner T, Hladuvka J, Bui Thi Mai M, Canhão H, Branco J, Rodrigues A, Gouveia N, Nehrer S, Fahrleitner-Pammer A, Dimai HP. FRI0545 A Novel Feature Selection Algorithm Based on Bone Micro Architecture Analysis To Identify Osteoarthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2853] [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: 11/04/2022]
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Ljuhar R, Nehrer S, Norman B, Ljuhar D, Haftner T, Hladuvka J, Bui Thi Mai M, Canhão H, Branco J, Rodrigues AM, Gouveia N, Fahrleitner-Pammer A, Dimai HP. SAT0557 A Clinical Study To Examine Thresholds of Joint Space Width and Joint Space Area for Identification of Knee Osteoarthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3568] [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: 11/03/2022]
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Ferreira J, Ferrer C, Cândido S, Moreira S, Jorge A, Carvalho M, Branco J, Glória F, Oliveira C. CP-186 Can the antiretroviral therapy effectiveness be connected with treatment simplification? Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.186] [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] Open
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Camacho A, Simão M, Ea HK, Cohen-Solal M, Richette P, Branco J, Cancela ML. Iron overload in a murine model of hereditary hemochromatosis is associated with accelerated progression of osteoarthritis under mechanical stress. Osteoarthritis Cartilage 2016; 24:494-502. [PMID: 26403062 DOI: 10.1016/j.joca.2015.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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] [Received: 06/08/2015] [Revised: 08/21/2015] [Accepted: 09/11/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hereditary hemochromatosis (HH) is a disease caused by mutations in the Hfe gene characterised by systemic iron overload and associated with an increased prevalence of osteoarthritis (OA) but the role of iron overload in the development of OA is still undefined. To further understand the molecular mechanisms involved we have used a murine model of HH and studied the progression of experimental OA under mechanical stress. DESIGN OA was surgically induced in the knee joints of 10-week-old C57BL6 (wild-type) mice and Hfe-KO mice. OA progression was assessed using histology, micro CT, gene expression and immunohistochemistry at 8 weeks after surgery. RESULTS Hfe-KO mice showed a systemic iron overload and an increased iron accumulation in the knee synovial membrane following surgery. The histological OA score was significantly higher in the Hfe-KO mice at 8 weeks after surgery. Micro CT study of the proximal tibia revealed increased subchondral bone volume and increased trabecular thickness. Gene expression and immunohistochemical analysis showed a significant increase in the expression of matrix metallopeptidase 3 (MMP-3) in the joints of Hfe-KO mice compared with control mice at 8 weeks after surgery. CONCLUSIONS HH was associated with an accelerated development of OA in mice. Our findings suggest that synovial iron overload has a definite role in the progression of HH-related OA.
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Affiliation(s)
- A Camacho
- Department of Orthopedics, Centro Hospitalar Lisboa Central, Lisboa, Portugal; PhD Program in Medicine, NOVA Medical School, University Nova de Lisboa, Lisbon, Portugal; Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal.
