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Hetland ML, Østergaard M, Stengaard-Pedersen K, Junker P, Ejbjerg B, Jacobsen S, Ellingsen T, Lindegaard H, Pødenphant J, Vestergaard A, Jurik AG, Krogh NS, Hørslev-Petersen K. Anti-cyclic citrullinated peptide antibodies, 28-joint Disease Activity Score, and magnetic resonance imaging bone oedema at baseline predict 11 years’ functional and radiographic outcome in early rheumatoid arthritis. Scand J Rheumatol 2018; 48:1-8. [DOI: 10.1080/03009742.2018.1466362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- ML Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO registry, Rigshospitalet, Glostrup, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - P Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - B Ejbjerg
- Department of Rheumatology, Zealand University Hospital, Køge, Denmark
| | - S Jacobsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - T Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - H Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - J Pødenphant
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte, Denmark
| | - A Vestergaard
- Department of Radiology, Hvidovre Hospital, Hvidovre, Denmark
| | - AG Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - NS Krogh
- ZiteLab ApS, Frederiksberg, Denmark
| | - K Hørslev-Petersen
- King Christian X’s Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark
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Herly M, Stengaard-Pedersen K, Hørslev-Petersen K, Hetland ML, Østergaard M, Christensen R, Løgstrup BB, Vestergaard P, Pødenphant J, Junker P, Ellingsen T. Association between baseline vitamin D metabolite levels and long-term cardiovascular events in patients with rheumatoid arthritis from the CIMESTRA trial: protocol for a cohort study with patient-record evaluated outcomes. BMJ Open 2017; 7:e014816. [PMID: 28391237 PMCID: PMC5541299 DOI: 10.1136/bmjopen-2016-014816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Cardiovascular morbidity and mortality is increased in patients with rheumatoid arthritis (RA), and among these patients, the prevalence of hypovitaminosis D is high. Moreover, low vitamin D levels have been associated with increased cardiovascular risk in healthy subjects. OBJECTIVE To evaluate the long-term risk of cardiovascular events in patients having low total 25-hydroxyvitamin D levels at baseline compared with patients with normal levels, in an efficiently treated, closed cohort of patients with an early diagnosis of RA. METHODS AND ANALYSIS This study is a prospective, closed, blinded endpoint cohort study, based on secondary analyses from a previous randomised trial (CIMESTRA study; NCT00209859, approved September 1999) including 160 patients with an early diagnosis of RA from Danish University clinics. Primary outcome will be the proportion of patients with any cardiovascular event in the follow-up period, evaluated using systematic journal audits. Logistic regression models will test the hypothesis that there are more cardiovascular events in enrolled patients with a low level of vitamin D (< 50 nmol/L). Secondarily, Cox regression models, based on survival analysis, will determine the extent to which independent variables (including different levels of vitamin D at baseline) predict whether a cardiovascular event will occur, and also when this will be. ETHICS AND DISSEMINATION All patients have received verbal and written information before enrolment, and have given written consent at baseline. To disseminate comprehension of factors of prognostic importance to cardiovascular outcome in RA, we will attempt to have a first draft ready no later than 1 year after the adjudication process has finished. If low vitamin D levels can predict cardiovascular events in RA, it is relevant to take into account in a prediction model, to be considered by patients, physicians and other decision-makers. TRIAL REGISTRATION NUMBER The parental controlled trial is registered as NCT00209859.
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Affiliation(s)
- M Herly
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - K Stengaard-Pedersen
- Department of Rheumatology, Centre of Cancer and Inflammation, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - K Hørslev-Petersen
- King Christian 10th Hospital for Rheumatic Diseases, Southern University of Denmark, Graasten, Denmark
| | - M L Hetland
- Department of Rheumatology, COPECARE, Copenhagen University Hospital, Glostrup, Denmark
| | - M Østergaard
- Department of Rheumatology, COPECARE, Copenhagen University Hospital, Glostrup, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - B B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - P Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University, Denmark
| | - J Pødenphant
- Department of Rheumatology, Copenhagen University Hospital, Gentofte, Denmark
| | - P Junker
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - T Ellingsen
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Møller-Bisgaard S, Ejbjerg BJ, Eshed I, Hørslev-Petersen K, Hetland ML, Jurik AG, Thomsen H, Torfing T, Stengaard-Pedersen K, Junker P, Krogh NS, Lottenburger T, Ellingsen T, Andersen LS, Skjødt H, Svendsen AJ, Tarp U, Hansen IT, Pødenphant J, Pedersen JK, Lindegaard H, Hanson LG, Vestergaard A, Glinatsi D, Østergaard M. Effect of a treat-to-target strategy based on methotrexate and intra-articular betamethasone with or without additional cyclosporin on MRI-assessed synovitis, osteitis, tenosynovitis, bone erosion, and joint space narrowing in early rheumatoid arthritis: results from a 2-year randomized double-blind placebo-controlled trial (CIMESTRA). Scand J Rheumatol 2016; 46:335-345. [PMID: 27775461 DOI: 10.1080/03009742.2016.1209550] [Citation(s) in RCA: 7] [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: 10/20/2022]
Abstract
OBJECTIVES To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients, and to investigate whether concomitant cyclosporin A (CyA) provides an additional effect. METHOD In the 2-year randomized, double-blind, treat-to-target trial CIMESTRA, 160 patients with eRA (< 6 months) were randomized to MTX, intra-articular betamethasone and CyA, or placebo CyA. A total of 129 patients participated in the MRI substudy, and had contrast-enhanced MR images of the non-dominant hand at months 0, 6, 12, and 24. MR images were evaluated for osteitis, synovitis, tenosynovitis, bone erosion, and joint space narrowing (JSN), using validated scoring methods. RESULTS Significant reductions were seen at 6 months in all inflammatory parameters [synovitis, mean change -1.6 (p < 0.001, Wilcoxon), tenosynovitis, -3.5 (p < 0.001), and osteitis, -1.3 (p < 0.05)] and at 12/24 months in synovitis and tenosynovitis [-1.6/-2.2 and -3.6/-3.8, respectively; all p < 0.001]. MRI signs of inflammation were not fully eliminated, and increases in erosion and JSN scores were observed at 6 months [0.4 (p < 0.01)/0.1 (p < 0.05)], 12 months [0.8 (p < 0.001)/0.3 (p < 0.01)], and 24 months [1.0 (p < 0.001)/0.4 (p < 0.001)]. Clinical measures decreased significantly (p < 0.001) at all time points. There were no consistent statistically significant differences between treatment groups. CONCLUSIONS In this eRA treat-to-target trial, MTX and intra-articular glucocorticoids markedly reduced, but did not eliminate, MRI osteitis, synovitis, and tenosynovitis. Accordingly, minimal but statistically significant increases in bone erosion and JSN were observed. No additional effect of CyA was demonstrated.
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Affiliation(s)
- S Møller-Bisgaard
- a Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases , Rigshospitalet , Glostrup , Denmark.,b Department of Rheumatology , Slagelse Hospital , Slagelse , Denmark
| | - B J Ejbjerg
- b Department of Rheumatology , Slagelse Hospital , Slagelse , Denmark
| | - I Eshed
- c Department of Radiology , Sheba Medical Centre , Tel Hashomer , Israel
| | - K Hørslev-Petersen
- d King Christian X's Hospital for Rheumatic Diseases , Graasten , Denmark
| | - M L Hetland
- a Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases , Rigshospitalet , Glostrup , Denmark.,e The DANBIO Registry, Centre for Rheumatology and Spine Diseases , Rigshospitalet , Glostrup , Denmark
| | - A G Jurik
- f Department of Radiology , Aarhus University Hospital , Aarhus , Denmark
| | - H Thomsen
- g Department of Radiology , Herlev-Gentofte University Hospital , Herlev , Denmark
| | - T Torfing
- h Department of Radiology , Odense University Hospital , Odense , Denmark
| | | | - P Junker
- j Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - N S Krogh
- k Zitelab ApS , Copenhagen , Denmark
| | - T Lottenburger
- l Department of Rheumatology , Vejle Hospital , Vejle , Denmark
| | - T Ellingsen
- j Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - L S Andersen
- m Department of Rheumatology , Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - H Skjødt
- a Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases , Rigshospitalet , Glostrup , Denmark
| | - A J Svendsen
- n Department of Epidemiology , Institute of Public Health, University of Southern Denmark , Odense , Denmark
| | - U Tarp
- i Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| | - I T Hansen
- i Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| | - J Pødenphant
- m Department of Rheumatology , Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - J K Pedersen
- j Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - H Lindegaard
- j Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - L G Hanson
- o Centre for Functional and Diagnostic Imaging and Research , Danish Research Centre for Magnetic Resonance (DRCMR), Copenhagen University Hospital Hvidovre , Hvidovre , Denmark.,p Biomedical Engineering, Elektro , Technical University of Denmark (DTU) , Lyngby , Denmark
| | - A Vestergaard
- q Department of Radiology , Copenhagen University Hospita Hvidovrel , Hvidovre , Denmark
| | - D Glinatsi
- a Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases , Rigshospitalet , Glostrup , Denmark
| | - M Østergaard
- a Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases , Rigshospitalet , Glostrup , Denmark
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Møller-Bisgaard S, Ejbjerg B, Eshed I, Hørslev-Petersen K, Hetland M, Jurik A, Thomsen H, Torfing T, Stengaard-Pedersen K, Junker P, Krogh N, Lottenburger T, Ellingsen T, Andersen L, Skjødt H, Svendsen A, Tarp U, Hansen I, Pødenphant J, Pedersen J, Lindegaard H, Vestergaard A, Glinatsi D, Østergaard M. FRI0547 Magnetic Resonance Imaging Joint Space Narrowing Is An Independent Predictor of Radiographic and MRI Damage Progression in Patients with Early Rheumatoid Arthritis: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3452] [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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Hørslev-Petersen K, Hetland ML, Ørnbjerg LM, Junker P, Pødenphant J, Ellingsen T, Ahlquist P, Lindegaard H, Linauskas A, Schlemmer A, Dam MY, Hansen I, Lottenburger T, Ammitzbøll CG, Jørgensen A, Krintel SB, Raun J, Johansen JS, Østergaard M, Stengaard-Pedersen K. Clinical and radiographic outcome of a treat-to-target strategy using methotrexate and intra-articular glucocorticoids with or without adalimumab induction: a 2-year investigator-initiated, double-blinded, randomised, controlled trial (OPERA). Ann Rheum Dis 2015; 75:1645-53. [PMID: 26489704 DOI: 10.1136/annrheumdis-2015-208166] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/29/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To study clinical and radiographic outcomes after withdrawing 1 year's adalimumab induction therapy for early rheumatoid arthritis (eRA) added to a methotrexate and intra-articular triamcinolone hexacetonide treat-to-target strategy (NCT00660647). METHODS Disease-modifying antirheumatic drug (DMARD)-naive patients with eRA started methotrexate (20 mg/week) and intra-articular triamcinolone (20 mg/ml) for 2 years. In addition, they were randomised to receive placebo adalimumab (DMARD group, n=91) or adalimumab (40 mg/every other week) (DMARD+adalimumab group, n=89) during the first year. Sulfasalazine and hydroxychloroquine were added if disease activity persisted after 3 months. During year 2, synthetic DMARDs continued. Adalimumab was (re)initiated if active disease reoccurred. Clinical response, remission, disability, quality of life and radiographic changes were assessed. RESULTS One year after adalimumab withdrawal, treatment profiles and clinical responses did not differ between groups. In the DMARD/DMARD+adalimumab groups, the median 2-year methotrexate dose was 20/20 mg/week (p=0.45), triple DMARD therapy had been initiated in 33/27 patients (p=0.49), adalimumab was (re)initiated in 12/12 patients and cumulative triamcinolone dose was 160/120 mg (p=0.15). The treatment target (disease activity score, 4 variables, C-reactive protein (DAS28CRP) ≤3.2 or DAS28>3.2 without swollen joints) was achieved at all visits in ≥85% of patients in year 2; remission rates were DAS28CRP<2.6:69%/66%; Clinical Disease Activity Index ≤2.8:55%/57%; Simplified Disease Activity Index <3.3:54%/49%; American College of Rheumatology/European League against Rheumatism (28 joints):44%/45% (p=0.66-1.00). Radiographic progression (Δtotal Sharp score/year) was similar 1.31/0.53 (p=0.12). Erosive progression (Δerosion score (ES)/year) was year 1:0.57/0.06 (p=0.02); year 2:0.38/0.05 (p=0.005). Proportion of patients without erosive progression (ΔES≤0) was year 1: 59%/76% (p=0.03); year 2:64%/79% (p=0.04). CONCLUSIONS An aggressive triamcinolone and synthetic DMARD treat-to-target strategy in eRA provided excellent 2-year clinical and radiographic disease control independent of adalimumab induction therapy. ES progression was slightly less during and following adalimumab induction therapy. TRIAL REGISTRATION NUMBER NCT00660647.
