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Coates LC, Nissen M, El Baou C, Zochling J, Marchesoni A, Liu Leage S, Soriano E, Azevedo VF, Machold K, Sapin C. FRI0332 EVALUATION OF THE INDIVIDUAL COMPONENTS OF ACR50+PASI100 AND MDA AT WEEK 24 FROM THE SPIRIT-H2H TRIAL COMPARING THE EFFICACY AND SAFETY OF IXE VERSUS ADA IN PATIENTS WITH PSA NAÏVE TO BDMARDS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2830] [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:Psoriatic arthritis (PsA) is a chronic systemic disease with manifestations affecting musculoskeletal and extra-articular domains. Treatment and assessment of response are therefore major challenges in routine clinical practice. Minimal disease activity (MDA) is a multidimensional endpoint that can define a treatment target1. In SPIRIT-H2H2, a head-to-head clinical trial comparing the efficacy and safety of ixekizumab (IXE) versus) to adalimumab (ADA), the percentage of patients simultaneously achieving American College of Rheumatology 50 (ACR50) and Psoriasis Area and Severity Index 100 (PASI100), was the primary endpoint in order to reflect improvement in two domains of PsA.Objectives:To evaluate how individual components of the simultaneous achievement of ACR50 and PASI100 compare with those of MDA at week 24.Methods:Patients with active PsA (defined as those with a tender joint count [TJC] ≥ 3/68, a swollen joint count [SJC] ≥ 3/66 and a body surface area [BSA] of active plaque psoriasis ≥ 3%) were randomised 1:1 to approved dosing (according to baseline psoriasis involvement) of IXE or ADA in SPIRIT-H2H, an open label, assessor-blinded study.The proportion of patients meeting each criterion of the composite endpoints was calculated for the intent-to-treat ([ITT], N=566) population and the population of MDA responders at Week 24 (N=235). Missing individual responses were imputed with non-responder status. Spidergrams were generated using SAS 9.4.Results:For both the overall ITT population and the MDA responders population, the use of PASI≤1 or BSA≤3% in the skin-related component of the MDA contributed to the higher response rate relative to the PASI100 response. Thus, the PASI100 response is a more stringent endpoint. Proportions of responders are similar across MDA and ACR50+PASI100 individual components for HAQ and SJC. The high baseline TJC levels (mean TJC: IXE=19.1, ADA=21.3) as opposed to lower levels observed for baseline SJC (mean SJC: IXE=10.1, ADA=10.7) made MDA-TJC criterion (≤1) more difficult to achieve than the equivalent criterion of the ACR50+PASI100 endpoint.Conclusion:Despite the differences in criteria definitions, there are consistent response patterns in the individual components of the simultaneous ACR50+PASI100 and MDA endpoints in particular for the peripheral arthritis domain.References:[1]Smolen, Josef S et al. “Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force.”Annals of the rheumatic diseasesvol. 77,1 (2018): 3-17.[2]Mease PJ The SPIRIT H2H study group, et al. “A head-to-head comparison of the efficacy and safety of ixekizumab and adalimumab in biological-naïve patients with active psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial.”Annals of the Rheumatic Diseases2020;79:123-131.Disclosure of Interests:Laura C Coates: None declared, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Celine El Baou Consultant of: Eli Lilly and Company, Jane Zochling Employee of: Jannssen Cilag, Speakers bureau: Janssen Cilag, AbbVie, Novartis, UCB, BMS, Eli Lilly, Antonio Marchesoni Speakers bureau: Abbvie, Pfizer, UCB, Novartis, Celgene, Eli Lilly, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche, Valderilio F Azevedo Grant/research support from: Abbvie, Janssen, Bristol-Myers Squibb, Boehringer-Ingelheim, Lilly and Novartis, Consultant of: Lilly, Novartis, Janssen, Boehringer-Ingelheim, Amgen, Pfizer and Abbvie, Speakers bureau: Sandoz, Celltrion, Lilly, Novartis, Janssen, Boehringer-Ingelheim, Amgen, Pfizer and Abbvie, Klaus Machold Grant/research support from: AbbVie, MSD, UCB, Consultant of: Arsanis, Astro, Baxter, BMS, Celgene, Eli-Lilly, MSD, Pfizer, Roche, Novartis, Sandoz, Speakers bureau: MSD, Pfizer, BMS, Janssen-Cilag, Sandoz, Novartis, Eli-Lilly, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company
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Kiltz U, van der Heijde D, Boonen A, Bautista-Molano W, Burgos-Vargas R, Chiowchanwisawakit P, Duruoz T, El-Zorkany B, Essers I, Gaydukova I, Géher P, Gossec L, Grazio S, Gu J, Khan MA, Kim TJ, Maksymowych WP, Marzo-Ortega H, Navarro-Compán V, Olivieri I, Patrikos D, Pimentel-Santos FM, Schirmer M, van den Bosch F, Weber U, Zochling J, Braun J. Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages. RMD Open 2016; 2:e000311. [PMID: 27752358 PMCID: PMC5051462 DOI: 10.1136/rmdopen-2016-000311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages. Methods Translation and cross-cultural adaptation has been carried out following the forward–backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included. Results The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option ‘not applicable’ was added to two items of the ASAS HI to improve appropriateness. Discussion This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet , Herne , Germany
| | - D van der Heijde
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - A Boonen
- Division of Rheumatology, Department of Internal Medicine , Maastricht University Medical Center , Maastricht , The Netherlands
| | - W Bautista-Molano
- Rheumatology Department, Faculty of Medicine , HMC/UMNG , Bogota , Colombia
| | - R Burgos-Vargas
- Department of Rheumatology , Hospital General de Mexico and Universidad Nacional Autonoma de Mexico , Mexico City , Mexico
| | | | - T Duruoz
- PM&R Department, Rheumatology Division , Marmara University, School of Medicine , Istanbul , Turkey
| | - B El-Zorkany
- Rheumatology Department , Cairo University , Cairo , Egypt
| | - I Essers
- Division of Rheumatology, Department of Internal Medicine , Maastricht University Medical Center , Maastricht , The Netherlands
| | - I Gaydukova
- Saratov State Medical University , Saratov , Russian Federation
| | - P Géher
- Semmelweis University , Budapest , Hungary
| | - L Gossec
- Department of Rheumatology , Sorbonne Universités, UPMC Univ, Paris 06, Institut Pierre Louis d'Epidémiologie et de, Santé Publique, GRC-UPMC 08 (EEMOIS); AP-HP,Pitié Salpêtrière Hospital , Paris , France
| | - S Grazio
- Sisters of Mercy University Hospital , Zagreb , Croatia
| | - J Gu
- Department of Rheumatology , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - M A Khan
- Case Western Reserve University Cleveland , Cleveland, Ohio , USA
| | - T J Kim
- Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , South Korea
| | - W P Maksymowych
- Division of Rheumatology, Department of Medicine , University of Alberta , Edmonton, Alberta , Canada
| | - H Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Alberton Hospital , Leeds , UK
| | | | - I Olivieri
- Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy
| | | | - F M Pimentel-Santos
- NOVA Medical School and CEDOC, Chronic Diseases, NOVA University of Lisbon , Lisboa , Portugal
| | - M Schirmer
- Department of Internal Medicine VI , Medical University of Innsbruck , Innsbruck , Austria
| | | | - U Weber
- King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J Zochling
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - J Braun
- Rheumazentrum Ruhrgebiet , Herne , Germany
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Quinlivan A, Thakkar V, Stevens W, Morrisroe K, Prior D, Rabusa C, Youssef P, Gabbay E, Roddy J, Walker JG, Zochling J, Sahhar J, Nash P, Lester S, Rischmueller M, Proudman SM, Nikpour M. Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis. Intern Med J 2016; 45:1134-40. [PMID: 26337683 DOI: 10.1111/imj.12890] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 04/11/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) is now standard care in this disease. The existing Australian Scleroderma Interest Group algorithm (ASIGSTANDARD ) is based on transthoracic echocardiography (TTE) and pulmonary function tests (PFT). Recently, ASIG has derived and validated a new screening algorithm (ASIGPROPOSED ) that incorporates N-terminal pro-B-type natriuretic peptide level together with PFT in order to decrease reliance on TTE, which has some limitations. Right heart catheterisation (RHC) remains the gold standard for the diagnosis of PAH in patients who screen 'positive'. AIM To compare the cost of PAH screening in SSc with ASIGSTANDARD and ASIGPROPOSED algorithms. METHODS We applied both ASIGSTANDARD and ASIGPROPOSED algorithms to 643 screen-naïve SSc patients from the Australian Scleroderma Cohort Study (ASCS), assuming a PAH prevalence of 10%. We compared the costs of screening, the number of TTE required and both the total number of RHC required and the number of RHC needed to diagnose one case of PAH, and costs, according to each algorithm. We then extrapolated the costs to the estimated total Australian SSc population. RESULTS In screen-naïve patients from the ASCS, ASIGPROPOSED resulted in 64% fewer TTE and 10% fewer RHC compared with ASIGSTANDARD , with $1936 (15%) saved for each case of PAH diagnosed. When the costs were extrapolated to the entire Australian SSc population, there was an estimated screening cost saving of $946 000 per annum with ASIGPROPOSED , with a cost saving of $851 400 in each subsequent year of screening. CONCLUSIONS ASIGPROPOSED substantially reduces the number of TTE and RHC required and results in substantial cost savings in SSc-PAH screening compared with ASIGSTANDARD .