| | - M Simão
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal; PhD Program in Biomedical Sciences, University of Algarve, Faro, Portugal
| | - H-K Ea
- Inserm 1132, Hôpital Lariboisière, Paris, France; Université Paris Diderot, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France
| | - M Cohen-Solal
- Inserm 1132, Hôpital Lariboisière, Paris, France; Université Paris Diderot, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France
| | - P Richette
- Inserm 1132, Hôpital Lariboisière, Paris, France; Université Paris Diderot, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France
| | - J Branco
- Department of Rheumatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal; CEDOC - Chronic Diseases Research Center, NOVA Medical School, University Nova de Lisboa, Lisbon, Portugal
| | - M L Cancela
- Department of Biomedical Sciences and Medicine (DCBM), University of Algarve, Faro, Portugal; Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal
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22
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Moreira S, Jorge A, Oliveira C, Glória F, Ferreira J, Branco J, Carvalho M, Cândido S, Ferrer C. PP-035 The outcome of microbiological monitoring in cytotoxic drug preparation. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.474] [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] Open
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Reginster JY, Reiter-Niesert S, Bruyère O, Berenbaum F, Brandi ML, Branco J, Devogelaer JP, Herrero-Beaumont G, Kanis J, Maggi S, Maheu E, Richette P, Rizzoli R, Cooper C. Recommendations for an update of the 2010 European regulatory guideline on clinical investigation of medicinal products used in the treatment of osteoarthritis and reflections about related clinically relevant outcomes: expert consensus statement. Osteoarthritis Cartilage 2015; 23:2086-2093. [PMID: 26187570 DOI: 10.1016/j.joca.2015.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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] [Received: 01/05/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The European Society on Clinical and Economic aspects of Osteoporosis and Osteoarthritis (ESCEO) organised a working group to evaluate the need for updating the current European guideline on clinical investigation of drugs used in the treatment of osteoarthritis (OA). DESIGN Areas of potential attention were identified and the need for modifications, update or clarification was examined. Proposals were then developed based on literature reviews and through a consensus process. RESULTS It was agreed that the current guideline overall still reflects the current knowledge in OA, although two possible modifications were identified. The first relates to the number and timing of measurements required as primary endpoints during clinical trials of symptom-relieving drugs, either drugs with rapid onset of action or slow acting drugs. The suggested modifications are intended to take into consideration the time related clinical need and expected time response to these drugs - i.e., a more early effect for the first category in addition to the maintenance of effect, a more continuous benefit over the long-term for the latter - in the timing of assessments. Secondly, values above which a benefit over placebo should be considered clinically relevant were considered. Based on literature reviews, the most consensual values were determined for primary endpoints of both symptom-relieving drugs (i.e., pain intensity on a visual analogue scale (VAS)) and disease-modifying drugs (i.e., radiographic joint-space narrowing). CONCLUSIONS This working document might be considered by the European regulatory authorities in a future update of the guideline for the registration of drugs in OA.
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Affiliation(s)
- J-Y Reginster
- Department of Public Health Sciences, University of Liège and CHU Centre Ville, Liège, Belgium.
| | - S Reiter-Niesert
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - O Bruyère
- Department of Public Health Sciences, University of Liège and CHU Centre Ville, Liège, Belgium
| | - F Berenbaum
- Department of Rheumatology, University Pierre and Marie Curie AP-HP, Hôpital Saint-Antoine, Paris, France; University of Paris06, INSERM, UMR-S938, Paris, France
| | - M-L Brandi
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - J Branco
- CEDOC - Department of Rheumatology, Faculdade de Ciências Médicas, Universidade Novade Lisboa, Lisbon, Portugal; CHLO, EPE-Hospital Egas Moniz, Lisbon, Portugal
| | - J-P Devogelaer
- Department of Rheumatology, Saint-Luc University Hospital, Catholic University, Louvain, Belgium
| | | | - J Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - S Maggi
- Aging Program, National Research Council, Padova, Italy
| | - E Maheu
- Rheumatology Department, AP-HP, St-Antoine Hospital, Paris, France
| | - P Richette
- Paris Diderot University, UFR médicale, Paris, France; AP-HP, Hôpital Lariboisière, fédération de Rhumatologie, Paris, France
| | - R Rizzoli
- Service of Bone Diseases, Department of Rehabilitation and Geriatrics, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - C Cooper