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Affiliation(s)
- K Hørslev-Petersen
- Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark Institute of Health Research, University of Southern Denmark, Gråsten, Denmark
| | - M L Hetland
- Department of Rheumatology, Copenhagen University Hospital Glostrup, Glostrup, Denmark Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark
| | - L M Ørnbjerg
- Department of Rheumatology, Copenhagen University Hospital Glostrup, Glostrup, Denmark Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark
| | - P Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - J Pødenphant
- Department of Rheumatology, Copenhagen University Hospital at Gentofte, Gentofte, Denmark
| | - T Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - P Ahlquist
- Department of Medicine, Vejle Regional Hospital, Vejle, Denmark
| | - H Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - A Linauskas
- Department of Rheumatology, Vendsyssel Hospital, Hjørring, Denmark
| | - A Schlemmer
- Department of Rheumatology, Aalborg Hospital, Aalborg, Denmark
| | - M Y Dam
- Diagnostic Centre, Silkeborg Region Hospital, Silkeborg, Denmark
| | - I Hansen
- Department of Rheumatology, Viborg Regional Hospital, Viborg, Denmark
| | - T Lottenburger
- Department of Rheumatology, Vendsyssel Hospital, Hjørring, Denmark
| | - C G Ammitzbøll
- Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
| | - A Jørgensen
- Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
| | - S B Krintel
- Department of Rheumatology, Copenhagen University Hospital Glostrup, Glostrup, Denmark Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark
| | - J Raun
- Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark Institute of Health Research, University of Southern Denmark, Gråsten, Denmark
| | - J S Johansen
- Departments of Medicine and Oncology, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - M Østergaard
- Department of Rheumatology, Copenhagen University Hospital Glostrup, Glostrup, Denmark Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark
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Møller-Bisgaard S, Ejbjerg B, Eshed I, Hørslev-Petersen K, Jurik A, Vallø J, Thomsen H, Torfing T, Stengaard-Pedersen K, Hetland M, Junker P, Krogh N, Lottenburger T, Ellingsen T, Andersen L, Hansen I, Skjødt H, Svendsen A, Tarp U, Pødenphant J, Pedersen J, Lindegaard H, Østergaard M. FRI0607 Effect of Methotrexate and Intra-Articular Betamethasone with or Without Additional Cyclosporine on Magnetic Resonance Imaging (MRI)-Determined Inflammatory and Destructive Changes in Very Early Rheumatoid Arthritis – Results from a 24-Months' Randomised Double Blind Placebo Controlled Trial. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ammitzbøll CG, Steffensen R, Bøgsted M, Hørslev-Petersen K, Hetland ML, Junker P, Johansen JS, Pødenphant J, Østergaard M, Ellingsen T, Stengaard-Pedersen K. CRP genotype and haplotype associations with serum C-reactive protein level and DAS28 in untreated early rheumatoid arthritis patients. Arthritis Res Ther 2014; 16:475. [PMID: 25359432 PMCID: PMC4247621 DOI: 10.1186/s13075-014-0475-3] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 10/17/2014] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Single-nucleotide polymorphisms (SNPs) in the CRP gene are implicated in the regulation of the constitutional C-reactive protein (CRP) expression and its response to proinflammatory stimuli. Previous reports suggest that these effects may have an impact on clinical decision-making tools based on CRP, such as the Disease Activity Score in 28 joints (DAS28). We aimed to investigate the possible association between seven CRP SNPs, their haplotypes and the serum levels of CRP, as well as DAS28 scores, in two cohorts of untreated active early rheumatoid arthritis (RA) patients followed during their initial treatment. METHODS Overall, 315 patients with RA from two randomized controlled trials (the CIMESTRA and OPERA trials) who were naïve to disease-modifying antirheumatic drugs and steroids with disease durations less than 6 months were included. Seven CRP SNPs were investigated: rs11265257, rs1130864, rs1205, rs1800947, rs2808632, rs3093077 and rs876538. The genotype and haplotype associations with CRP and DAS28 levels were evaluated using linear regression analysis adjusted for age, sex and treatment. RESULTS The minor allele of rs1205 C > T was associated with decreased CRP levels at baseline (P = 0.03), with the TT genotype having a 50% reduction in CRP from 16.7 to 8.4 mg/L (P = 0.005) compared to homozygosity of the major allele, but no association was observed at year 1 (P = 0.38). The common H2 haplotype, characterized by the T allele of rs1205, was associated with a 26% reduction in CRP at baseline (P = 0.043), although no effect was observed at year 1 (P = 0.466). No other SNP or haplotype was associated with CRP at baseline or at year 1 (P ≥ 0.09). We observed no associations between SNPs or haplotypes and DAS28 scores at baseline or at year 1 (P ≥ 0.10). CONCLUSION CRP genotype and haplotype were only marginally associated with serum CRP levels and had no association with the DAS28 score. This study shows that DAS28, the core parameter for inflammatory activity in RA, can be used for clinical decision-making without adjustment for CRP gene variants. TRIAL REGISTRATION The OPERA study is registered at Clinicaltrials.gov (NCT00660647). The CIMESTRA study is not listed in a clinical trials registry, because patients were included between October 1999 and October 2002.
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Affiliation(s)
- Christian Gytz Ammitzbøll
- />Department of Rheumatology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- />Department of Medicine, Randers Regional Hospital, Skovlyvej 1, 8930 Randers, Denmark
| | - Rudi Steffensen
- />Department of Clinical Immunology, Aalborg University Hospital, Urbansgade 32, 9000 Aalborg, Denmark
| | - Martin Bøgsted
- />Department of Haematology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark
- />Department of Mathematical Sciences, Aalborg University, Fredrik Bajers Vej 7G, 9220 Aalborg, Denmark
| | - Kim Hørslev-Petersen
- />King Christian 10th Hospital for Rheumatic Diseases, Toldbodgade 3, 6300 Gråsten, Denmark
- />South Jutland Hospital, Institute of Regional Health Services Research, University of Southern Denmark, Winsløwparken 19, Odense M, Denmark
| | - Merete L Hetland
- />Copenhagen Center for Arthritis Research, Glostrup Hospital, Glostrup, Nordre Ringvej 57, 2600 Copenhagen, Denmark
- />Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Peter Junker
- />Department of Rheumatology C, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Julia S Johansen
- />Department of Medicine and Oncology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
- />Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Jan Pødenphant
- />Copenhagen University at Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Mikkel Østergaard
- />Copenhagen Center for Arthritis Research, Glostrup Hospital, Glostrup, Nordre Ringvej 57, 2600 Copenhagen, Denmark
- />Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Torkell Ellingsen
- />Department of Rheumatology C, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- />Department of Medicine, Silkeborg Regional Hospital, Falkevej 3, 8600 Silkeborg, Denmark
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Krol A, Garred P, Heegaard NHH, Christensen AF, Hetland ML, Stengaard-Pedersen K, Junker P, Madsen HO, Lottenburger T, Ellingsen T, Andersen LS, Hansen I, Pedersen JK, Svendsen AJ, Tarp U, Pødenphant J, Lindegaard H, Østergaard M, Hørslev-Petersen K, Jacobsen S. Interactions between smoking, increased serum levels of anti-CCP antibodies, rheumatoid factors, and erosive joint disease in patients with early, untreated rheumatoid arthritis. Scand J Rheumatol 2014; 44:8-12. [PMID: 25205362 DOI: 10.3109/03009742.2014.918651] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine to what extent shared epitopes, smoking, and anti-cyclic citrullinated peptide (anti-CCP) antibodies are associated with disease activity and erosive disease in patients with rheumatoid arthritis (RA) at disease onset. METHOD RA patients not previously treated with disease-modifying anti-rheumatic drugs (DMARDs) and with a disease duration of < 6 months (CIMESTRA study) were examined for shared epitopes, anti-CCP antibodies, immunoglobulin M rheumatoid factor (IgM-RF) and IgA-RF, radiographic erosive changes in hands and feet, and clinical disease activity. RESULTS The study comprised 153 patients, of whom 104 (68%) were ever-smokers. The prevalence of patients with 0, 1, or 2 shared epitopes was 40 (48%), 71 (49%), and 33 (23%), respectively. Anti-CCP antibodies, IgM-RF, and IgA-RF were present in 89 (58%), 99 (65%), and 82 (54%) patients, respectively. Among smokers, erosive disease was associated with anti-CCP antibodies [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.6-9.3], IgM-RF (OR 4.9, 95% CI 1.9-12), and IgA-RF (OR 2.8, 95% CI 1.2-6.4) but absent with regard to shared epitopes. Among never-smokers, erosive disease was not associated with either shared epitopes or antibodies. All antibody levels measured were associated with smoking and shared epitopes. CONCLUSIONS Shared epitopes and smoking were associated with the production of anti-CCP antibodies and rheumatoid factors of IgM and IgA isotypes, which again were associated with erosive disease at presentation only in smokers. As shared epitopes and smoking were not directly associated with erosive disease, smoking may enhance the development of erosive disease in RA at different levels or through separate pathways.