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Affiliation(s)
- A Quinlivan
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - V Thakkar
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Rheumatology, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - W Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - K Morrisroe
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - D Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Rabusa
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - P Youssef
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - E Gabbay
- The University of Notre Dame, Fremantle, Australia
| | - J Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J G Walker
- Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - J Zochling
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - J Sahhar
- Department of Rheumatology, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - P Nash
- Rheumatology Research Unit, Department of Medicine, University of Queensland, Sunshine Coast, Queensland, Australia
| | - S Lester
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - M Rischmueller
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - S M Proudman
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - M Nikpour
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
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Hawson J, Sonigra A, Sreedharan S, Wright L, Zochling J, Kilpatrick D, Dwyer N. An Article on the Benefit of Advanced Therapy for Pulmonary Hypertension in Patients with Systemic Sclerosis Who Have Latent Pulmonary Hypertension Unmasked by Fluid Bolus. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.023] [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: 10/21/2022]
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Nicholls D, Nakayama A, Griffiths H, Littlejohn G, Bird P, Roberts L, de Jager J, Zochling J, Richter S, Louw S, Tymms K. THU0436 A Retrospective Non-Interventional Multi-Centre Study Evaluating Treatment Regimens Used in Psoriatic Arthritis Patients in Australia- The PSA Real Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2099] [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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Khan H, Aitken D, Lewis P, Zochling J. FRI0419 Association between Objectively Assessed Physical Activity and Disease Progression in A Population Based Sample of Ankylosing Spondylitis Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4529] [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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Patterson KA, Roberts-Thomson PJ, Lester S, Tan JA, Hakendorf P, Rischmueller M, Zochling J, Sahhar J, Nash P, Roddy J, Hill C, Nikpour M, Stevens W, Proudman SM, Walker JG. Interpretation of an Extended Autoantibody Profile in a Well-Characterized Australian Systemic Sclerosis (Scleroderma) Cohort Using Principal Components Analysis. Arthritis Rheumatol 2016; 67:3234-44. [PMID: 26246178 DOI: 10.1002/art.39316] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/30/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the relationships between systemic sclerosis (SSc)-related autoantibodies, as well as their clinical associations, in a well-characterized Australian patient cohort. METHODS Serum from 505 Australian SSc patients were analyzed with a commercial line immunoassay (EuroLine; Euroimmun) for autoantibodies to centromere proteins CENP-A and CENP-B, RNA polymerase III (RNAP III; epitopes 11 and 155), the 90-kd nucleolar protein NOR-90, fibrillarin, Th/To, PM/Scl-75, PM/Scl-100, Ku, topoisomerase I (topo I), tripartite motif-containing protein 21/Ro 52, and platelet-derived growth factor receptor. Patient subgroups were identified by hierarchical clustering of the first 2 dimensions of a principal components analysis of quantitative autoantibody scores. Results were compared with detailed clinical data. RESULTS A total of 449 of the 505 patients were positive for at least 1 autoantibody by immunoblotting. Heatmap visualization of autoantibody scores, along with principal components analysis clustering, demonstrated strong, mutually exclusive relationships between CENP, RNAP III, and topo I. Five patient clusters were identified: CENP, RNAP III strong, RNAP III weak, topo I, and other. Clinical features associated with CENP, RNAP III, and topo I were consistent with previously published reports concerning limited cutaneous and diffuse cutaneous SSc. A novel finding was the statistical separation of RNAP III into 2 clusters. Patients in the RNAP III strong cluster had an increased risk of gastric antral vascular ectasia, but a lower risk of esophageal dysmotility. Patients in the other cluster were more likely to be male and to have a history of smoking and a history of malignancy, but were less likely to have telangiectasia, Raynaud's phenomenon, and joint contractures. CONCLUSION Five major autoantibody clusters with specific clinical and serologic associations were identified in Australian SSc patients. Subclassification and disease stratification using autoantibodies may have clinical utility, particularly in early disease.
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Affiliation(s)
- K A Patterson
- Flinders University, Bedford Park, South Australia, and Commonwealth Scientific and Industrial Research Organization (CSIRO), Adelaide, South Australia, Australia
| | - P J Roberts-Thomson
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and SA Pathology, Adelaide, South Australia, Australia
| | - S Lester
- Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J A Tan
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - P Hakendorf
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - M Rischmueller
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J Zochling
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - J Sahhar
- Monash Health and Monash University, Melbourne, Victoria, Australia
| | - P Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - J Roddy
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - C Hill
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - M Nikpour
- University of Melbourne and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - W Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S M Proudman
- University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J G Walker
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and Repatriation General Hospital, Daw Park, South Australia, Australia
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Morrisroe KB, Stevens W, Nandurkar H, Prior D, Thakkar V, Roddy J, Zochling J, Sahhar J, Tymms K, Sturgess A, Major G, Kermeen F, Hill C, Walker J, Nash P, Gabbay E, Youssef P, Proudman SM, Nikpour M. The association of antiphospholipid antibodies with cardiopulmonary manifestations of systemic sclerosis. Clin Exp Rheumatol 2014; 32:S-133-7. [PMID: 24564981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/15/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the prevalence and correlates of antiphospholipid antibodies (APLA) in systemic sclerosis (SSc). METHODS Nine hundred and forty SSc patients were tested for APLA using an ELISA assay at recruitment. Clinical manifestations were defined as present, if ever present from SSc diagnosis. Logistic regression analysis was used to determine the associations of APLA. RESULTS One or more types of APLA were present in 226 (24.0%) patients. Anticardiolipin (ACA) IgG (ACA-IgG) antibodies were associated with right heart catheter-diagnosed pulmonary arterial hypertension (PAH), with higher titres corresponding with a higher likelihood of PAH (moderate titre (20-39 U/ml) ACA-IgG odds ratio [OR] 1.70, 95% CI: 1.01-2.93, p=0.047; high titre (>40 U/ml) ACA-IgG OR 4.60, 95% CI:1.02-20.8, p=0.047). Both ACA-IgM (OR 2.04, 95% CI: 1.4-3.0, p<0.0001) and ACA-IgG (OR 1.84, 95% CI: 1.2-2.8, p=0.005) were associated with interstitial lung disease (ILD). Increasing ACA-IgM and IgG titres were associated with increased likelihood of ILD. ACA-IgG was a marker of coexistent pulmonary hypertension and ILD (ILD-PH) (OR 2.10, 95% CI: 1.1-4.2, p=0.036). We also found an association between ACA-IgG and digital ulcers (OR 1.76, 95% CI: 1.16-2.67, p=0.008) and ACA-IgM and Raynaud's phenomenon (OR 2.39, 95% CI: 1.08-5.27, p=0.031). There was no association between APLA and SSc disease subtype, peak skin score, presence of other autoantibodies, mortality or other disease manifestations. CONCLUSIONS The association of APLA with PAH, ILD, ILD-PH, Raynaud's phenomenon and digital ulcers suggests that endothelial abnormalities and small vessel thrombosis may be important in the pathogenesis of these disease features.