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK
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Migliore A, Scirè C, Carmona L, Bizzi E, Damjanov N, Ionescu R, Rashkov R, Bablic-Nagic D, Collaku L, Denisov L, Barskova T, Martusevitch N, Diracoglu D, Herrero Beaumont G, Chevalier X, Maheu E, Branco J, Ramonda R, Scarpellini M, Bagnato G, Matucci Cerinic M. AB0834 A Proposal of Definition of Early Symptomatic Knee Osteoarthritis (Eskoa). Results from an International Consensus Promoted by the Italian Society of Rheumatology (Sir). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4663] [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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Laires P, Canhão H, Gouveia M, Rodrigues A, Gouveia N, Branco J. AB1155 Self-Reported Rheumatic Diseases and Early Retirement in Portugal – Results from the Portuguese Epidemiology Study on Rheumatic Diseases (Epireumapt). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4091] [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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Branco J, Rodrigues A, Gouveia N, Pereira L, Eusébio M, Ramiro S, Machado P, Mourão A, Silva I, Laires P, Sepriano A, Araújo F, Gonçalves S, Coelho P, Tavares V, Cerol J, Mendes J, Carmona L, Canhão H. OP0052 Prevalence and Physical and Mental Health Patterns of Rheumatic and Musculoskeletal Diseases in Portugal: Results from Epireumapt, A National Health Survey. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3854] [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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Laires P, Canhão H, Gouveia M, Rodrigues A, Gouveia N, Branco J. FRI0363 Osteoarthritis and Early Exit from Work – Results from the Portuguese Epidemiology Study on Rheumatic Diseases (Epireumapt). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6020] [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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Kanis JA, McCloskey E, Branco J, Brandi ML, Dennison E, Devogelaer JP, Ferrari S, Kaufman JM, Papapoulos S, Reginster JY, Rizzoli R. Goal-directed treatment of osteoporosis in Europe. Osteoporos Int 2014; 25:2533-43. [PMID: 25199574 DOI: 10.1007/s00198-014-2787-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/19/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED Despite the proven predictive ability of bone mineral density, Fracture Risk Assessment Tool (FRAX®), bone turnover markers, and fracture for osteoporotic fracture, their use as targets for treatment of osteoporosis is limited. INTRODUCTION Treat-to-target is a strategy applied in several fields of medicine and has recently become an area of interest in the management of osteoporosis. Its role in this setting remains controversial. This article was prepared following a European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group meeting convened under the auspices of the International Osteoporosis Foundation (IOF) to discuss the feasibility of applying such a strategy in osteoporosis in Europe. METHODS Potential targets range from the absence of an incident fracture to fixed levels of bone mineral density (BMD), a desired FRAX® score, a specified level of bone turnover markers or indeed changes in any one or a combination of these parameters. RESULTS Despite the proven predictive ability of all of these variables for fracture (particularly BMD and FRAX), their use as targets remains limited due to low sensitivity, the influence of confounders and current lack of evidence that targets can be consistently reached. CONCLUSION ESCEO considers that it is not currently feasible to apply a treat-to-target strategy in osteoporosis, though it did identify a need to continue to improve the targeting of treatment to those at higher risk (target-to-treat strategy) and a number of issues for the research agenda. These include international consensus on intervention thresholds and definition of treatment failure, further exploration of the relationship between fracture and BMD, and FRAX and treatment efficacy and investigation of the potential of short-term targets to improve adherence.
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Affiliation(s)
- J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK,
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Rizzoli R, Branco J, Brandi ML, Boonen S, Bruyère O, Cacoub P, Cooper C, Diez-Perez A, Duder J, Fielding RA, Harvey NC, Hiligsmann M, Kanis JA, Petermans J, Ringe JD, Tsouderos Y, Weinman J, Reginster JY. Management of osteoporosis of the oldest old. Osteoporos Int 2014; 25:2507-29. [PMID: 25023900 DOI: 10.1007/s00198-014-2755-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/16/2014] [Indexed: 12/25/2022]
Abstract
UNLABELLED This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement. INTRODUCTION This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80 years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent. METHODS This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12 months. RESULTS The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed. CONCLUSION These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness.