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Affiliation(s)
- A Krol
- Department of Infectious Diseases and Rheumatology, Rigshospitalet , Copenhagen , Denmark
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Ammitzbøll C, Steffensen R, Bøgsted M, Hørslev-Petersen K, Hetland M, Junker P, Pødenphant J, Østergaard M, Ellingsen T, Johansen J, Stengaard-Pedersen K. AB0001 Genotype and Haplotype Effects of 7 Single-Nucleotide Polymorphisms in the CRP Gene on Levels of C-Reactive Protein and DAS28 in Two Cohorts of Treatment NaÏVe, Recent Onset Rheumatoid Arthritis Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1357] [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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Hørslev-Petersen K, Hetland ML, Junker P, Pødenphant J, Ellingsen TJ, Ahlqvist P, Lindegaard HM, Linauskas A, Schlemmer A, Dam MY, Hansen I, Lottenburger T, Jørgensen A, Krintel SB, Raun J, Ammitzbøll CG, Johansen JS, Østergaard M, Stengaard-Pedersen K. THU0212 Improved Remission Rates Acquired by Adding Adalimumab to Methotrexate and Intraarticular Glucocorticoid Cannot be Maintained after Withdrawal of Adalimumab. A 2-Year Investigator Initiated Randomised, Controlled Study on Early Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ammitzbøll C, Jensenius J, Ellingsen T, Thiel S, Hørslev-Petersen K, Hetland M, Junker P, Johansen J, Østergaard M, Pødenphant J, Stengaard-Pedersen K. OP0223 M-ficolin, an activator of the complement system, predicts DAS28 remission in early DMARD naïve rheumatoid arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.1906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Axelsen MB, Eshed I, Hørslev-Petersen K, Stengaard-Pedersen K, Hetland ML, Møller J, Junker P, Pødenphant J, Schlemmer A, Ellingsen T, Ahlquist P, Lindegaard H, Linauskas A, Dam MY, Hansen I, Horn HC, Ammitzbøll CG, Jørgensen A, Krintel SB, Raun J, Krogh NS, Johansen JS, Østergaard M. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis: results from the OPERA randomised controlled trial. Ann Rheum Dis 2014; 74:867-75. [PMID: 24412895 DOI: 10.1136/annrheumdis-2013-204537] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/15/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate whether a treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid injections suppresses MRI inflammation and halts structural damage progression in patients with early rheumatoid arthritis (ERA), and whether adalimumab provides an additional effect. METHODS In a double-blind, placebo-controlled trial, 85 disease-modifying antirheumatic drug-naïve patients with ERA were randomised to receive methotrexate, intra-articular glucocorticosteroid injections and placebo/adalimumab (43/42). Contrast-enhanced MRI of the right hand was performed at months 0, 6 and 12. Synovitis, osteitis, tenosynovitis, MRI bone erosion and joint space narrowing (JSN) were scored with validated methods. Dynamic contrast-enhanced MRI (DCE-MRI) was carried out in 14 patients. RESULTS Synovitis, osteitis and tenosynovitis scores decreased highly significantly (p<0.0001) during the 12-months' follow-up, with mean change scores of -3.7 (median -3.0), -2.2 (-1) and -5.3 (-4.0), respectively. No overall change in MRI bone erosion and JSN scores was seen, with change scores of 0.1 (0) and 0.2 (0). The tenosynovitis score at month 6 was significantly lower in the adalimumab group, 1.3 (0), than in the placebo group, 3.9 (2), Mann-Whitney: p<0.035. Furthermore, the osteitis score decreased significantly during the 12-months' follow-up in the adalimumab group, but not in the placebo group, Wilcoxon: p=0.001-0.002 and p=0.062-0.146. DCE-MRI parameters correlated closely with conventional MRI inflammatory parameters. Clinical measures decreased highly significantly during follow-up. CONCLUSIONS A treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid in patients with ERA effectively decreased synovitis, osteitis and tenosynovitis and halted structural damage progression as judged by MRI. The findings suggest that addition of adalimumab is associated with further suppression of osteitis and tenosynovitis.
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Affiliation(s)
- Mette Bjørndal Axelsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Iris Eshed
- Department of Radiology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | - Kim Hørslev-Petersen
- King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark South Jutland Hospital, Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | | | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark The DANBIO Registry, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark
| | - Jakob Møller
- Department of Radiology, Copenhagen University Hospital at Herlev, Copenhagen, Denmark
| | - Peter Junker
- Department of Rheumatology C, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jan Pødenphant
- Department of Rheumatology, Copenhagen University Hospital at Gentofte, Gentofte, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annette Schlemmer
- Department of Rheumatology, Aarhus University Hospital in Aalborg, Aalborg, Denmark
| | | | - Palle Ahlquist
- Department of Medicine, Vejle Regional Hospital, Vejle, Denmark
| | - Hanne Lindegaard
- Department of Rheumatology C, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Asta Linauskas
- Department of Rheumatology, Vendsyssel Hospital, Hjørring, Denmark
| | - Mette Yde Dam
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ib Hansen
- Department of Rheumatology, Viborg Regional Hospital, Viborg, Denmark
| | | | | | - Anette Jørgensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Sophine B Krintel
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark
| | - Johnny Raun
- King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark South Jutland Hospital, Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | | | - Julia Sidenius Johansen
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark Department of Medicine and Oncology, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark The DANBIO Registry, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark
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Krintel SB, Dehlendorff C, Hetland ML, Hørslev-Petersen K, Andersen KK, Junker P, Pødenphant J, Ellingsen T, Ahlqvist P, Lindegaard HM, Linauskas A, Schlemmer A, Dam MY, Hansen I, Horn HC, Jørgensen A, Raun J, Ammitzbøll CG, Østergaard M, Stengaard-Pedersen K, Johansen JS. SAT0016 Microrna Expression Profiles as Biomarkers for Prediction of Treatment Response to Adalimumab in Patients with Early Rheumatoid Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1742] [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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Hørslev-Petersen K, Hetland M, Junker P, Pødenphant J, Ellingsen T, Ahlquist P, Lindegaard H, Linauskas A, Schlemmer A, Dam M, Hansen I, Horn H, Jørgensen A, Krintel S, Raun J, Ammitzbøll C, Johansen J, Østergaard M, Stengaard-Pedersen K. FRI0148 Remission rates increase substantially by adding adalimumab to methotrexate and intra-articular glucocorticoid in patients with early rheumatoid arthritis - 1-year results of investigator-initiated, double-blinded randomized clinical trial (OPERA):. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2605] [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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Jensen TW, Hansen MS, Hørslev-Petersen K, Hyldstrup L, Abrahamsen B, Langdahl B, Zerahn B, Pødenphant J, Stengaard-Petersen K, Junker P, Østergaard M, Lottenburger T, Ellingsen T, Andersen LS, Hansen I, Skjødt H, Pedersen JK, Lauridsen UB, Svendsen AJ, Tarp U, Lindegaard H, Jurik AG, Vestergaard A, Hetland ML. Periarticular and generalised bone loss in patients with early rheumatoid arthritis: influence of alendronate and intra-articular glucocorticoid treatment. Post hoc analyses from the CIMESTRA trial. Ann Rheum Dis 2013; 73:1123-9. [DOI: 10.1136/annrheumdis-2012-203171] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hørslev-Petersen K, Hetland ML, Junker P, Pødenphant J, Ellingsen T, Ahlquist P, Lindegaard H, Linauskas A, Schlemmer A, Dam MY, Hansen I, Horn HC, Ammitzbøll CG, Jørgensen A, Krintel SB, Raun J, Johansen JS, Østergaard M, Stengaard-Pedersen K. Adalimumab added to a treat-to-target strategy with methotrexate and intra-articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA Study: an investigator-initiated, randomised, double-blind, parallel-group, placebo-controlled trial. Ann Rheum Dis 2013; 73:654-61. [PMID: 23434570 DOI: 10.1136/annrheumdis-2012-202735] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES An investigator-initiated, double-blinded, placebo-controlled, treat-to-target protocol (Clinical Trials:NCT00660647) studied whether adalimumab added to methotrexate and intra-articular triamcinolone as first-line treatment in early rheumatoid arthritis (ERA) increased the frequency of low disease activity (DAS28CRP<3.2) at 12 months. METHODS In 14 Danish hospital-based clinics, 180 disease-modifying anti-rheumatic drugs (DMARD)-naïve ERA patients (<6 months duration) received methotrexate 7.5 mg/week (increased to 20 mg/week within 2 months) plus adalimumab 40 mg every other week (adalimumab-group, n=89) or methotrexate+placebo-adalimumab (placebo-group, n=91). At all visits, triamcinolone was injected into swollen joints (max. four joints/visit). If low disease activity was not achieved, sulfasalazine 2 g/day and hydroxychloroquine 200 mg/day were added after 3 months, and open-label biologics after 6-9 months. Efficacy was assessed primarily on the proportion of patients who reached treatment target (DAS28CRP<3.2). Secondary endpoints included DAS28CRP, remission, Health Assessment Questionnaire (HAQ), EQ-5D and SF-12. Analysis was by intention-to-treat with last observation carried forward. RESULTS Baseline characteristics were similar between groups. In the adalimumab group/placebo group the 12-month cumulative triamcinolone doses were 5.4/7.0 ml (p=0.08). Triple therapy was applied in 18/27 patients (p=0.17). At 12 months, DAS28CRP<3.2 was reached in 80%/76% (p=0.65) and DAS28CRP was 2.0 (1.7-5.2) (medians (5th/95th percentile ranges)), versus 2.6 (1.7-4.7) (p=0.009). Remission rates were: DAS28CRP<2.6: 74%/49%, Clinical Disease Activity Index≤2.8: 61%/41%, Simplified Disease Activity Index<3.3: 57%/37%, European League Against Rheumatism/American College of Rheumatology Boolean: 48%/30% (0.0008<p<0.014, number-needed-to-treat: 4.0-5.4). Twelve months HAQ, SF12PCS and EQ-5D improvements were most pronounced in the adalimumab group. Treatments were well tolerated. CONCLUSIONS Adalimumab added to methotrexate and intra-articular triamcinolone as first-line treatment did not increase the proportion of patients who reached the DAS28CRP<3.2 treatment target, but improved DAS28CRP, remission rates, function and quality of life in DMARD-naïve ERA.