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Affiliation(s)
- K B Morrisroe
- Department of Rheumatology, St. Vincent's Hospital, Melbourne, Australia.
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Littlejohn G, Roberts L, Bird P, de Jager J, Griffiths H, Nicholls D, Young J, Zochling J, Tymms K. AB0241 Rheumatoid Arthritis Patients in Australian Database Show Significant Improvement in Disease Activity over 5 Years. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4834] [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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Nikpour M, Stevens W, Proudman SM, Buchbinder R, Prior D, Zochling J, Williams T, Gabbay E, Nandurkar H. Should patients with systemic sclerosis-related pulmonary arterial hypertension be anticoagulated? Intern Med J 2014; 43:599-603. [PMID: 23668273 DOI: 10.1111/imj.12111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/03/2013] [Indexed: 11/29/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a major cause of mortality in scleroderma and despite 'advanced' therapies confers a median survival of less than 5 years. Anticoagulation in systemic sclerosis-related PAH (SSc-PAH) is currently one of the most contentious issues in the management of patients with connective tissue disease. While some studies have shown a survival benefit with warfarin therapy in this disease, others have not. Accordingly, a state of clinical equipoise exists in relation to anticoagulation in SSc-PAH. With an over fivefold reduction in mortality demonstrated in some observational studies, the issue of anticoagulation in SSc-PAH demands resolution through a well-designed randomised controlled trial.
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Affiliation(s)
- M Nikpour
- Department of Medicine, St Vincent's Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia.
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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Thakkar V, Byron J, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M. THU0235 Identifying and quantifying prognostic factors in systemic sclerosis-related interstitial lung disease using a time-varying covariate survival model. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2200] [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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Charlesworth J, Stankovich J, Lewis P, Byron J, Stevens W, Sahhar J, Proudman S, Roddy J, Nash P, Tymms K, Brown M, Zochling J. THU0005 An immunochip based interrogation of scleroderma susceptibility variants. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1970] [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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Roberts L, Tymms K, de Jager J, Littlejohn G, Griffiths H, Nicholls D, Bird P, Hill J, McCloud P, Zochling J. AB0778 A longitudinal study of the clinical effects of conventional and biologic disease modifying anti-rheumatic drugs in australian rheumatology practice. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3100] [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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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Thakkar V, Byron J, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M. FRI0243 Extent of disease on high-resolution CT lung is a predictor of decline and mortality in systemic sclerosis-related interstitial lung disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2700] [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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Thakkar V, Stevens W, Prior D, Moore O, Byron J, Patterson K, Hissaria P, Roddy J, Zochling J, Sahhar J, Nash P, Tymms K, Celermajer D, Gabbay E, Youssef P, Proudman S, Nikpour M. THU0258 N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2223] [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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16
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Nikpour M, Baron M, Hudson M, Carreira P, Hunzelmann N, Frech T, Sahhar J, Nash P, Major G, Youssef P, Roddy J, Zochling J, Proudman S, Stevens W. FRI0372 Early mortality in systemic sclerosis: rationale for forming a multinational inception cohort of patients with scleroderma (the insync study). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1499] [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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Graf SW, Buchbinder R, Zochling J, Whittle SL. The accuracy of methods for urate crystal detection in synovial fluid and the effect of sample handling: a systematic review. Clin Rheumatol 2012; 32:225-32. [PMID: 23138881 DOI: 10.1007/s10067-012-2107-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 09/29/2012] [Accepted: 10/23/2012] [Indexed: 11/28/2022]
Abstract
This study aims to compare different methods of monosodium urate crystal (MSU) detection in synovial fluid (SF) and the effect of sample storage and handling on crystal detection. A systematic literature search was performed in MEDLINE, EMBASE, the Cochrane Library and the American College of Rheumatology/European League Against Rheumatism conference abstracts of 2010 and 2011. Studies that compared a method for detecting MSU crystals in SF with polarised light microscopy (PLM) or compared various SF storage and handling factors with the detection of MSU crystals as an outcome were included. Twelve studies out of 247 identified references were included in the review. Seven studies compared different methods of MSU crystal detection in SF with PLM. Due to study heterogeneity, methodological limitations and risk of bias, no firm conclusions could be drawn from the available data. Five studies examining SF storage and handling factors were identified. A reduction in MSU crystal concentration was observed over time at room temperature that was not seen in refrigerated samples. The use of anticoagulation as a storage medium provided no benefit. Dried cytospin preparations appeared to be a suitable medium for long-term storage and delayed crystal analysis for at least 12 months. The existing data do not provide a compelling argument for the replacement of PLM as the current standard. SF sample storage and handling have an effect on MSU crystals and may impact on the reliability of analysis.
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Affiliation(s)
- S W Graf
- Department of Rheumatology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia 5011, Australia.
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Thakkar V, Stevens W, Prior D, Byron J, Patterson K, Hissaria P, Moore O, Roddy J, Zochling J, Sahhar J, Nash P, Tymms K, Youssef P, Proudman S, Nikpour M, Launay D, Sitbon O, Cordier JF, Hachulla E, Mouthon L, Gressin V, Rottat L, Clerson P, Simonneau G, Humbert M, Carreira P, Carmona L, Joven BE, Denton CP, Allanore Y, Walker UA, Matucci-Cerinic M, Muller-Ladner U, Hsu V, Cheng Q, Steen V. S.4.1 N-terminal pro-brain natriuretic peptide levels predict incident pulmonary arterial hypertension in SSc. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Byron J, Thakkar V, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M, Moore O, Goh N, Corte T, Rouse H, Hennessy O, Byron J, Thakkar V, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M, Tourkina E, Dyer S, Reese C, Oates JC, Hofbauer A, Bonner M, Visconti RP, Zhang J, Silver RM, Hoffman S, Liu X, Mayes M, Tan F, Harper B, Gonzalez E, Draeger H, Sharif R, Reveille J, Arnett F, Assassi S, Bogatkevich G, Akter T, Atanelishvili I, Liang J, Spyropoulos D, Silver R. S.2.1 Identifying and quantifying prognostic factors in SSc-related interstitial lung disease using a time-varying covariate survival model. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Charlesworth J, Stankovich J, Lewis P, Byron J, Stevens W, Sahhar J, Proudman S, Roddy J, Nash P, Tymms K, Brown M, Zochling J, Leask A, Parapuram S, Shiwen X, Denton C, Abraham D, Liu S, Vettori S, Brock M, Iwamoto N, Maurer B, Jungel A, Gay RE, Calcagni M, Valentini G, Distler JH, Gay S, Distler O, Assassi S, Mayes M, Liu X, Harper B, Gonzalez E, Draeger H, Zhou X, Khanna D, Furst D, Tan F. S.8.1 An immunochip-based interrogation of scleroderma susceptibility variants. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Machado P, Castrejon I, Katchamart W, Koevoets R, Kuriya B, Schoels M, Silva-Fernández L, Thevissen K, Vercoutere W, Villeneuve E, Aletaha D, Carmona L, Landewé R, van der Heijde D, Bijlsma JWJ, Bykerk V, Canhão H, Catrina AI, Durez P, Edwards CJ, Mjaavatten MD, Leeb BF, Losada B, Martín-Mola EM, Martinez-Osuna P, Montecucco C, Müller-Ladner U, Østergaard M, Sheane B, Xavier RM, Zochling J, Bombardier C. Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis 2010; 70:15-24. [PMID: 20724311 PMCID: PMC3002765 DOI: 10.1136/ard.2010.130625] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective To develop evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis (UPIA). Methods 697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008–9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007–2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results A total of 39 756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA. Conclusions Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use.