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Affiliation(s)
- R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland,
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Sepriano A, Araujo F, Aguiar R, Vieira R, Sousa E, Pimentel-Santos F, Sequeira G, Canhão H, Santos H, Garcia J, Pereira Silva J, Canas Silva J, Miranda L, Oliveira M, Salvador M, Bernardes M, Monteiro P, Nόvoa T, Branco J. AB0653 Retention Rate and Predictive Factors of Tnf-α Inhibitor Discontinuation in Patients with Ankylosing Spondylitis - Results from the Rheumatic Diseases Portuguese Register Reuma.Pt. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3916] [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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Falcao S, Castillo-Gallego C, Peiteado D, Branco J, Martín Mola E, de Miguel E. SAT0212 Can We Use Enthesis Ultrasound as an Outcome Measure of Disease Activity in Spondyloarthritis? A Study at Achilles Level. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2674] [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: 11/04/2022]
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Araújo F, Sepriano A, Madureira P, Aguiar R, Bernardo A, Silva C, Sousa E, Santos F, Sequeira G, Canhão H, Santos H, Garcia J, Pereira Silva J, Canas Silva J, Oliveira M, Salvador M, Nero P, Monteiro P, Nόvoa T, Branco J. AB0660 Predictive Factors of Treatment Response to A Second Tnf-α Inhibitor in Patients with Ankylosing Spondylitis - Results from the Portuguese Register Reuma.Pt. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5590] [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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Romao V, Santos M, Polido-Pereira J, Duarte C, Nero P, Miguel C, Costa J, Pimentel-Santos F, Barcelos F, Costa L, Melo Gomes J, Pereira da Silva J, Branco J, Canas da Silva J, Da Silva J, Fonseca J, Canhao H. OP0031 Tocilizumab is Associated with Higher CDai/Sdai Remission in Biologic-Naïve Rheumatoid Arthritis Patients – Data from Reuma.Pt: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2668] [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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Romao V, Santos M, Polido-Pereira J, Duarte C, Nero P, Miguel C, Costa J, Pimentel-Santos F, Barcelos F, Costa L, Melo Gomes J, Pereira da Silva J, Branco J, Canas da Silva J, Da Silva J, Fonseca J, Canhao H. AB0451 Changes in DAS28, CDAI and SDAI are Associated with Biologic Class, Gender, Previous Biologic Therapy and ACPA/RF Status – Results from Reuma.PT. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3414] [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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Carrasqueira A, Pimentel-Santos F, Gomes da Silva M, Branco J. FRI0562-HPR Effectiveness of the Introduction of Proprioceptive Training in the Exercise Programs for Knee Osteoarthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5083] [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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Inês L, Silva C, Galindo M, Lopez-Longo F, Terroso G, Romão V, Rúa-Figueroa I, Santos M, Pego-Reigosa J, Nero P, Cerqueira M, Duarte C, Miranda L, Almaraz E, Bernardes M, Gonçalves M, Raposo A, Mouriño-Rodriguez C, Araújo F, Barcelos A, Sequeira G, Nόvoa T, Couto M, Abreu P, Otόn-Sanchez T, Macieira C, Ramos F, Branco J, Da Silva J, Canhão H, Canhão H. THU0011 The SLICC 2012 Classification Criteria Have Higher Sensitivity for SLE than the ACR 1997 Criteria: A Study of 2055 Patients from A Real-Life, Multicenter, International SLE Cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2506] [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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37
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Ramiro S, Machado P, Roque R, Santos H, Polido-Pereira J, Peixoto D, Duarte C, Pimentel-Santos F, Silva C, Fonseca J, Teixeira F, Marques A, Araújo F, Branco J, da Silva J, Costa J, Pereira da Silva J, Miranda L, Canas da Silva J, Canhão H, van Tubergen A, van der Heijde D, Landewé R, Santos M. THU0283 Predictive factors of response at 12 weeks in patients with ankylosing spondylitis starting biological therapies - results from the portuguese register - REUMA.PT:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2248] [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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38
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Branco J, Mota A, Tavares V, da Silva JAP, Marques A. THU0371 A Frax Model for the Estimation of Osteoporotic Fracture Probability in Portugal. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.899] [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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39
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Reginster J, Berenbaum F, Nash P, Zamani O, Cohen-Solal M, Bianchi G, Branco J, Navarro F, Cooper C. SAT0309 Strontium Ranelate Prevents Radiological Progression in Patients with Primary Knee Osteoarthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2034] [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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40