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Affiliation(s)
- Kim Hørslev-Petersen
- Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, , Gråsten, Denmark; South Jutland Hospital, Institute of Regional Health Services Research, University of Southern Denmark, , Odense, Denmark
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Nguyen MTT, Pødenphant J, Ravn P. Three cases of severely disseminated Staphylococcus aureus infection in patients treated with tocilizumab. BMJ Case Rep 2013; 2013:bcr-2012-007413. [PMID: 23283607 DOI: 10.1136/bcr-2012-007413] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report three cases of severe disseminated Staphylococcus aureus infection in patients with rheumatoid arthritis (RA) treated with tocilizumab. Tocilizumab is a new drug, unknown to most internists, and injections given weeks before admission may not be considered by the patient as part of their 'current medical treatment', and the physician may not be aware that the patient is severely immunosuppressed. Severe infections in RA patients treated with tocilizumab may present with mild symptoms despite severe and disseminated infection and, as these patients are severely immunodeficient-intensive diagnostic work-up and early treatment should be performed. Systematic postmarketing studies are needed to clarify if there is a true increased risk of disseminated S aureus infections. We suggest caution when prescribing tocilizumab to patients with prosthetic joints and/or prior invasive S aureus infections and that patients are taught to inform health staff about their medication history and their increased risk of infection.
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Affiliation(s)
- Mai T T Nguyen
- Department of Infectious Diseases, University Hospital, Odense, Denmark
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Ostergaard M, Møller Døhn U, Duer-Jensen A, Hetland ML, Hørslev-Petersen K, Stengaard-Pedersen K, Junker P, Pødenphant J, Ejbjerg B. Patterns of magnetic resonance imaging bone erosion in rheumatoid arthritis--which bones are most frequently involved and show the most change? J Rheumatol 2012; 38:2014-7. [PMID: 21885509 DOI: 10.3899/jrheum.110416] [Citation(s) in RCA: 11] [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: 10/17/2022]
Abstract
OBJECTIVE To investigate by magnetic resonance imaging (MRI) which bones in wrists and metacarpophalangeal (MCP) joints most frequently show bone erosions, and which most frequently demonstrate erosive progression, in early and established rheumatoid arthritis (RA). METHODS MRI datasets from 258 RA patients [126 with early RA (disease duration < 6 months)] were analyzed, of whom 223, including 126 with early RA, had 1-year followup MRI. All patients had MRI of one wrist, whereas 86 patients had additional images of 2nd-5th MCP joints, and 46 patients additional images of the contralateral wrist. MRI were evaluated blinded by one reader, according to the OMERACT RA MRI scoring system (RAMRIS) for erosions, and presence/absence of erosions was noted in each bone, as was presence/absence of erosive progression. RESULTS The capitate, ulna, lunate, triquetrum, and scaphoid were the 5 bones with both most frequent baseline erosions and most frequently demonstrated erosive progression. No bones were without erosions. Patterns of erosions and progression were similar in early and established RA. No major difference between dominant and nondominant wrists was detected. In the fingers, the 2nd-3rd MCP joint most frequently displayed erosions and erosive progression. CONCLUSION The distribution and frequency of bone erosion and erosive progression as detected by MRI in RA wrists and MCP joints were identified. No pattern differences between early versus established disease and dominant versus nondominant sides were detected. No bones showed erosive progression. Thus, no self-evident simplification of the RAMRIS erosion score was identified. Bone involvement patterns may be considered, when joints are selected for MRI protocols for clinical trials and practice.
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Affiliation(s)
- Mikkel Ostergaard
- Department of Rheumatology and Department of Radiology, Copenhagen University Hospital at Glostrup, Copenhagen.
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Hetland ML, Østergaard M, Ejbjerg B, Jacobsen S, Stengaard-Pedersen K, Junker P, Lottenburger T, Hansen I, Andersen LS, Tarp U, Svendsen A, Pedersen JK, Skjødt H, Ellingsen T, Lindegaard H, Pødenphant J, Hørslev-Petersen K. Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP. Ann Rheum Dis 2012; 71:851-6. [PMID: 22302316 DOI: 10.1136/annrheumdis-2011-200632] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA). METHODS During 2 years of follow-up in the CIMESTRA trial, 160 patients received intra-articular betamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested. RESULTS 1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not. CONCLUSION In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.
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Teilmann G, Boisen K, Pødenphant J, Zak M, Nielsen S. Transfer-consultations for young people: how do we do? Pediatr Rheumatol Online J 2011. [PMCID: PMC3194638 DOI: 10.1186/1546-0096-9-s1-p272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Glintborg B, Hesse U, Houe T, Claus Munk J, Pødenphant J, Zerahn B. Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors. Adv Orthop 2010; 2011:468717. [PMID: 21991414 PMCID: PMC3170766 DOI: 10.4061/2011/468717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 08/17/2010] [Accepted: 10/11/2010] [Indexed: 12/01/2022] Open
Abstract
We aimed to determine whether the Emergency Department (ED) is a suitable entrance point for osteoporosis screening among fallers without concomitant fracture compared to referral from general practice. Furthermore, to identify factors associated with osteoporosis among fallers. Methods. Patients aged 50-80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3 cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous fracture P = .044, height reduction P = .0016). The osteoporosis frequency among fallers from ED did not differ from a similarly aged patient-group referred from general practice (P = .34). Conclusion. Osteodensitometry should be considered among fallers without fracture presenting in the ED, especially if the patient has a prior fracture or declined body height. Since fallers generally have higher fracture risk, the ED might serve as an additional entrance to osteodensitometry compared to referral from primary care.
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Affiliation(s)
- Bente Glintborg
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark
- Department of Rheumatology and Internal Medicine, 2900 Hellerup, Gentofte Hospital, Denmark
| | - Ulrik Hesse
- Danish Medicines Agency, 2300 Copenhagen, Denmark
| | - Thomas Houe
- Department of Orthopaedic Surgery, 2730 Herlev Hospital, Denmark
| | | | - Jan Pødenphant
- Department of Rheumatology and Internal Medicine, 2900 Hellerup, Gentofte Hospital, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark
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Christensen AF, Hørslev-Petersen K, Christgau S, Lindegaard HM, Lottenburger T, Junker K, Hetland ML, Stengaard-Pedersen K, Jacobsen S, Ellingsen T, Andersen LS, Hansen I, Skjødt H, Pedersen JK, Lauridsen UB, Svendsen AJ, Tarp U, Pødenphant J, Heegaard NHH, Vestergaard A, Jurik AG, Ostergaard M, Junker P. Uncoupling of collagen II metabolism in newly diagnosed, untreated rheumatoid arthritis is linked to inflammation and antibodies against cyclic citrullinated peptides. J Rheumatol 2010; 37:1113-20. [PMID: 20436079 DOI: 10.3899/jrheum.091265] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the relationship between markers of collagen II synthesis and degradation with disease activity measures, autoantibodies, and radiographic outcomes in a 4-year protocol on patients with early rheumatoid arthritis (RA) who are naïve to disease-modifying antirheumatic drugs. METHODS One hundred sixty patients with newly diagnosed, untreated RA entered the Cyclosporine, Methotrexate, Steroid in RA (CIMESTRA) trial. Disease activity and radiograph status were measured at baseline and 4 years. The N-terminal propeptide of collagen IIA (PIIANP) and the cross-linked C-telopeptide of collagen II (CTX-II) were quantified at baseline by ELISA. PIIANP was also assayed at 2 and 4 years. Anticyclic citrullinated peptide (anti-CCP) was recorded at baseline. An uncoupling index for cartilage collagen metabolism was calculated from PIIANP and CTX-II measurements. RESULTS PIIANP was low at diagnosis and 4 years on (p < 0.001), irrespective of treatment and disease activity. PIIANP was lowest in anti-CCP positive patients (p = 0.006), and there was a negative correlation between PIIANP and anti-CCP titers (rho = -0.25, p 0.002). CTX-II was increased (p < 0.001) and correlated positively with disease activity and radiographic progression, but not with anti-CCP (p = 0.93). The uncoupling index was not superior to CTX-II in predicting radiographic changes. CONCLUSION These results suggest that cartilage collagen formation and degradation are unbalanced when RA is diagnosed. The different associations of collagen II anabolism (PIIANP) and collagen II degradation (CTX-II) with anti-CCP, synovitis, and radiographic progression indicate that at this early stage of RA, cartilage collagen degradation is mainly driven by synovitis, while anti-CCP antibodies may interfere with cartilage regeneration by inhibiting collagen IIA formation. Trial registration j.nr NCT00209859.
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Affiliation(s)
- Anne Friesgaard Christensen
- Department of Rheumatology at Odense University Hospital and Institute of Clinical Research, Medical Biotechnology Centre, University of Southern Denmark, Odense, Denmark.