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Affiliation(s)
- P Machado
- Department of Rheumatology, Coimbra University Hospital, Coimbra, Portugal.
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Gossec L, Bijlsma JWJ, Bombardier C, Canhao H, Devlin J, Edwards CJ, Hamuryudan V, Kvien TK, Leeb BF, Martin-Mola EM, Mielants H, Muller-Ladner U, Ostergaard M, Pereira IA, Ramos-Remus C, Zochling J, Dougados M. Dissemination and evaluation of the 3E initiative recommendations for use of methotrexate in rheumatic disorders: results of a study among 2233 rheumatologists. Ann Rheum Dis 2010; 70:388-9. [DOI: 10.1136/ard.2010.128652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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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Braun J, Zochling J, Märker-Hermann E, Stucki G, Böhm H, Rudwaleit M, Zeidler H, Sieper J. [Recommendations for the management of ankylosing spodylitis after ASAS/EULAR. Evaluation in the German language area]. Z Rheumatol 2009; 65:728-42. [PMID: 17119900 DOI: 10.1007/s00393-006-0119-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 12/17/2022]
Abstract
AIM Our aim was to adapt and implement the evidence based recommendations for the management of ankylosing spodylitis (AS) of the "Assessments in AS" (ASAS) International Working Group together with the European League Against Rheumatism (EULAR) within the framework of a competence network (CN) in rheumatology in the German language area. METHODS The ASAS/EULAR project calculated the effective size (ES), rate ratio, number of patients requiring treatment (number needed to treat, NNT) and the incremental cost-effectiveness ratio (ICER). The strength of the recommendations was determined through the evidence level found in the literature, the risk-benefit trade-off and the clinical experience of the experts. The recommendations were recently published in English. All of the centers taking part in the study area Spondyloarthritis (SpA) CN, as well as an additional 35 experts, were sent the English manuscript. All 35 participants were asked to evaluate the ten main management recommendations on a scale from 0 to 10. RESULTS The recommendations encompass the use of drugs such as non-steroid anti-inflammatories (NSAR), which, along with conventional NSAR include coxibs and the parallel application of gastroprotectives, so called disease-modifying anti-rheumatic drugs, biologicals, simple analgesics, local and systematic glucocorticoids, non-drug therapies (such as patient training, medical training therapy and physiotherapy), in addition to surgical treatment methods. Moreover, three general recommendations were formulated and a therapy scheme created, taking into consideration the various clinical manifestations. The strength of the ASAS/EULAR recommendations was generally high. There was a marked consensus between the German speaking experts and the international proposal: a mean of 9.13 with relatively low variation between the recommendations. SUMMARY Ten key recommendations for the treatment of AS were developed. These were strengthened by a systematic search of the literature and by expert consensus. The large group of German speaking experts were largely in agreement with the proposal. This can be seen as a starting point for the dissemination and implementation of the recommendations.
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Affiliation(s)
- J Braun
- Rheumazentrum-Ruhrgebiet, St. Josefs-Krankenhaus, Landgrafenstrasse 15, 44652, Herne, Deutschland.
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Cross MJ, Smith EUR, Zochling J, March LM. Differences and similarities between ankylosing spondylitis and rheumatoid arthritis: epidemiology. Clin Exp Rheumatol 2009; 27:S36-S42. [PMID: 19822044] [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: 05/28/2023]
Abstract
Ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are among the most common rheumatic diseases. The epidemiology of these diseases highlights both similarities and differences. Prevalence rates of approximately 0.2-1% have been reported for the diseases, but the rate for AS is increasing while RA is declining. Geographical variations exist in the incidence and prevalence of the diseases, although the majority of studies have been conducted in northern Europe and North America. AS is a predominantly a male disorder, whereas more females are affected by RA. Both diseases result in increased disability, reduced work productivity, and increased mortality rates. These similarities and differences may give us important clues as to the aetiology of both diseases.
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Affiliation(s)
- M J Cross
- Institute of Bone & Joint Research, University of Sydney, Australia.
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Zochling J, Braun J. Mortality in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol 2009; 27:S127-S130. [PMID: 19822059] [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: 05/28/2023]
Abstract
The rheumatic diseases not only bring pain, disability and poorer quality of life, but also a premature mortality which is often overlooked. Alongside mortality due to the direct complications of disease comes an increase in deaths related to specific therapies and indirect causes such as cancer and cardiovascular mortality. By comparing mortality and its causes in two of the most common inflammatory arthritides, rheumatoid arthritis and ankylosing spondylitis, common threads emerge which give us insight into the impact of chronic inflammatory disease and new directions for patient management.
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Affiliation(s)
- J Zochling
- Menzies Research Institute, Hobart, Australia
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Visser K, Katchamart W, Loza E, Martinez-Lopez JA, Salliot C, Trudeau J, Bombardier C, Carmona L, van der Heijde D, Bijlsma JWJ, Boumpas DT, Canhao H, Edwards CJ, Hamuryudan V, Kvien TK, Leeb BF, Martín-Mola EM, Mielants H, Müller-Ladner U, Murphy G, Østergaard M, Pereira IA, Ramos-Remus C, Valentini G, Zochling J, Dougados M. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis 2008; 68:1086-93. [PMID: 19033291 PMCID: PMC2689523 DOI: 10.1136/ard.2008.094474] [Citation(s) in RCA: 307] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use.
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Affiliation(s)
- K Visser
- Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands.
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Zochling J, Braun J. Mortality in ankylosing spondylitis. Clin Exp Rheumatol 2008; 26:S80-S84. [PMID: 19026148] [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: 05/27/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease which causes pain along with loss of physical function and quality of life over many years. It has also been shown to increase mortality compared to the general population, independent of treatment modalities. Cardiovascular deaths are increased, and recent studies suggest both an abnormality of lipid regulation and microvascular changes. Increased rates of suicide, accidental death, and alcohol-related deaths have also been reported. This review examines rates and causes of increased mortality in AS and highlights a need to focus on cardiovascular risk factors and psychological health in addition to physical disability in patients with AS.