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Teixeira F, Rovisco J, Ramiro S, Branco J, Buchbinder R. AB0631 Efficacy and safety of urine alkalinization for patients with uric acid nephrolithiasis with or without gout arthritis:. a systematic review. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2953] [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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41
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Mourão AF, Ramos F, Santos MJ, Martins F, Oliveira M, Costa J, Brito I, Figueira R, Duarte C, Salgado M, Sousa M, Furtado C, Figueiredo G, Melo Gomes J, Branco J, Eurico Fonseca J, Canhão H. SAT0448 JADAS-CRP Instead of JADAS-ESR…Results from Reuma.Pt. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2172] [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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42
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Araujo F, Cordeiro I, Ramiro S, Branco J, Buchbinder R. SAT0368 Outcomes Assessed in Trials of Gout and Accordance with Omeract Recommendations. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2093] [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: 11/04/2022]
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43
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Falcao S, de Miguel E, Mourao A, Papoila A, Branco J. SAT0414 Role of ultrasound in therapeutic decision and monitoring of response to intra-articular injection of triamcinolone hexacetonide in aseptic arthritis: A six month follow-up study:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3360] [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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44
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Cordeiro I, Araujo F, Ramiro S, Branco J, Buchbinder R. SAT0372 The Burden of Gout in Patients Included in Clinical Trials: A Systematic Review. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2097] [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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45
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Pereira D, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage 2011; 19:1270-85. [PMID: 21907813 DOI: 10.1016/j.joca.2011.08.009] [Citation(s) in RCA: 494] [Impact Index Per Article: 38.0] [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: 12/06/2010] [Revised: 07/31/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints. METHOD A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through meta-analysis and between-study heterogeneity was quantified. RESULTS Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence meta-analysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn't allow us to make any comparison according to joint site or OA definition. CONCLUSIONS Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions.
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Affiliation(s)
- D Pereira
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal
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46
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Canhão H, Lucas R, Fonseca JE, Costa L, Romeu JC, Branco J, Barros H. Factors influencing calcaneus quantitative ultrasound measurements in an urban population. Clin Exp Rheumatol 2008; 26:67-72. [PMID: 18328149] [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] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To estimate the effect of demographic, social, behavioural and anthropometric factors on quantitative ultrasound (QUS) parameters in an urban population. METHODS Cross-sectional evaluation of consecutive subjects selected as part of the EPIPorto study, Portugal. Information was obtained on demographic, social, clinical and behavioural characteristics using a standard protocol. Calcaneus QUS parameters (Broadband Ultrasound Attenuation-BUA, and Speed of Sound-SOS) were obtained for men and women, stratified by age group. Comparisons according to exposure levels were made using the Kruskal-Wallis test and the multivariate effect on QUS parameters was estimated by linear regression. RESULTS 1482 consecutive subjects (1010 females and 472 males), aged from 18 to 92 years. Higher levels of QUS parameters were found in the younger groups and progressive decrease with age were reported. Men showed higher values as compared to women in all parameters and differences between them increased with age. Differences were significant for BUA after the age of 39 and for SOS after the age of 59. In women, the multivariate model showed that age, body mass index (BMI) and smoking status were independent predictors of BUA and SOS. In men, age, BMI and calcium intake were significantly associated with BUA and SOS. CONCLUSION The reference values in our Portuguese population are similar to others obtained in Southern European countries. In the Portuguese population, QUS parameters have age, sex and BMI as its major determinants. In addition, BUA and SOS may reflect specific bone characteristics influenced by a different set of independent determinants.