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Christensen AF, Sørensen GL, Hørslev-Petersen K, Holmskov U, Lindegaard HM, Junker K, Hetland ML, Stengaard-Pedersen K, Jacobsen S, Lottenburger T, Ellingsen T, Andersen LS, Hansen I, Skjødt H, Pedersen JK, Lauridsen UB, Svendsen A, Tarp U, Pødenphant J, Vestergaard A, Jurik AG, Østergaard M, Junker P. Circulating surfactant protein -D is low and correlates negatively with systemic inflammation in early, untreated rheumatoid arthritis. Arthritis Res Ther 2010; 12:R39. [PMID: 20211020 PMCID: PMC2888186 DOI: 10.1186/ar2948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/11/2010] [Accepted: 03/08/2010] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Surfactant protein D (SP-D) is a collectin with immuno-regulatory functions, which may depend on oligomerization. Anti-microbial and anti-inflammatory properties have been attributed to multimeric SP-D variants, while trimeric subunits per se have been suggested to enhance inflammation. Previously, we reported low circulating SP-D in early rheumatoid arthritis (RA), and the present investigation aims to extend these data by serial SP-D serum measurements, studies on synovial fluid, SP-D size distribution and genotyping in patients with early RA. METHODS One-hundred-and-sixty disease-modifying antirheumatic drug (DMARD) naïve RA patients with disease duration less than six months were studied prospectively for four years (CIMESTRA (Ciclosporine, Methotrexate, Steroid in RA) trial) including disease activity measures (C-reactive protein, joint counts and Health Assessment Questionnaire (HAQ) score), autoantibodies, x-ray findings and SP-D. SP-D was quantified by enzyme-linked immunosorbent assay (ELISA) and molecular size distribution was assessed by gel filtration chromatography. Further, SP-D Met11Thr single nucleotide polymorphism (SNP) analysis was performed. RESULTS Serum SP-D was significantly lower in RA patients at baseline compared with healthy controls (P < 0.001). SP-D increased slightly during follow-up (P < 0.001), but was still subnormal at four years after adjustment for confounders (P < 0.001). SP-D in synovial fluid was up to 2.5-fold lower than in serum. While multimeric variants were detected in serum, SP-D in synovial fluid comprised trimeric subunits only. There were no significant associations between genotype distribution and SP-D. Baseline SP-D was inversely associated to CRP and HAQ score. A similar relationship was observed regarding temporal changes in SP-D and CRP (zero to four years). SP-D was not associated to x-ray findings. CONCLUSIONS This study confirms that circulating SP-D is persistently subnormal in early and untreated RA despite a favourable therapeutic response obtained during four years of follow-up. SP-D correlated negatively to disease activity measures, but was not correlated with x-ray progression or SP-D genotype. These observations suggest that SP-D is implicated in RA pathogenesis at the protein level. The exclusive presence of trimeric SP-D in affected joints may contribute to the maintenance of joint inflammation. TRIAL REGISTRATION (j.nr NCT00209859).
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Pødenphant J, Christiansen C, Catherwood BD, Deftos LJ. Serum bone Gla protein and other biochemical estimates of bone turnover in early postmenopausal women during prophylactic treatment for osteoporosis. Acta Med Scand 2009; 218:329-33. [PMID: 3907290 DOI: 10.1111/j.0954-6820.1985.tb06133.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Serum bone Gla protein (BGP) and conventional biochemical indices of bone metabolism were determined in 66 early postmenopausal women during a double-blind therapeutic trial performed to investigate the effect of oestrogen, calcium and 1,25 (OH)2D3 on postmenopausal osteoporosis. The biochemical variables were determined before, during and after withdrawal of therapy. We found a very high correlation between serum BGP and serum alkaline phosphatase--a measure of bone formation, less high correlation between serum BGP and the remaining parameters--indices of bone resorption. It is concluded that serum BGP probably reflects bone formation and may prove to be a useful new biochemical marker.
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Jacobsen S, Garred P, Madsen HO, Heegaard NHH, Hetland ML, Stengaard-Pedersen K, Junker P, Lottenburger T, Ellingsen T, Smedegaard Andersen L, Hansen I, Skjødt H, Pedersen JK, Lauridsen UB, Svendsen AJ, Tarp U, Pødenphant J, Lindegaard H, Vestergaard A, Østergaard M, Hørslev-Petersen K. Mannose-binding lectin gene polymorphisms are associated with disease activity and physical disability in untreated, anti-cyclic citrullinated peptide-positive patients with early rheumatoid arthritis. J Rheumatol 2009; 36:731-5. [PMID: 19273450 DOI: 10.3899/jrheum.080846] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the association between polymorphisms in the mannose-binding lectin gene (MBL2) and disease activity, physical disability, and joint erosions in patients with newly diagnosed rheumatoid arthritis (RA). METHODS Patients with early RA (n=158) not previously treated with disease modifying antirheumatic drugs, participating in a treatment trial (CIMESTRA study) were examined at inclusion for MBL2 pooled structural genotypes (O/O, A/O, A/A), regulatory MBL2 promoter polymorphism in position -221 (XX, XY, YY), anti-cyclic citrullinated peptide 2 antibodies (anti-CCP2), disease activity by Disease Activity Score-28 (DAS28 score), physical disability by Health Assessment Questionnaire (HAQ) score, and erosive changes in hands and feet (Sharp-van der Heijde score). RESULTS Eight patients were homozygous MBL2 defective (O/O), 101 belonged to an intermediate group, and 49 were MBL2 high producers (YA/YA). Anti-CCP was present in 93 patients (59%). High scores of disease activity, C-reactive protein-based DAS28 (p=0.02), and physical disability by HAQ (p=0.01) were associated with high MBL2 expression genotypes in a gene-dose dependent way, but only in anti-CCP-positive patients. At this early stage of the disease there was no association with erosion score from radiographs. CONCLUSION The results point to a synovitis-enhancing effect of MBL in anti-CCP-positive RA, whereas such an effect was not demonstrated for joint erosions.
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Affiliation(s)
- Søren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Hetland ML, Lindegaard HM, Hansen A, Pødenphant J, Unkerskov J, Ringsdal VS, Østergaard M, Tarp U. Do changes in prescription practice in patients with rheumatoid arthritis treated with biological agents affect treatment response and adherence to therapy? Results from the nationwide Danish DANBIO Registry. Ann Rheum Dis 2008; 67:1023-6. [PMID: 18272669 DOI: 10.1136/ard.2007.087262] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prescription practice for tumour necrosis factor alpha (TNFalpha) inhibitors has changed towards treating patients with lower disease activity. OBJECTIVE To determine the trend in treatment response in cohorts of patients with rheumatoid arthritis who started TNFalpha inhibitor treatment between 2000 and 2005. METHODS 1813 patients with RA starting treatment with biological agents in 2000-5 were registered prospectively in the nationwide DANBIO Registry. Baseline disease activity and 12 months' treatment responses were determined in cohorts based on start year (2000/1; 2002; 2003; 2004; 2005). RESULTS Despite decreasing baseline disease activity from the 2000/2001 cohort to 2005 cohort (28-joint count Disease Activity Score (DAS28): from 5.9 to 5.3 (p<0.001)), the 12 months' DAS improvement increased from 1.8 units (2000/2001 cohort) to 2.2 units (2005 cohort) (p<0.001). The fraction with good EULAR response increased from 28% (2000/2001 cohort) to 50% (2005 cohort); the fraction with no response decreased from 29% (2000/2001 cohort) to 16% (2005 cohort). ACR20/50/70 response rates increased from 53%/31%/13% (2000/2001 cohort) to 69%/51%/30% (2005 cohort). After correction for withdrawals, treatment responses were lower, but patterns unchanged. One-year drug survival was for the 2000/2001 cohort: 73%, 2002: 62%, 2003: 67%, 2004: 70%, 2005: 69%. CONCLUSION From 2000 to 2005, significantly improved treatment responses to TNF inhibitors were seen in clinical practice despite decreasing baseline disease activity levels. This lends support to the less stringent prescription practice towards treating patients with lower disease activity that has been observed in several countries.
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Affiliation(s)
- M L Hetland
- DANBIO Registry, Department of Rheumatology, Hvidovre Hospital, Kettegård Alle 30, DK 2650, Hvidovre, Denmark.
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Hjardem E, Østergaard M, Pødenphant J, Tarp U, Andersen LS, Bing J, Peen E, Lindegaard HM, Ringsdal VS, Rødgaard A, Skøt J, Hansen A, Mogensen HH, Unkerskov J, Hetland ML. Do rheumatoid arthritis patients in clinical practice benefit from switching from infliximab to a second tumor necrosis factor alpha inhibitor? Ann Rheum Dis 2007; 66:1184-9. [PMID: 17389656 PMCID: PMC1955158 DOI: 10.1136/ard.2006.054742] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the efficacy of switching to a second biological drug in rheumatoid arthritis (RA) patients. METHODS Since 2000, Danish RA patients (n = 1021) receiving biological therapy have been registered in the nationwide DANBIO database. The first and second treatment series of patients, who switched therapy before 2005 (n = 235), were analysed for their reasons for switching, Disease Activity Score 28 (DAS28), DAS28 improvement, European League against Rheumatology (EULAR) response and drug survival. Most patients switched from infliximab to etanercept or adalimumab. RESULTS Median survivals for switchers' first/second treatment were 37/92 weeks (all patients' first treatment 119 weeks). Reasons for switching were lack of efficacy (LOE; 109 patients), adverse events (AE; 72), other reasons (54). If patients experienced AE to the first drug, 15% had AE to the second. Median DAS28 improvements in first/second treatment at 3 months were: LOE switchers 1.1/1.6; AE switchers 1.5/0.8. In LOE switchers, a good/moderate EULAR response was more prevalent during the second treatment course than during the first (63% versus 54%, p = 0.02). AE switchers achieved similar EULAR responses to both treatments (59% versus 50%, p = 0.38). CONCLUSION LOE switchers had a better clinical response to the second treatment. AE switchers responded equally well to both treatments, with a low risk of discontinuing the second drug as a result of AE. Drug survival of the switchers' second biological therapy was higher than of the first, but lower than that of non-switchers. No difference between various sequences of drugs were found. Danish post-marketing data thus support that RA patients may benefit from switching biological therapy.