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Kiltz U, Zochling J, Schmidt WE, Braun J. Use of NSAIDs and infection with Helicobacter pylori--what does the rheumatologist need to know? Rheumatology (Oxford) 2008; 47:1342-7. [PMID: 18477642 DOI: 10.1093/rheumatology/ken123] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES NSAID-induced gastroduodenal lesions are a frequent and potentially serious health problem in patients with rheumatic diseases. Helicobacter pylori (H. pylori) has also been recognized as a major risk factor for the development of ulcer disease. However, the role of H. pylori in the pathogenesis of NSAID-induced gastroduodenal lesions has remained controversial, and there is currently no clear consensus on the management of NSAID users who are infected with H. pylori. METHODS To clarify this situation we have performed a systematic literature search to find randomized controlled trials comparing the efficacy of eradication in patients receiving NSAIDs to prevent ulcer development. RESULTS Seven randomized controlled trials and one meta-analysis were identified. There were three papers on NSAID-naive patients. According to this data, NSAID-naive users benefit from testing for H. pylori infection and subsequent H. pylori eradication therapy prior to the initiation of NSAID. In contrast, H. pylori eradication alone does not protect chronic NSAID users with recent ulcer complications from further gastrointestinal (GI) events. To prevent recurrent ulcer bleeding long-term acid suppressive therapy is needed. CONCLUSIONS In conclusion, ulcer risk reduction after H. pylori eradication therapy is clearly more marked in patients beginning NSAID therapy than in patients who were already receiving and tolerating NSAID therapy. Thus, the management of H. pylori infection and the prevention of GI complications in NSAID users need to be individualized on the basis of recently published data.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, St. Josefs Hospital, Landgrafenstr. 15, 44652 Herne, Germany.
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Zochling J, Braun J. Quality indicators, guidelines and outcome measures in ankylosing spondylitis. Clin Exp Rheumatol 2007; 25:147-152. [PMID: 18021521] [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: 05/25/2023]
Abstract
The challenge of managing knowledge is a difficult one, and it is no longer enough simply to conduct clinical trials. Quality of care requires the incorporation of research knowledge into clinical practice. As our knowledge of the chronic inflammatory rheumatic disease ankylosing spondylitis (AS) has grown, evidence-based recommendations for the early diagnosis and management of AS and scientifically-derived outcome measures have been developed to aid the clinician at the point of care. Some of these, including the ASAS/EULAR recommendations for the management of AS, are now being validated in national and international studies. This article discusses existing recommendations and the need for specific quality indicators in the field of AS.
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Affiliation(s)
- J Zochling
- Research Fellow, Menzies Research Institute, Hobart, Australia
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Braun J, Zochling J, Grill E, Liman W, Stucki G. Die Internationale Klassifikation für Funktionsfähigkeit, Behinderung und Gesundheit und ihre Bedeutung für die Rheumatologie. Z Rheumatol 2007; 66:603-6, 608-10. [PMID: 17704927 DOI: 10.1007/s00393-007-0188-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 10/22/2022]
Abstract
The international classification of functioning, disability and health (ICF) has been developed by the World Health Organization (WHO) to describe health and handicaps in more detail in order to allow better classification and registration. The ICF comprises the disease, structure, functioning, activity and participation as well as corresponding factors related to the individual and the environment. By this means an integrated concept and assessment of biologic, individual and social aspects of health is attained. The ICF represents an essential addition to the international classification of diagnoses (ICD) and procedures (OPS). The ICF consists of two interelated parts. The first part that describes functioning and disability contains two components: one related to the body (functioning and structure) and one related to activity and participation. The second part describes the context factors (related to the environment and the individual). Body functions are the physical and mental functions of the organism. Body structures are the anatomically defined parts of the body. Activity describes how a task is solved or how an action can be performed and participation is the way in which an individual is involved in the environment and society. The ICF categories make the classification of all aspects of functioning and health in individuals easier and independent of diseases or specific assessment instruments. However, since there are more than 1,400 categories, the ICF cannot be used in daily practice in this form. Therefore, attempts are made to identify those parts of the ICF that are relevant for specific patients, situations and disease states or activities. These are the so-called ICF core sets. This article attempts to give an overview on the ICF, to provide an insight into recent work on the ICF related to musculoskeletal and rheumatic diseases and, finally, to describe how an ICF core set for patients with acute arthritis was made possible by means of a successful multicenter cooperative effort.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Landgrafenstrasse 15, 44652 Herne, Deutschland.
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Zochling J, Grill E, Alten R, Ernst J, Stucki G, Braun J. Identification of relevant functional issues for the care of patients with acute arthritis by health professionals, using the ICF framework and a multi-disciplinary focus group approach. Clin Exp Rheumatol 2007; 25:354-60. [PMID: 17631729] [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: 05/16/2023]
Abstract
OBJECTIVE To identify the most relevant problems to be addressed in the multi-disciplinary care of patients with acute arthritis using focus groups of health professionals followed by a Delphi process. METHODS Focus group and Delphi methodology were applied. The focus groups were conducted at three specialist rheumatology hospital clinics in Germany, each group comprising rheumatologists, nurses, physiotherapists, occupational therapists, psychologists and social workers. The participants were asked to decide which categories of the International Classification of Functioning, Disability and Health (ICF) are relevant to the care of patients with acute inflammatory arthritis. The results from the focus groups were then followed by an anonymous Delphi process. RESULTS Twenty-six health professionals participated in the 3 focus groups. 167 of the second-level ICF categories (63% of all second-level categories) were considered as relevant by the rheumatology health professionals. Items from all four components, Body Functions, Body Structures, Activities and Participation and Environmental Factors were represented. Agreement between focus groups and between different health professional groups was substantial for all components with the exception of Environmental Factors (Cohen's kappa 0.23). CONCLUSION The involvement of experts from different health professions is a valuable tool to identify typical patient characteristics, expressed as distinct ICF categories, to aid in patient care in the acute rheumatology setting. Acute patient care cannot and should not be separated from ongoing long-term management.
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Affiliation(s)
- J Zochling
- Rheumazentrum-Ruhrgebiet, St. Josefs-Krankenhaus, Herne, Germany
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Grill E, Zochling J, Stucki G, Mittrach R, Scheuringer M, Liman W, Kostanjsek N, Braun J. International Classification of Functioning, Disability and Health (ICF) Core Set for patients with acute arthritis. Clin Exp Rheumatol 2007; 25:252-8. [PMID: 17543150] [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: 05/15/2023]
Abstract
OBJECTIVE The aim of this consensus process was to construct a preliminary version of the ICF Core Set for acute inflammatory arthritis. METHODS The development of the ICF Core Set involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature, and empiric data collection from patients. RESULTS Thirty-three experts selected a total of 79 second-level categories for the Comprehensive Core Set and 40 second-level categories for the Brief Core Set. The largest number of categories was selected from the ICF component Activities and Participation (28 categories or 35%). Eighteen (23%) of the categories were selected from the component Body Functions, 13 (16%) from the component Body Structures, and 20 (25%) from the component Environmental Factors. CONCLUSION The ICF Core Set for acute arthritis is a clinical framework designed to comprehensively assess patients in acute care hospitals and early post-acute rehabilitation facilities. This preliminary version of the ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.
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Affiliation(s)
- E Grill
- ICF Research Branch of the WHO FIC Collaborating Center (DIMDI), Institute for Health and Rehabilitation Sciences, Ludwig-Maximilian-University, Munich, Germany
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Kiltz U, Brandt J, Zochling J, Braun J. Rheumatic manifestations of lymphoproliferative disorders. Clin Exp Rheumatol 2007; 25:35-9. [PMID: 17417988] [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: 05/14/2023]
Abstract
OBJECTIVE The association between musculoskeletal features and lymphoproliferative disorders as well as the association of rheumatic diseases with an increased risk of malignancies is well-known. METHODS This paper describes three patients with inflammatory joint diseases treated with disease modifying antirheumatic drugs who developed lymphoproliferative disorders either of an abnormal type or with unusual clinical features. RESULTS The difficulty in differentiating the musculoskeletal symptoms of an underlying lymphoproliferative disease from the features of the rheumatic disease itself with special regard to treatment with disease-modifying antirheumatic drugs including biologics is emphasised on the example of patient 1. Patient 2 presented with a rare type of lymphoma and had been mistakenly diagnosed as having seronegative RA. The last patient with oligoarthritis represents an example of the sarcoidosis-lymphoma syndrome. CONCLUSION This article addresses several of the problems rheumatologists may experience with the various rheumatologic manifestations of lymphoproliferative disorders. Until more definitive data are available, patients who develop unexpected arthritis should be considered for histologic biopsy to rule out coexistent neoplasia.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne, Germany.