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Affiliation(s)
- H Canhão
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
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47
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Santos MJ, Capela S, Figueira R, Nero P, Matos AA, Silva C, Miranda L, Barcelos A, Marques A, Teixeira A, Branco J, da Silva JC, de Queiroz MV. [Characterization of a Portuguese population with systemic lupus erytematosus]. Acta Reumatol Port 2007; 32:153-61. [PMID: 17576395] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
UNLABELLED To characterize systemic lupus erythematosus (SLE) in Portuguese patients and to identify differences in diseases expression related to sex and ethnicity. PATIENTS AND METHODS Retrospective cohort analysis of patients with SLE followed at five Rheumatology Departments between 1976 and 2006. Demographic data, diseases manifestations, medications used, co morbidity and damage scores were recorded. RESULTS Five hundred forty four patients were studied, 93% female, 89% Caucasians, with an average age at disease diagnosis of 35 years. The most frequent clinical features were musculoskeletal (91%), cutaneous and mucous membrane (90%) and the hematological involvement (58%). Renal diseases and serositis occurred more often in males while myositis was more common in black patients. Immunological features included the presence of anti-nuclear antibodies in 99% of the patients, anti-DNA (76%) anti-SSA (33%), anti-SSB (20%), anti-RNP (26%), anti-Sm (22%), anticardiolipine (31%) and lupus anticoagulant (21%). Anti-SSA, anti-RNP, and anti-Sm antibodies were significantly more prevalent among black patients. The presence and severity of damage measured by SLICC/ACR was similar between sexes and ethnicities. In multivariate analyses diseases duration and the presence of hypertension showed a positive association, while educational and antimalarials were negatively associated with the presence of damage. CONCLUSION In this cohort of Portuguese patients SLE present clinical features similar to those observed in other predominantly Caucasian populations, albeit a higher prevalence of anti-RNP and anti-Sm antibodies was observed. Some particular features were associated with male sex and African ethnicity. Some socio-demographic and clinical variables were associated with damage accrual.
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Affiliation(s)
- M J Santos
- Servicio de Reumatologia do Hospital Garcia de Orta, Almada.
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48
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Ligeiro D, Fonseca JE, Abade O, Abreu I, Cruz M, Nero P, Cavaleiro J, Teles J, Trindade H, Caetano JM, Branco J. Influence of human leucocyte antigen-DRB1 on the susceptibility to rheumatoid arthritis and on the production of anti-cyclic citrullinated peptide antibodies in a Portuguese population. Ann Rheum Dis 2006; 66:246-8. [PMID: 16793843 PMCID: PMC1798513 DOI: 10.1136/ard.2005.051177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To clarify the influence of the HLA-DRB1 locus on the susceptibility to rheumatoid arthritis and the production of anti-cyclic citrullinated peptide antibodies (anti-CCP) in a Portuguese population. METHODS 141 patients with rheumatoid arthritis fulfilling the American College of Rheumatology 1987 revised criteria for rheumatoid arthritis were compared with 150 healthy controls. Human leucocyte antigen (HLA)-DRB1 locus genotyping was assessed by polymerase chain reaction reverse probing assays and sequence-specific primers. Anti-CCP antibodies were quantified by ELISA in patients with rheumatoid arthritis. Frequencies between groups were compared by the two-sided Fisher's exact test and considered significant if p<0.05. RESULTS The HLA-DRB1*04 and HLA-DRB1*10 groups were highly associated with rheumatoid arthritis (p<0.001 and p = 0.031, respectively). High titres of anti-CCP antibodies were largely associated with the presence of HLA-DRB1*04/10. CONCLUSION The well-recognised susceptibility alleles to rheumatoid arthritis, HLA-DRB1*04, were associated with rheumatoid arthritis in Portuguese patients. The relatively rare DRB1*10 was also associated with rheumatoid arthritis, as was described previously in other southern European countries. Both groups were associated with high anti-CCP titres, reinforcing its relevance to disease onset.