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Affiliation(s)
- Elisabeth Hjardem
- Department of Rheumatology, Copenhagen University Hospital, Hvidovre, Denmark
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Hetland ML, Stengaard-Pedersen K, Junker P, Lottenburger T, Ellingsen T, Andersen LS, Hansen I, Skjødt H, Pedersen JK, Lauridsen UB, Svendsen A, Tarp U, Pødenphant J, Hansen G, Lindegaard H, de Carvalho A, Østergaard M, Hørslev-Petersen K. Combination treatment with methotrexate, cyclosporine, and intraarticular betamethasone compared with methotrexate and intraarticular betamethasone in early active rheumatoid arthritis: an investigator-initiated, multicenter, randomized, double-blind, parallel-group, placebo-controlled study. ACTA ACUST UNITED AC 2006; 54:1401-9. [PMID: 16645967 DOI: 10.1002/art.21796] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [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: 11/08/2022]
Abstract
OBJECTIVE To investigate whether disease control can be achieved in early active rheumatoid arthritis (RA) by treatment with methotrexate and intraarticular betamethasone, and whether the addition of cyclosporine to the regimen has any additional effect. METHODS Patients (n = 160) were randomized to receive methotrexate 7.5 mg/week plus cyclosporine 2.5 mg/kg of body weight/day (combination therapy) or methotrexate plus placebo-cyclosporine (monotherapy). At weeks 0, 2, 4, 6, and 8 and every 4 weeks thereafter, betamethasone was injected into swollen joints (maximum 4 joints or 4 ml per visit). Beginning at week 8, if synovitis was present, the methotrexate dosage was increased stepwise up to 20 mg/week, with a subsequent stepwise increase in the cyclosporine or placebo-cyclosporine dosage up to 4 mg/kg. RESULTS At 52 weeks, 20% improvement according to the American College of Rheumatology criteria (ACR20) was achieved in 85% of the combination therapy group versus 68% of the monotherapy group (P = 0.02). The median individual overall ACR response (ACR-N) in the 2 groups was 80.0% (interquartile range 40.1-91.8%) and 54.5% (interquartile range 2.4-87.8%), respectively (P = 0.025). At 48 and 52 weeks, ACR remission criteria were met in 35% of the combination therapy group and 28% of the monotherapy group. Progression in the Larsen score at 52 weeks was -0.2 +/- 6.5 and 0.4 +/- 6.9 (mean +/- SD) in the combination therapy and monotherapy groups, respectively. Serum creatinine levels increased by 7%, and hypertrichosis was more prevalent, in the combination therapy group. CONCLUSION Combined treatment with methotrexate and intraarticular glucocorticoid showed excellent disease control and stopped the progression of erosions in patients with early active RA, who had a poor prognosis. Addition of cyclosporine improved the ACR20 and ACR-N responses, whereas the ACR50 and ACR70 responses, remission rates, and radiographic changes did not differ between the 2 study groups.
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Horn HC, Terslev L, Pødenphant J. [Picture of the month: arthritis urica]. Ugeskr Laeger 2006; 168:2471. [PMID: 16824374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Broholm B, Pødenphant J, Biering-Sørensen F. Erratum: The course of bone mineral density and biochemical markers of bone turnover in early postmenopausal spinal cord-lesioned females. Spinal Cord 2005. [DOI: 10.1038/sj.sc.3101865] [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: 11/09/2022]
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Jensen T, Hansen M, Jensen KE, Pødenphant J, Hansen TM, Hyldstrup L. Comparison of dual X-ray absorptiometry (DXA), digital X-ray radiogrammetry (DXR), and conventional radiographs in the evaluation of osteoporosis and bone erosions in patients with rheumatoid arthritis. Scand J Rheumatol 2005; 34:27-33. [PMID: 15903022 DOI: 10.1080/03009740510017986] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 10/25/2022]
Abstract
OBJECTIVE To compare the relationship between bone mineral density (BMD) in the metacarpal bones and forearm measured by dual X-ray absorptiometry (DXA) and digital X-ray radiogrammetry (DXR) and radiological alterations in patients with early and established rheumatoid arthritis (RA). PATIENTS AND METHODS In each of the three disease duration groups, 11 female RA patients were included. The patients were further divided into two groups according to bone erosions. BMD in the metacarpals was evaluated by DXA and DXR. RESULTS A significant relationship between DXA-BMD and DXR-BMD was observed. DXR-BMD and the individually combined cortical thickness (CT) of the metacarpo-phalangeal (MCP) joints were related to disease duration and erosions. Patients with erosive disease had lower values of age- and sex-adjusted BMD measured with DXA, but most significantly with DXR. CONCLUSION DXR appears to be a more sensitive method than DXA in detecting early bone loss in patients with RA. The relationship of DXR-BMD to disease duration and bone damage indicates that the DXR method may be useful in the evaluation of disease activity and progression.
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Affiliation(s)
- T Jensen
- Department of Rheumatology, Hvidovre Hospital, Denmark.
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Broholm B, Pødenphant J, Biering-Sørensen F. The course of bone mineral density and biochemical markers of bone turnover in early postmenopausal spinal cord-lesioned females. Spinal Cord 2005; 43:674-7. [PMID: 15968297 DOI: 10.1038/sj.sc.3101788] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/09/2022]
Abstract
STUDY DESIGN A prospective observational study. OBJECTIVE To evaluate bone mineral density (BMD) and biochemical markers of bone turnover in spinal cord-lesioned females in the early postmenopausal period. SETTING Clinic for Spinal Cord Injuries, H:S Rigshospitalet, Denmark. MATERIAL In all, 18 early postmenopausal females with spinal cord lesions (SCL) of more than 2 years duration were recruited. In total, 11 completed the study. METHODS Using dual energy X-ray absorption, BMD of the lumbar spine, femoral neck, trochanter and proximal tibia was measured every 6 months for 30 months. Biochemical markers of bone turnover in blood and urine were collected at the same time points. RESULTS A significant increase in markers of bone formation in the blood was found and markers of bone resorption in urine tended to increase. BMD values changed insignificantly but for all regions decreased, except the lumbar spine. CONCLUSION An accelerated bone turnover occurs in early postmenopausal SCL females. At the same time, we showed an insignificant decrease in BMD data from the lower extremity.
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Affiliation(s)
- B Broholm
- Clinic for Spinal Cord Injuries, H:S Rigshospitalet, Copenhagen University Hospitals, Hornbaek, Denmark
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Grum-Schwensen TA, Zerahn B, Lausten GS, Pødenphant J, Hansen ILK. [Frequency of osteoporosis in women aged 50-80 years with Colles' fracture]. Ugeskr Laeger 2004; 166:583-6. [PMID: 15005040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Tomas Andreas Grum-Schwensen
- Ortopaedkirurgisk Afdeling, Medicinsk Reumatologisk Afdeling, Amtssygehuset i Herlev, Klinisk Fysiologisk Afdeling
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Jensen T, Klarlund M, Hansen M, Jensen KE, Pødenphant J, Hansen TM, Skjødt H, Hyldstrup L. Bone loss in unclassified polyarthritis and early rheumatoid arthritis is better detected by digital x ray radiogrammetry than dual x ray absorptiometry: relationship with disease activity and radiographic outcome. Ann Rheum Dis 2004; 63:15-22. [PMID: 14672886 PMCID: PMC1754726 DOI: 10.1136/ard.2003.013888] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [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: 11/03/2022]
Abstract
OBJECTIVE To compare changes in regional bone mineral density (BMD) of the metacarpal joints measured by dual x ray absorptiometry (DXA) and digital x ray radiogrammetry (DXR) in relation to disease activity and radiographic outcome in a two year follow up study of patients with early RA and unclassified polyarthritis. PATIENTS AND METHODS 72 patients with symmetrically swollen and tender second and third metacarpophalangeal or proximal interphalangeal joints for at least four weeks and less than two years were included. 51 patients fulfilled the ACR criteria for RA. 21 patients had unclassified polyarthritis. The patients with RA were divided into groups according to mean disease activity, average glucocorticoid dose, and MRI and x ray detected bone erosions in the hands. Clinical and biochemical measurements were made every month and an x ray examination of the hands and BMD of the metacarpal joints every six months. RESULTS DXR BMD decreased significantly only in patients with RA from month 6 and was associated with the mean disease activity. Patients with RA and erosive as well as non-erosive disease showed a significant decrease in the rate of bone loss, greatest in those with erosive disease. No changes in BMD measured by DXA were seen in any patient group. CONCLUSION DXR is a useful measure of the destructive disease activity in patients with RA and unclassified polyarthritis, providing valuable information about bone changes associated with disease activity and erosive disease in early RA. DXR is better than DXA for detecting and monitoring periarticular osteoporosis of the metacarpal bone.
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Affiliation(s)
- T Jensen
- Department of Rheumatology, H:S Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark.
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Madsen OR, Pødenphant J, Egsmose C, Jensen EM. [Investigation and treatment of Colles' fracture]. Ugeskr Laeger 2001; 164:71. [PMID: 11810806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Pødenphant J. [Rofecoxib, a new NSAID preparation with selective COX-2 inhibition]. Ugeskr Laeger 2000; 162:5233-6. [PMID: 11043057] [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: 02/18/2023]
Abstract
NSAIDs are effective by inhibition of the enzyme cyclooxygenase, which leads to formation of prostaglandins. At the beginning of the 90-ties it became evident, that cyclooxygenase existed in two isoforms (COX-1 and COX-2). COX-1 is found in a number of tissues. In these tissues prostaglandins have several physiological functions. COX-2 is an induceable enzyme involved in inflammation. A new NSAID, rofecoxib, has selective COX-2 inhibition defined as inhibition of COX-2, but not COX-1 in the therapeutic dose range. Trial results have shown pain relief analogous to common NSAIDs (ibuprofen and diclofenac) in patients with osteoarthritis of the hip or knee. The incidence of gastric ulcers was significantly reduced in the rofecoxib treated group compared to the groups treated with common NSAIDs. It is concluded that selective COX-2 inhibition is a promising new treatment. At present it seems appropriate to consider the drug in patients with good indication for an NSAID and simultaneous gastrointestinal risk factors.