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Zochling J, Braun J. Remission in ankylosing spondylitis. Clin Exp Rheumatol 2006; 24:S-88-92. [PMID: 17083769] [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: 05/12/2023]
Abstract
Remission is a major goal of medical therapy in chronic disease. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that affects the axial skeleton and other body structures, causing pain, stiffness, functional loss, and disability. Until recently only symptomatic therapies were available, and control was poor in patients with severe disease. However, the TNF antagonists have now changed this substantially. The concept of disease remission in AS has not received much attention in the current literature. There exists one set of partial remission criteria formally developed by the ASsessments in Ankylosing Spondylitis (ASAS) working group on the basis of clinical trials with nonsteroidal anti-inflammatory drugs for use in clinical trials. Furthermore, a state of low disease activity has been defined empirically in studies of anti-tumour necrosis factor (anti-TNF) therapy to describe clinically relevant treatment efficacy. As more effective therapies become available for AS, disease remission is increasingly regarded as an appropriate therapeutic goal that may then be translated into modification of progressive structural damage. There is a need to further define and evaluate current proposals concerning remission in AS.
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Affiliation(s)
- J Zochling
- Rheumazentrum-Ruhrgebiet, St. Josefs-Krankenhaus, Herne, Germany
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Braun J, Zochling J, Baraliakos X, Alten R, Burmester G, Grasedyck K, Brandt J, Haibel H, Hammer M, Krause A, Mielke F, Tony HP, Ebner W, Gömör B, Hermann J, Zeidler H, Beck E, Baumgaertner M, Sieper J. Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomised controlled trial. Ann Rheum Dis 2006; 65:1147-53. [PMID: 16606646 PMCID: PMC1798286 DOI: 10.1136/ard.2006.052878] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2006] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the effect of sulfasalazine (SSZ) on inflammatory back pain (IBP) due to active undifferentiated spondyloarthritis (uSpA) or ankylosing spondylitis in patients with symptom duration <5 years. METHODS Patients with IBP and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) >3 from 12 centres were randomly assigned to 24 weeks' treatment with SSZ 2 g/day or placebo. The primary outcome variable was the change in BASDAI over 6 months. Secondary outcomes included measures of spinal pain, physical function and inflammation. RESULTS 230 patients (50% men, age range 18-64 years, 67% human leucocyte antigen B27 positive) were treated with either SSZ 2x1 g/day or placebo for 6 months. Enthesitis was found in 50%, and peripheral arthritis in 47% of the patients. The mean (SD) BASDAI dropped markedly in both groups: by 3.7 (2.7) and 3.8 (2.4), respectively, as did most secondary outcome measures. No noticeable difference in treatment was observed between groups. Patients with IBP and no peripheral arthritis had significantly (p = 0.03) more benefit with SSZ (BASDAI 5.1 (1.3) to 2.8 (2.3)) than with placebo (5.2 (1.6) to 3.8 (2.4)). Spinal pain (p = 0.03) and morning stiffness (p = 0.05) improved with SSZ in these patients, but other secondary outcomes were not markedly different. CONCLUSION SSZ was no better than placebo for the treatment of the signs and symptoms of uSpA; however, SSZ was more effective than placebo in the subgroup of patients with IBP and no peripheral arthritis.
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Affiliation(s)
- J Braun
- Rheumazentrum-Ruhrgebiet, Landgrafenstrasse 15, 44652 Herne, Germany.
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Chen JS, Seibel MJ, Zochling J, March L, Cameron ID, Cumming RG, Schwarz J, Simpson JM, Sambrook PN. Calcaneal ultrasound but not bone turnover predicts fractures in vitamin D deficient frail elderly at high risk of falls. Calcif Tissue Int 2006; 79:37-42. [PMID: 16868667 DOI: 10.1007/s00223-005-0287-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 11/28/2005] [Accepted: 04/08/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Biochemical markers of bone turnover have been reported to predict fracture risk independent of bone mass in postmenopausal women. We investigated their use in predicting fractures in the frail elderly. METHODS Cases were 151 low trauma fractures. For each case, a control was selected marched for sex, age, institution type and follow-up period. We measured two bone resorption markers (serum ICTP and serum CTX-I) and two bone formation markers (serum PINP and serum BAP). Quantitative Ultrasound (QUS) was measured in the calcaneus. Fractures were ascertained by x-ray reports. RESULTS The mean age of subjects was 86.8 years (+/- 5.8 SD) and 86% were female. 76% had hypovitaminosis D (a serum 25 hydroxy vitamin D (25OHD) level < 39 nmol/L) and 81% had BUA < 67.4 dB/MHz (corresponding to a BMD T-score < -2.5). No significant differences in bone turnover markers were detected between fracture cases and their matched controls. In contrast, there was a significant difference between cases and controls for both broadband ultrasound attenuation (BUA) and velocity of sound (VOS) (both P < 0.05). These results remained the same after adjusting for weight, lower leg length and walking aids as well as the higher falls incidence in cases than controls (average 2.7 vs 0.9 falls respectively; P < 0.001) during the follow-up period. CONCLUSION In the frail elderly with vitamin D deficiency and high falls risk, calcaneal ultrasound but not markers of bone turnover were associated with fractures.
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Affiliation(s)
- J S Chen
- Institute of Bone & Joint Research, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
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Zochling J, Grill E, Scheuringer M, Liman W, Stucki G, Braun J. Identification of health problems in patients with acute inflammatory arthritis, using the International Classification of Functioning, Disability and Health (ICF). Clin Exp Rheumatol 2006; 24:239-46. [PMID: 16870089] [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: 05/11/2023]
Abstract
OBJECTIVES To identify the most common health problems experienced by patients with acute inflammatory arthritis using the International Classification of Functioning, Disability and Health (ICF), and to provide empirical data for the development of an ICF Core Set for acute inflammatory arthritis. METHODS Cross-sectional survey of patients with acute inflammatory arthritis of two or more joints requiring admission to an acute hospital. The second level categories of the ICF were used to collect information on patients' health problems. Relative frequencies of impairments, limitations and restrictions in the study population were reported for the ICF components Body Functions, Body Structures, and Activities and Participations. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. RESULTS In total, 130 patients were included in the survey. The mean age of the population was 59.9 years (median age 63.0 years), 75% of the patients were female. Most had rheumatoid arthritis (57%) or early inflammatory polyarthritis (22%). Fifty-four second-level ICF categories had a prevalence of 30% or more: 3 (8%) belonged to the component Body Structures and 10 (13%) to the component Body Functions. Most categories were identified in the components Activities and Participation (19; 23%) and Environmental Factors (22; 56%). CONCLUSION Patients with acute inflammatory arthritis can be well described by ICF categories and components. This study is the first step towards the development of an ICF Core Set for patients with acute inflammatory arthritis.
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Affiliation(s)
- J Zochling
- Rheumazentrum-Ruhrgebiet, St. Josefs-Krankenhaus, Herne, Germany
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Zochling J, Braun J. Assessment of ankylosing spondylitis. Clin Exp Rheumatol 2005; 23:S133-41. [PMID: 16273797] [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: 05/05/2023]
Abstract
Outcome measures for the assessment of patients with ankylosing spondylitis (AS) have been the subject of considerable research in the last decade, largely through the contributions of the ASessments in Ankylosing Spondylitis (ASAS) International Working Group. This review focuses on the measurement of disease activity, physical function and structural damage in AS, both in daily patient care and to measure treatment response in clinical trials. The ASAS Core Sets for assessment in AS are an important tool to guide disease monitoring, and the domains they contain are discussed, along with other possible concepts important to patient care, including imaging and health-related quality of life. In clinical trials, the assessment of disease response to therapy using the ASAS Response Criteria is a valuable means of determining treatment efficacy and allows comparison of response across trials and interventions.