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Affiliation(s)
- D Ligeiro
- Centro de Histocompatibilidade do Sul, Lisboa, Portugal
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49
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Abreu I, Laroche P, Bastos A, Issert V, Cruz M, Nero P, Fonseca JE, Branco J, Machado Caetano JA. Multiplexed immunoassay for detection of rheumatoid factors by FIDISTM technology. Ann N Y Acad Sci 2005; 1050:357-63. [PMID: 16014552 DOI: 10.1196/annals.1313.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Our objective was to (i) compare FIDIS Rheuma, a new multiplexed immunoassay designed for simultaneous detection of IgM class rheumatoid factors (RF) directed against Fc determinants of IgG from humans and animals, with agglutination and ELISA (conventional methods) and (ii) evaluate the clinical sensitivity and specificity of biological markers for rheumatoid arthritis (RA). To do this, FIDIS technology was employed using the Luminex system. It consists of distinct color-coded microsphere sets, a flow cytometer, and digital signal processing hardware and software. Agglutination and ELISA tests were performed with commercial kits. The study included 134 samples from RA patients and 105 from healthy blood donors. For human specificity, we compared FIDIS with latex agglutination and ELISA. Relative sensitivities were 98.9% and 88.5% and specificities were 90.2% and 94.6%, respectively. For animal specificity, we compared FIDIS with Waaler-Rose and ELISA. The results were 84.9% and 71.9% for the sensitivities and 97.5% and 98.4% for the specificities, respectively. Detection of IgG anti-CCP by ELISA and IgG antikeratin by immunofluorescence was also determined in order to compare their clinical sensitivity and specificity with IgM-RF, according to the method used. The results were: IgG anti-CCP 72.3%, 97.2%; IgG antikeratin 36.6%, 100%; latex agglutination 66.4%, 97.2%; Waaler-Rose 55.9%, 96.3%; FIDIS human 73.9%, 92.1%; FIDIS animal 49.2%, 97.2%; ELISA human 93.2%, 95.5%; and ELISA animal 74.6%, 91.3%. The results showed the efficiency of FIDIS with analytical performance equivalent to the conventional methods, but having the advantage of giving quantitative results (IU/mL).
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Affiliation(s)
- I Abreu
- Faculty of Medical Sciences, Department of Immunology, New University of Lisbon, Lisbon, Portugal.
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50
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Altman RD, Abadie E, Avouac B, Bouvenot G, Branco J, Bruyere O, Calvo G, Devogelaer JP, Dreiser RL, Herrero-Beaumont G, Kahan A, Kreutz G, Laslop A, Lemmel EM, Menkes CJ, Pavelka K, Van De Putte L, Vanhaelst L, Reginster JY. Total joint replacement of hip or knee as an outcome measure for structure modifying trials in osteoarthritis. Osteoarthritis Cartilage 2005; 13:13-9. [PMID: 15639632 DOI: 10.1016/j.joca.2004.10.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 10/05/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Group for the Respect of Ethics and Excellence in Science (GREES) organized a working group to assess the value of time to joint surgery as a potential therapeutic failure outcome criterion for osteoarthritis (OA) of the hip or knee in the assessment of potential structure modifying agents. METHODS PubMed was searched for manuscripts from 1976 to 2004. Relevant studies were discussed at a 1-day meeting. RESULTS There are no accepted guidelines for 'time to' and 'indications for' joint replacement surgery. A limited number of trials have examined joint replacement surgery within the study population. Several parameters, particularly joint space narrowing (interbone distance), correlate with surgical intervention. However, at the level of the knee, none of the parameters have positive predictive value for joint replacement surgery better than 30%. In contrast, lack of significant joint space narrowing has a strong negative predictive value for joint replacement surgery (>90%), that remains after controlling for OA pain severity. CONCLUSION At this time, GREES cannot recommend time to joint surgery as a primary endpoint of failure for structure modifying trials of hip or knee OA-as the parameter has sensitivity but lacks specificity. In contrast, in existing trials, a lack of progression of joint space narrowing has predictive value of >90% for not having surgery. GREES suggests utilizing joint space narrowing (e.g., >0.3-0.7 mm) combined with a lack of clinically relevant improvement in symptoms (e.g., >/=20-25%) for 'failure' of a secondary outcome in structure modifying trials of the hip and knee.
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MESH Headings
- Antirheumatic Agents/therapeutic use
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Disease Progression
- Drug Approval
- Female
- Humans
- Male
- Osteoarthritis, Hip/drug therapy
- Osteoarthritis, Hip/pathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/drug therapy
- Osteoarthritis, Knee/pathology
- Osteoarthritis, Knee/surgery
- Pain Measurement/methods
- Practice Guidelines as Topic
- Randomized Controlled Trials as Topic
- Risk Factors
- Time Factors
- Treatment Failure
- Treatment Outcome
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Affiliation(s)
- R D Altman
- Rheumatology and Immunology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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