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Jacobsen S, Starklint H, Petersen J, Ullman S, Junker P, Voss A, Rasmussen JM, Tarp U, Poulsen LH, van Overeem Hansen G, Skaarup B, Hansen TM, Pødenphant J, Halberg P. Prognostic value of renal biopsy and clinical variables in patients with lupus nephritis and normal serum creatinine. Scand J Rheumatol 1999; 28:288-99. [PMID: 10568425 DOI: 10.1080/03009749950155464] [Citation(s) in RCA: 20] [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
OBJECTIVE To evaluate factors with possible influence on the renal outcome in patients with lupus nephritis but without chronic renal insufficiency (CRI). METHODS Renal biopsies from 94 patients were re-assessed with regard to WHO class, activity, chronicity and tubulointerstitial indices without knowledge of clinical features. The outcome parameters were CRI defined as irreversibly increased serum creatinine and renal end stage disease. RESULTS The risk ratios (RR) of developing CRI were 2.6 for active urinary sediment, 3.1 for hyaline thrombi and 7.3 for glomerular leukocyte exudation. The RR of renal end stage disease was 5.0 when the duration of renal disease exceeded one year at the time of biopsy and 4.3 when biopsy disclosed a class IV lesion. Glomerular sclerosis was also associated to renal end stage disease. CONCLUSION Early renal biopsy and the abovementioned signs of active renal disease carry prognostic information that may have significant therapeutic implications.
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Affiliation(s)
- S Jacobsen
- Department of Rheumatology at Copenhagen University Hospital at Hvidovre, Denmark
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Jacobsen S, Petersen J, Ullman S, Junker P, Voss A, Rasmussen JM, Tarp U, Poulsen LH, van Overeem Hansen G, Skaarup B, Hansen TM, Pødenphant J, Halberg P. Mortality and causes of death of 513 Danish patients with systemic lupus erythematosus. Scand J Rheumatol 1999; 28:75-80. [PMID: 10229135 DOI: 10.1080/030097499442522] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [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: 10/16/2022]
Abstract
A multicentre cohort of 513 clinic attenders with systemic lupus erythematosus (SLE) was retrospectively identified, representing 4185 patient-years of follow-up. Expected numbers of death were calculated by means of age- and sex-specific mortality rates of the general Danish population. The observed number of deaths was 122. The survival rates were 97%, 91%, 76%, 64% and 53% after 1, 5, 10, 15, and 20 years respectively. The overall mortality rate was 2.9% per year (95% CI 2.4-3.5), and the standardized mortality rate (SMR) was 4.6 (95% CI 3.8-5.5). The causes of death included active SLE (n = 19), end stage organ failure due to SLE (n = 16), infections (n = 25), malignancy (n = 9), cardiovascular disease (n = 32), and other causes (n = 21). SLE was directly related to one third of the excess mortality. In conclusion, SLE patients in the present cohort had a 4.6-fold increased mortality compared with the general population and half of the deaths were caused by SLE manifestations or infections, especially in young patients during the early period of the disease.
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Affiliation(s)
- S Jacobsen
- Department of Rheumatology at Copenhagen University Hospital at Hvidovre Hospital, Denmark
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Jacobsen S, Petersen J, Ullman S, Junker P, Voss A, Rasmussen JM, Tarp U, Poulsen LH, van Overeem Hansen G, Skaarup B, Hansen TM, Pødenphant J, Halberg P. A multicentre study of 513 Danish patients with systemic lupus erythematosus. II. Disease mortality and clinical factors of prognostic value. Clin Rheumatol 1999; 17:478-84. [PMID: 9890675 DOI: 10.1007/bf01451283] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [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: 11/24/2022]
Abstract
In this Danish multicentre study, predictive clinical factors of mortality and survival were calculated for 513 patients with systemic lupus erythematosus (SLE), 122 of whom died within a mean observation period of 8.2 years equalling a mortality rate of 2.9% per year. Survival rates were 97%, 91%, 76% and 64% after 1, 5, 10 and 15 years, respectively. The direct causes of death included SLE (n = 35), infections (n = 25), malignancy (n = 9), cardiovascular disease (n = 32) and other causes (n = 21). Uni- and multivariate analyses of survival and mortality were performed for all deaths and for SLE-related deaths. Azotaemia (one-fifth of the patients) was a strong predictor of increased overall and SLE-related mortality, but nephropathy per se (one-half of the patients) and large proteinuria (one-sixth of the patients) were unrelated to survival. Haemolytic anaemia had a significant negative influence on survival related to mortality caused by infections. Diffuse central nervous system disease and myocarditis were related to increased SLE-related mortality, whereas photosensitivity predicted a decreased mortality. Non-fatal infections and thrombotic events predicted a decreased overall survival. Since 1980 the mortality caused by SLE manifestations has decreased significantly.
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Affiliation(s)
- S Jacobsen
- Department of Rheumatology at Copenhagen University Hospitals at Hvidovre Hospital, Hvidovre, Denmark
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40
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Jacobsen S, Petersen J, Ullman S, Junker P, Voss A, Rasmussen JM, Tarp U, Poulsen LH, van Overeem Hansen G, Skaarup B, Hansen TM, Pødenphant J, Halberg P. A multicentre study of 513 Danish patients with systemic lupus erythematosus. I. Disease manifestations and analyses of clinical subsets. Clin Rheumatol 1999; 17:468-77. [PMID: 9890674 DOI: 10.1007/bf01451282] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.3] [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: 10/25/2022]
Abstract
A Danish multicentre study was undertaken of the manifestations, infections, thrombotic events, survival and predictive factors of survival in 513 Danish patients with systemic lupus erythematosus (SLE) according to the 1982 classification criteria of the American College of Rheumatology. The mean duration of follow-up was 8.2 years from diagnosis and 12.8 years from first symptom. This paper describes the most common clinical and laboratory manifestations and their relationship to sex and age at the time of onset and diagnosis. Cluster analysis revealed three clinically defined clusters at the time of disease onset. Cluster 1 (57% of patients) consisted of relatively elderly patients without nephropathy or malar rash, but with a high prevalence of discoid lesions. Cluster 2 (18%) consisted of patients with nephropathy, a third of whom also developed serositis and lymphopenia. The patients of the third cluster (25%) all had malar rash and half were photosensitive. Follow-up showed that the patients of cluster 2 developed azotaemia, large proteinuria, arterial hypertension and myositis significantly more often than did the rest of the patients, but the mortality was not increased. The risk of developing renal end-stage disease was highest in men with early-onset disease.
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Affiliation(s)
- S Jacobsen
- Department of Rheumatology at Copenhagen University Hospitals at Hvidovre Hospital, Hvidovre, Denmark
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41
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Pødenphant J, Gotfredsen A, Engelhart M, Andersen V, Heitmann BL, Kondrup J. Comparison of body composition by dual energy X-ray absorptiometry to other estimates of body composition during weight loss in obese patients with rheumatoid arthritis. Scand J Clin Lab Invest 1996; 56:615-25. [PMID: 8981657 DOI: 10.3109/00365519609090596] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 02/03/2023]
Abstract
Body composition was determined by dual energy X-ray absorptiometry (DXA) scanning and classical reference methods (40K, 3H2O, and a combination of these in a four-compartment model) in 19 overweight patients with rheumatoid arthritis who underwent a 12-week weight-reducing regimen. The aim of the study was to investigate whether DXA provides a valid estimate of body composition. The results showed that weight as determined by DXA was highly significantly correlated to weight determined by scales. Furthermore, significant correlations were found in the body components (fat-free mass, fat mass) determined by DXA, 40K, 3H2O and the four-compartment model. Mean values differed slightly but significantly. With respect to changes in body composition, no significant correlations were found between any of the methods, except for the weight loss recorded by DXA and scales, and loss of fat mass (and fat free mass) estimated by 3H2O and the four-compartment model. The sparseness of correlations reflected the small changes in fat-free mass and fat mass (2.6 and 1.7 kg respectively), and the fact that changes were comparable to measurement errors of the various methods. We suggest that DXA scanning is a valid supplement for determination of body composition. Validation of DXA scanning requires new experimental in vitro investigations, which, incidentally, also applies to the classical reference methods.
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Affiliation(s)
- J Pødenphant
- Department of Medicine TTA, Rigshospitalet, National University Hospital, Copenhagen, Denmark
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42
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Hansen M, Florescu A, Stoltenberg M, Pødenphant J, Pedersen-Zbinden B, Hørslev-Petersen K, Hyldstrup L, Lorenzen I. Bone loss in rheumatoid arthritis. Influence of disease activity, duration of the disease, functional capacity, and corticosteroid treatment. Scand J Rheumatol 1996; 25:367-76. [PMID: 8996471 DOI: 10.3109/03009749609065648] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [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: 02/03/2023]
Abstract
Axial and appendicular bone mass were studied in 95 patients with rheumatoid arthritis. The aims were to quantify bone mineral density (BMD) and to evaluate the importance of disease activity, duration of disease, functional capacity, and corticosteroid treatment for bone loss in patients with rheumatoid arthritis. The BMD in the lumbar spine (BMDSPINE) did not differ from age-matched healthy controls, but distal forearm BMD (BMDARM) and metacarpal BMD (BMDMCB) were significantly lower in the patients (p < 0.01 and p < 0.001, respectively). Neither BMDSPINE nor BMDMCB were related to the disease activity at the time of investigation. By contrast, BMDARM was decreased in patients with active disease. BMD in any of the three measured locations was not directly correlated to duration of the disease. However, the bone mass in the appendicular skeleton was already decreased within the first two years after the start of the disease. The overall functional capacity in terms of physical activity increased BMD in the axial skeleton. The local functional capacity in terms of grip strength was positively related to BMD in the appendicular skeleton. Patients with severe functional impairment had the lowest BMDARM. The decreased BMD in patients with rheumatoid arthritis seems primarily to be caused by an impaired physical activity which may be related to disease activity. Corticosteroids did not decrease BMD in neither the axial nor the appendicular skeleton. The antiinflammatory effect of steroids lead to clinical improvement, which may counteract the expected negative effect of these drugs on bone in rheumatoid arthritis.