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Affiliation(s)
- J Zochling
- St. Josefs-Krankenhaus, Landgrafenstr 15, 44652 Herne, Germany
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Zochling J, van der Heijde D, Dougados M, Braun J. Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Ann Rheum Dis 2005; 65:423-32. [PMID: 16126792 PMCID: PMC1798100 DOI: 10.1136/ard.2005.041129] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess available management strategies in ankylosing spondylitis (AS) using a systematic approach, as a part of the development of evidence based recommendations for the management of AS. METHODS A systematic search of Medline, Embase, CINAHL, PEDro, and the Cochrane Library was performed to identify relevant interventions for the management of AS. Evidence for each intervention was categorised by study type, and outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated for each intervention where possible. Results from randomised controlled trials were pooled where appropriate. RESULTS Both pharmacological and non-pharmacological interventions considered to be of interest to clinicians involved in the management of AS were identified. Good evidence (level Ib) exists supporting the use of non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs for symptomatic treatment. Non-pharmacological treatments are also supported for maintaining function in AS. The use of conventional antirheumatoid arthritis drugs is not well supported by high level research evidence. Tumour necrosis factor inhibitors (infliximab and etanercept) have level Ib evidence supporting large treatment effects for spinal pain and function in AS over at least 6 months. Level IV evidence supports surgical interventions in specific patients. CONCLUSION This extensive literature review forms the evidence base considered in the development of the new ASAS/EULAR recommendations for the management of AS.
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Affiliation(s)
- J Zochling
- Rheumazentrum-Ruhrgebiet, St Josefs-Krankenhaus, Landgrafenstr 15, 44652 Herne, Germany
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Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC, Dijkmans B, Dougados M, Géher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Böhm H, van Royen BJ, Braun J. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2005; 65:442-52. [PMID: 16126791 PMCID: PMC1798102 DOI: 10.1136/ard.2005.041137] [Citation(s) in RCA: 414] [Impact Index Per Article: 21.8] [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: 12/17/2022]
Abstract
OBJECTIVE To develop evidence based recommendations for the management of ankylosing spondylitis (AS) as a combined effort of the 'ASsessment in AS' international working group and the European League Against Rheumatism. METHODS Each of the 22 participants was asked to contribute up to 15 propositions describing key clinical aspects of AS management. A Delphi process was used to select 10 final propositions. A systematic literature search was then performed to obtain scientific evidence for each proposition. Outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, relative risk, number needed to treat, and incremental cost effectiveness ratio were calculated. On the basis of the search results, 10 major recommendations for the management of AS were constructed. The strength of recommendation was assessed based on the strength of the literature evidence, risk-benefit trade-off, and clinical expertise. RESULTS The final recommendations considered the use of non-steroidal anti-inflammatory drugs (NSAIDs) (conventional NSAIDs, coxibs, and co-prescription of gastroprotective agents), disease modifying antirheumatic drugs, treatments with biological agents, simple analgesics, local and systemic steroids, non-pharmacological treatment (including education, exercise, and physiotherapy), and surgical interventions. Three general recommendations were also included. Research evidence (categories I-IV) supported 11 interventions in the treatment of AS. Strength of recommendation varied, depending on the category of evidence and expert opinion. CONCLUSION Ten key recommendations for the treatment of AS were developed and assessed using a combination of research based evidence and expert consensus. Regular updating will be carried out to keep abreast of new developments in the management of AS.
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Affiliation(s)
- J Zochling
- Rheumazentrum-Ruhrgebiet, St Josefs-Krankenhaus, Landgrafenstr 15, 44652 Herne, Germany
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Zochling J, Brandt J, Braun J. The current concept of spondyloarthritis with special emphasis on undifferentiated spondyloarthritis. Rheumatology (Oxford) 2005; 44:1483-91. [PMID: 16091395 DOI: 10.1093/rheumatology/kei047] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- J Zochling
- Rheumazentrum-Ruhrgebiet, St Josefs-Krankenhaus, Landgrafenstrasse 15, 44652 Herne, Germany
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Chen JS, March LM, Schwarz J, Zochling J, Makaroff J, Sitoh YY, Lau TC, Lord SR, Cameron ID, Cumming RG, Sambrook PN. A multivariate regression model predicted falls in residents living in intermediate hostel care. J Clin Epidemiol 2005; 58:503-8. [PMID: 15845337 DOI: 10.1016/j.jclinepi.2004.08.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 05/17/2004] [Accepted: 08/30/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate whether individual falls risk could be predicted in a frail elderly population. STUDY DESIGN AND SETTING We developed and tested an assessment tool and falls risk score for predicting falls based on a multivariate regression model in a prospective cohort study of intermediate care residents. RESULTS During the follow-up period, 1,736 falls by 1,107 subjects were recorded with an average of 170 falls per 100 person-years. Fifty percent of the study population had at least one fall within a year. Significant independent risk factors were poor balance, cognitive impairment, incontinence, higher illness severity rating, and older age. Twenty-two percent of participants with a falls risk score > or =7 accounted for 42% of the total falls, with a falls rate of 317 per 100 person-years. This rate was a sixfold increase from the falls rate of 52 per 100 person-years observed in participants with a score < 3. A high score (> or =7) indicated almost a 2 in 3 chance of falling, while a low score (<3) indicated approximately a 1 in 7 chance of falling within 6 months. CONCLUSION The assessment tool and falls risk score could identify individuals in this frail elderly population at high risk of falls.
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Affiliation(s)
- J S Chen
- Institute of Bone & Joint Research, Department of Medicine, Level 4, Block 4, Royal North Shore Hospital, University of Sydney, St Leonards, NSW 2065, Australia.
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Sitoh YY, Lau TC, Zochling J, Schwarz J, Chen JS, March LM, Cumming RG, Lord SR, Sambrook PN, Cameron ID. Determinants of health-related quality of life in institutionalised older persons in northern Sydney. Intern Med J 2005; 35:131-4. [PMID: 15705146 DOI: 10.1111/j.1445-5994.2004.00742.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 11/29/2022]
Abstract
It is recognised that the focus of health-care interventions for frail older persons should not be restricted to increasing longevity, but should encompass measures aimed at improving or maintaining the health-related quality of life (HRQoL) of these individuals. We studied the HRQoL profile of 612 frail older persons residing in nursing homes and hostels in northern Sydney, Australia, and sought to ascertain some of the factors that affect their perceived quality of life. Our findings suggest that common health states that may cause loss of independence and dignity (e.g. presence of osteoarthritis, presence of urinary incontinence, previous fracture, Parkinson's Disease and increasing frailty as reflected by residence in nursing homes) are strongly, and independently, associated with the HRQoL of institutionalised older persons. Some of these conditions may be amenable to intervention.
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Affiliation(s)
- Y Y Sitoh
- Institute of Bone and Joint Research, University of Sydney, Sydney, Australia.