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Affiliation(s)
- M Hansen
- Department of Rheumatology, Hvidovre Hospital, University of Copenhagen, Denmark
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43
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Heitmann BL, Kondrup J, Engelhart M, Kristensen JH, Pødenphant J, Høie H, Andersen V. Changes in fat free mass in overweight patients with rheumatoid arthritis on a weight reducing regimen. A comparison of eight different body composition methods. Int J Obes Relat Metab Disord 1994; 18:812-9. [PMID: 7894520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this work was to compare and validate seven different methods for estimating changes in fat free mass, in patients suffering from rheumatoid arthritis. Measurements were made of fat and fat free mass before and after 12 weeks on an energy restricted, protein rich diet and physical training. The subjects were sixteen female and three male overweight out-patients (mean body mass index at baseline: 30 kg/m2) suffering from rheumatoid arthritis, according to the criteria of the American Rheumatism Association. Fat free mass was estimated by eight different body composition methods (a four-compartment model, total body water, total body potassium, impedance, near infrared interactance, creatinine excretion, body mass index and skinfold measurements). Mean weight loss was 2.7 kg fat and 1.7 kg fat free mass. There was no difference between measurements of mean change in fat free mass by the four-compartment model and the other methods, except for the creatinine method (P = 0.03). Compared to the four-compartment method, the total body water method gave the most accurate estimate of individual fat free mass changes (residual Mean Square: 0.4 kg), second to this method, the impedance method, seemed most valid (residual Mean Square: 0.8 kg). Accuracies of the other methods were lower (residual Mean Square between 4.2 and 8.2 kg [corrected]). Of eight methods for estimating changes in FFM, the TBW method gave the most accurate estimate of individual FFM changes, compared to a four-compartment model used as reference.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B L Heitmann
- Institute of Preventive Medicine, Copenhagen Health Services, Municipal Hospital of Copenhagen, Denmark
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44
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Hassager C, Jensen LT, Pødenphant J, Thomsen K, Christiansen C. The carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen in serum as a marker of bone resorption: the effect of nandrolone decanoate and hormone replacement therapy. Calcif Tissue Int 1994; 54:30-3. [PMID: 8118750 DOI: 10.1007/bf00316286] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [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: 01/28/2023]
Abstract
Carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) in serum has recently been proposed as a new biochemical marker of bone resorption. In the present study we compared serum ICTP with radiopharmaceutical and histomorphometric measurements of bone turnover in postmenopausal women with mild osteoporosis, and assessed the effect of hormone replacement therapy (HRT) (2 mg 17 beta-estradiol plus 1 mg norethisterone daily) and anabolic steroid therapy (50 mg nandrolone decanoate (ND) i.m. every 3 weeks) on serum ICTP in two double-blind placebo-controlled studies with 55 to 75-year-old women. Serum ICTP measured by radioimmunoassay (RIA) correlated significantly with the 24-hour whole body retention of 99m-technetium diphosphonate (Rho = 0.47, P < 0.001, n = 66), but not with histomorphometric measurements of bone turnover in iliac crest biopsies. One year of HRT (n = 16) versus placebo (n = 15) did not produce significant changes in serum ICTP. Compared with placebo (n = 17), 1 year of ND (n = 19) produced an increase in serum ICTP of 90 +/- 16% (P < 0.0001); 6 months after discontinuation of the treatment, serum ICTP had returned to pretreatment values. We conclude that serum ICTP does reflect bone metabolism in postmenopausal osteoporosis, but it is not a sensitive marker of the changes in bone resorption induced by hormone replacement therapy, and it does not correspond with other measures of bone resorption during anabolic steroid therapy.
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Affiliation(s)
- C Hassager
- Center for Clinical & Basic Research, Ballerup, Denmark
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Florescu A, Pødenphant J, Thamsborg G, Hansen M, Leffers AM, Andersen V. Distal metacarpal bone mineral density by dual energy X-ray absorptiometry (DEXA) scan. Methodological investigation and application in rheumatoid arthritis. Clin Exp Rheumatol 1993; 11:635-8. [PMID: 8299255] [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: 01/29/2023]
Abstract
Dual energy X-ray absorptiometry scanning was performed along the axis of the third metacarpal bone of the non-dominant hand and including metacarpal bones 2, 3, 4 and 5. The Bone Mineral Density (BMD) was calculated for the distal 1/4 of each metacarpal bone. Ten patients with seropositive, erosive rheumatoid arthritis (RA) and 10 healthy, sex- and age-matched persons were investigated twice. The average BMD in RA patients was 73.6% of the value found in normals. The coefficient of variation on double determinations (in patients and controls) was 0.9-3.0%. We suggest that dual energy X-ray absorptiometry scanning with the scanning procedure proposed here may be an important instrument for the quantification of disease progression.
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Affiliation(s)
- A Florescu
- Department of Internal Medicine TTA, Rigshospitalet, Copenhagen, Denmark
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46
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Faarvang KL, Egsmose C, Kryger P, Pødenphant J, Ingeman-Nielsen M, Hansen TM. Hydroxychloroquine and sulphasalazine alone and in combination in rheumatoid arthritis: a randomised double blind trial. Ann Rheum Dis 1993; 52:711-5. [PMID: 7903034 PMCID: PMC1005166 DOI: 10.1136/ard.52.10.711] [Citation(s) in RCA: 40] [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: 01/27/2023]
Abstract
OBJECTIVES To compare the effects of hydroxychloroquine and sulphasalazine alone and in combination in rheumatoid arthritis. METHODS A six month randomised, multicentre, double blind trial with three parallel groups was performed. Ninety one outpatients with active rheumatoid arthritis were included. Monthly assessments of erythrocyte sedimentation rate, morning stiffness, number of swollen joints, a pain score, and global assessments were carried out. Radiographs of hands and wrists were taken before and after the trial. RESULTS Sixty two patients completed the study. The 29 withdrawals caused no evident bias, and there was no difference in side effects among the three groups. All variables improved significantly with time. Patients treated with a combination of hydroxychloroquine and sulphasalazine responded better and faster than those treated with hydroxychloroquine alone, but there was no statistically significant difference between the combination treatment and single drug treatment with sulphasalazine or between treatment with hydroxychloroquine and sulphasalazine given alone. CONCLUSION The present results do not support a recommendation to use a combination of hydroxychloroquine and sulphasalazine in the treatment of rheumatoid arthritis.
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Affiliation(s)
- K L Faarvang
- Department of Rheumatology, Kong Christian d X's Gigthospital, Graasten, Denmark
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47
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Heaf JG, Pødenphant J, Gammelgaard B. The reliability and representativity of non-dynamic bone histomorphometry in uremic osteodystrophy. Scand J Urol Nephrol 1993; 27:305-10. [PMID: 8290908 DOI: 10.3109/00365599309180439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In order to evaluate the reliability and representativity of iliac crest bone biopsy in uremic osteodystrophy, non-dynamic bone histomorphometry was performed post-mortem on the right and left iliac crests and the 3rd lumbar vertebra in 20 patients with chronic uremia. High (> 0.8) right-left correlation coefficients were found for bone volume, osteoid volume, osteoid surface, osteoid thickness, eroded surface, osteoclast surface and aluminium labelling intensity; moderate (0.7-0.8) for trabecular thickness, and low (< 0.7) for cortical thickness, porosity and aluminium bone concentration. High iliac crest-vertebra correlations were found for trabecular thickness, osteoid volume, osteoid surface, eroded surface, osteoclast surface and aluminium labelling intensity, and low correlations for bone volume, osteoid thickness and bone aluminium concentration. In conclusion, non-dynamic iliac trabecular bone indices are reliable variables and, with the possible exception of bone mass determination, indicative of systemic bone disease. Bone aluminium concentration and cortical bone indices are unreliable measures of uremic bone disease. These reservations apply to the diagnostic use of biopsy in individuals, but not necessarily its research use in groups of patients.
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Affiliation(s)
- J G Heaf
- Department of Nephrology P, Rigshospitalet, Copenhagen, Denmark
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48
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49
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Abstract
Placebo controlled trials of methotrexate, auranofin, penicillamine, azathioprine, sulphasalazine, gold sodium thiomalate and chloroquines were subjected to meta-analysis. The difference between drugs and placebo in the erythrocyte sedimentation rate was 8.8 mm/hr [95% confidence interval (CI), 6.4-11.3]. In multiple linear regression analyses, with the physician's global evaluation and relative change in joint tenderness count as outcome variables, a substantial sample size bias was demonstrated. The effect decreased with increasing sample size. The risk of dropping out from any cause was larger on drug than on placebo (odds ratio, 1.17; CI, 0.99-1.38). No evidence of a worthwhile effect on radiological changes was found. Of the 3439 patients, 4 went into complete remission on drug. We conclude that the benefit of second-line drugs is uncertain.
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Affiliation(s)
- P C Gøtzsche
- Department of Rheumatology, Hvidovre Hospital, Denmark
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50
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Joffe P, Hyldstrup L, Heaf JG, Pødenphant J, Henriksen JH. Bisphosphonate kinetics in patients undergoing continuous ambulatory peritoneal dialysis: relations to dynamic bone histomorphometry, osteocalcin and parathyroid hormone. Am J Nephrol 1992; 12:419-24. [PMID: 1292341 DOI: 10.1159/000168492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 12/26/2022]
Abstract
In the evaluation of renal osteodystrophy bone biopsy is often performed. However, a reliable noninvasive test could be very useful, and recently the estimation of osseous tracer uptake as an index of bone formation has been introduced-the bone bisphosphonate clearance (BBC). The aim of the present investigation therefore was to compare BBC with parameters of bone histology, serum levels of osteocalcin, alkaline phosphatase, and parathyroid hormone in patients (n = 8) undergoing continuous ambulatory peritoneal dialysis (CAPD). No significant correlations were found between BBC values and the bone histomorphometrical variables measured. A positive correlation was seen between serum osteocalcin and resorption and active resorption surface (p < 0.05), as well as tetracycline-labelled surface, bone formation rate, surfaces, volume and tissue referents, respectively (p < 0.01). Furthermore, levels of alkaline phosphatase showed significant correlations to mineral appositional rate, tetracycline-labelled surface and bone formation rate, volume referent (p < 0.05). Values of parathyroid hormone were significantly correlated to resorption surface (p < 0.02), active resorption surface, mineral appositional rate and mineralization lag time (p < 0.05). In conclusion, BBC was of no use in patients treated with CAPD as a noninvasive test for evaluation of bone histomorphometry. However, osteocalcin correlated best with resorption and bone dynamics indices. Levels of alkaline phosphatase and parathyroid hormone were of a more limited value.
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Affiliation(s)
- P Joffe
- Department of Nephrology, Hvidovre Hospital, University of Copenhagen, Denmark
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