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Zochling J, Nguyen TV, March LM, Sambrook PN. Quantitative ultrasound measurements of bone: measurement error, discordance, and their effects on longitudinal studies. Osteoporos Int 2004; 15:619-24. [PMID: 14968291 DOI: 10.1007/s00198-004-1594-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2003] [Accepted: 12/01/2003] [Indexed: 11/28/2022]
Abstract
The performance of quantitative ultrasound (QUS) for the assessment of osteoporotic fracture must be fully defined if it is to be used in the clinical setting. We have examined the precision and reproducibility of two ultrasound instruments in 1,267 institutionalized elderly men and women (mean age 82.1 and 85.9 years, respectively). Measurement of BUA and VOS was reliable, least significant change for BUA being 2.4% and for VOS 0.3% using the CUBA McCue instrument and 2.7% for BUA using the Metra QUS-2. Importantly, age was not found to influence the precision of either parameter. Comparison of the instruments showed the QUS-2 measures BUA higher than the CUBA by 1.9 dB/MHz (+/-9.55 dB/MHz). Moreover classification of individuals as osteoporotic by machine-derived T-score was different between instruments (kappa = 0.44 in men and kappa = 0.62 in women). Fifty-six residents were remeasured by CUBA after 2.2 years; BUA was observed to decrease by 5.2% (+/-16.5%, p = 0.02) without significant change in VOS, suggesting BUA is more useful in longitudinal studies. In conclusion, ultrasound measurements were highly reliable and sensitive to longitudinal change even in the very elderly. However, diagnosis by T-score criteria was instrument specific, and such criteria should be interpreted with caution in the assessment of fracture risk.
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Affiliation(s)
- J Zochling
- Institute of Bone & Joint Research, University of Sydney, Australia
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Abstract
BACKGROUND Patients with osteoarthritis commonly use complementary and alternative medicines (CAM), either as an adjunct to or in place of conventional analgesics. OBJECTIVES To undertake a prospective investigation of the prevalence of CAM use for osteoarthritis and the direct costs incurred. METHODS The subjects were 341 patients with osteoarthritis of the knee or hip drawn from central and northern Sydney, Australia, and comprising 83 community based patients and 258 awaiting joint replacement. Information on CAM use was obtained from prospective three monthly diaries. Variables of interest included health related quality of life scores. Prospective out of pocket costs were recorded over a 12 month follow up period. RESULTS The prevalence of CAM use was 40%, which falls within the range of previous studies. Average annual expenditure on CAM was 32.25 Australian dollars (range 0 to 603.30). CAM users were more likely to be female (odds ratio (OR) 1.8 (95% confidence interval, 1.1 to 3.0)), reported a higher level of bodily pain (OR 0.97 (0.95 to 0.99)), and were less likely to purchase conventional analgesics (OR 3.3 (1.6 to 7.0)), either prescribed or over the counter. Vitamin supplementation was the most common CAM reported, followed by celery extract, fish oils, and garlic extracts. CONCLUSIONS There are no good quality clinical trials to support the use of most preparations purchased by patients with osteoarthritis. There is a need for patient education on the risks and benefits of complementary medicine in osteoarthritis.
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Affiliation(s)
- J Zochling
- Institute of Bone and Joint Research, University of Sydney, Australia.
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Sambrook PN, Chen JS, March LM, Cameron ID, Cumming RG, Lord SR, Zochling J, Sitoh YY, Lau TC, Schwarz J, Seibel MJ. Serum parathyroid hormone predicts time to fall independent of vitamin D status in a frail elderly population. J Clin Endocrinol Metab 2004; 89:1572-6. [PMID: 15070914 DOI: 10.1210/jc.2003-031782] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [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] [Indexed: 11/19/2022]
Abstract
Very frail older people constitute an increasing proportion of ageing populations and often have vitamin D deficiency. Falls are frequent in this population and have usually been associated with vitamin D deficiency. In this prospective study we measured serum 25-hydroxyvitamin D (25OHD), serum PTH, and falls in 637 ambulatory subjects living in institutional aged care facilities (intermediate-care hostels or nursing homes). The study sample comprised 121 men (mean age, 82.1 yr) and 516 women (mean age, 86.7 yr). Two hundred and seventy-four subjects fell one or more times over a mean duration of follow-up of 10.2 months. Vitamin D deficiency, defined as a serum 25OHD level below 39 nmol/liter was present in 73.6%. Baseline serum 25OHD and PTH were significantly associated with falls in univariate analyses. In multivariate analyses that also corrected for balance and health status, PTH remained a significant predictor of falls independent of 25OHD. Serum PTH is a predictor of time to first fall in the frail elderly independent of vitamin D status and measures of general health.
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Affiliation(s)
- P N Sambrook
- Institute of Bone and Joint Research, Department of Public Health, ANZAC Research Institute, University of Sydney, Prince of Wales Medical Research Institute, Sydney, New South Wales 2065, Australia.
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Zochling J, Sitoh YY, Lau TC, Cameron ID, Cumming RG, Lord SR, Schwarz J, Trube A, March LM, Sambrook PN. Quantitative ultrasound of the calcaneus and falls risk in the institutionalized elderly: sex differences and relationship to vitamin D status. Osteoporos Int 2002; 13:882-7. [PMID: 12415435 DOI: 10.1007/s001980200121] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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] [Indexed: 10/27/2022]
Abstract
Very frail older people constitute an increasing proportion of aging populations and are likely to contribute substantially to costs due to osteoporosis. Quantitative ultrasound (QUS) of the calcaneus is potentially a simple method for assessing fracture risk in frail elderly, but there have been few studies of male/female differences in QUS or its relationship to falls risk or vitamin D status, which is often subnormal in this population. We studied QUS, falls risk and serum 25(OH)-vitamin D in subjects living in institutional aged care facilities (hostels or nursing homes). The study sample comprised 294 men (mean age 81.2 years, range 65-102 years) and 899 women (mean age 86.7 years, range 65-104 years). Broadband ultrasound attenuation (BUA) and velocity of sound (VOS) were higher in men than women by approximately 30% and 2% respectively ( p<0.0001) and this difference was maintained at all ages. Serum 25(OH)D levels were higher in men than women ( p<0.001) but vitamin D deficiency was very common in both sexes and serum 25(OH)D was not associated with QUS in either sex. There was no significant decline in BUA or VOS with age in men; however, for women BUA declined by 2.8-4.7% per decade and VOS by 1% per decade (both p<0.001). Mean BUA T-scores were -1.55 and -2.48 at age 90 years in men and women. Quadriceps strength and weight but not serum 25(OH)D were significantly associated with BUA. These data suggest only minor loss occurs at the calcaneal site in BUA and VOS with very old age in either sex.
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Affiliation(s)
- J Zochling
- Institute of Bone & Joint Research, University of Sydney, Australia
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Abstract
The mechanism behind the inverse association between osteoporosis and osteoarthritis shown in large epidemiological studies remains unclear. Because both diseases often demonstrate a family history, the objective of the present study was to compare peak bone density in daughters categorized according to the presence or absence of hand osteoarthritis in their mothers. Radiographs of the hands were obtained in women aged 50-75 years from a well-defined community population group. X-rays were graded for hand osteoarthritis (OA) using the Kellgren and Lawrence criteria. In 60 daughters (mean age 33.6 years) of these women, bone mineral density (BMD) was measured at five regions of the hip and lumbar spine and quantitative ultrasound (QUS) at the calcaneus. Daughters whose mothers had hand OA (i.e., OA at either the carpometacarpal [CMC] or distal interphalageal [DIP] joints) had significantly higher mean BMD, when adjusted for body mass index (BMI) (5.1%-8.1%, p < 0.05), at all hip regions except the trochanter. However, differences in lumbar BMD and calcaneal QUS were not statistically significant. In multiple regression analysis, maternal hand OA status was found to be a significant predictor of daughters' hip BMD when daughters' BMI and mothers' BMD were included in the model. These findings suggest that the observation of higher BMD in older patients with OA may be due in part to achievement of a higher peak bone mass at some sites.
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Affiliation(s)
- V Naganathan
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia
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