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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. Evaluation of the Diagnostic Performance of American College of Rheumatology, EULAR, and National Institute for Health and Clinical Excellence Criteria Against Clinically Relevant Knee Osteoarthritis: Data From the CHECK Cohort. Arthritis Care Res (Hoboken) 2024; 76:511-516. [PMID: 37933434 DOI: 10.1002/acr.25270] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/17/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Our objective was to evaluate the diagnostic performance of the EULAR, American College of Rheumatology (ACR), and National Institute for Health and Care Excellence (NICE) criteria by using clinical experts' diagnosis of clinically relevant knee osteoarthritis (OA) as the outcome of interest. METHODS In a previous study, we recruited clinical experts to evaluate longitudinal (5-, 8-, and 10-year follow-up) clinical and radiographic data of symptomatic knees from the Cohort Hip and Cohort Knee (CHECK) study for the presence or absence of clinically relevant OA. In the current study, ACR, EULAR, and NICE criteria were applied to the same 5-, 8-, and 10-year follow-up data; then a knee was diagnosed with OA if fulfilling the criteria at one of the three time points (F1), two of the time points (F2), or at all three time points (F3). Using clinically relevant OA as the reference standard, the sensitivity, specificity, and positive and negative predictive values for the three criteria were assessed. RESULTS A total of 539 participants for a total of 833 examined knees were included. Thirty-six percent of knees were diagnosed with clinically relevant OA by experts. Sixty-seven percent to 74% of the knees received the same diagnosis (OA or non-OA) by the three criteria sets for the different definitions (F1 to F3). EULAR consistently (F1 through F3) had the highest specificity, and NICE consistently had the highest sensitivity. CONCLUSION The diagnoses only moderately overlapped among the three criteria sets. The EULAR criteria seemed to be more suitable for study enrollment (when aimed at recruiting clinically relevant OA knees), given the highest specificities. The NICE criteria, given the highest sensitivities, could be more useful for an initial diagnosis in clinical practice.
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Affiliation(s)
- Qiuke Wang
- Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands, and Shanghai Sixth People's Hospital, Shanghai, China
| | - Jos Runhaar
- Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
| | | | - Maarten Boers
- Amsterdam University Medical Center, Amsterdam, The Netherlands
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Bijlsma JWJ. Annals of the Rheumatic Diseases collection on glucocorticoids (2020-2023): novel insights and advances in therapy. Ann Rheum Dis 2024; 83:4-8. [PMID: 37739452 DOI: 10.1136/ard-2023-224847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bacardit J, Bierma-Zeinstra SMA. A machine learning approach reveals features related to clinicians' diagnosis of clinically relevant knee osteoarthritis. Rheumatology (Oxford) 2023; 62:2732-2739. [PMID: 36534939 DOI: 10.1093/rheumatology/keac707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/09/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To identify highly ranked features related to clinicians' diagnosis of clinically relevant knee OA. METHODS General practitioners (GPs) and secondary care physicians (SPs) were recruited to evaluate 5-10 years follow-up clinical and radiographic data of knees from the CHECK cohort for the presence of clinically relevant OA. GPs and SPs were gathered in pairs; each pair consisted of one GP and one SP, and the paired clinicians independently evaluated the same subset of knees. A diagnosis was made for each knee by the GP and SP before and after viewing radiographic data. Nested 5-fold cross-validation enhanced random forest models were built to identify the top 10 features related to the diagnosis. RESULTS Seventeen clinician pairs evaluated 1106 knees with 139 clinical and 36 radiographic features. GPs diagnosed clinically relevant OA in 42% and 43% knees, before and after viewing radiographic data, respectively. SPs diagnosed in 43% and 51% knees, respectively. Models containing top 10 features had good performance for explaining clinicians' diagnosis with area under the curve ranging from 0.76-0.83. Before viewing radiographic data, quantitative symptomatic features (i.e. WOMAC scores) were the most important ones related to the diagnosis of both GPs and SPs; after viewing radiographic data, radiographic features appeared in the top lists for both, but seemed to be more important for SPs than GPs. CONCLUSIONS Random forest models presented good performance in explaining clinicians' diagnosis, which helped to reveal typical features of patients recognized as clinically relevant knee OA by clinicians from two different care settings.
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Affiliation(s)
- Qiuke Wang
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jaume Bacardit
- School of Computing, Newcastle University, Newcastle, UK
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
- Department of Orthopaedics and Sport Medicine, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
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Alunno A, Avcin T, Haines C, Ramiro S, Sivera F, Badreh S, Baraliakos X, Bijlsma JWJ, Buttgereit F, Chaudhuri K, Da Silva JAP, Dudler J, Ferreira RJO, Gudu T, Hachulla E, Holland-Fischer M, Iagnocco A, Kragstrup TW, Nagy G, Romão VC, Stones SR, van Onna M, Edwards CJ. Points to consider: EULAR-UEMS standards for the training of European rheumatologists. Ann Rheum Dis 2023; 82:1107-1113. [PMID: 37188497 DOI: 10.1136/ard-2023-223941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Postgraduate rheumatology training programmes are already established at a national level in most European countries. However, previous work has highlighted a substantial level of heterogeneity in the organisation and, in part, content of programmes. OBJECTIVE To define competences and standards of knowledge, skills and professional behaviours required for the training of rheumatologists. METHODS A European Alliance of Associations for Rheumatology (EULAR) task force (TF) of 23 experts, including two members of the European Union of Medical Specialists (UEMS) section of rheumatology, was convened. The mapping phase consisted of the retrieval of key documents on specialty training in rheumatology and other related specialties across a broad set of international sources. The content of these documents was extracted and represented the foundation for the document draft that underwent several rounds of online discussion within the TF, and afterwards was also distributed to a broad group of stakeholders for collecting feedback. The list of generated competences was voted on during the TF meetings, while the level of agreement (LoA) with each statement was established by anonymous online voting. RESULTS A total of 132 international training curricula were retrieved and extracted. In addition to the TF members, 253 stakeholders commented and voted on the competences through an online anonymous survey. The TF developed (1) an overarching framework indicating the areas that should be addressed during training, (2) 7 domains defining broad areas that rheumatology trainees should master by the end of the training programme, (3) 8 core themes defining the nuances of each domain and (4) 28 competences that trainees should acquire to cover each of the areas outlined in the overarching framework. A high LoA was achieved for all competences. CONCLUSION These points to consider for EULAR-UEMS standards for the training of European rheumatologists are now defined. Their dissemination and use can hopefully contribute to harmonising training across European countries.
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Affiliation(s)
- Alessia Alunno
- Internal Medicine and Nephrology Division, Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Tadej Avcin
- Unit of Allergy, Rheumatology and Clinical Immunology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Catherine Haines
- Education Committee, EULAR, Zurich, Switzerland
- Clinical Education, King's College London, London, UK
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Francisca Sivera
- Faculty of Medicine, Miguel Hernandez University of Elche, Sant Joan D'Alacant, Spain
- Rheumatology, Hospital General Universitario Elda, Elda, Spain
| | - Sara Badreh
- EULAR Patient Research Partner, Stockholm, Sweden
| | | | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Immunology, Charité University, Berlin, Germany
| | - Kaushik Chaudhuri
- Rheumatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jose A P Da Silva
- Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jean Dudler
- Service de Rhumatologie, Médecine Physique et Rééducation, HFR Fribourg, Hôpital Cantonal, Fribourg, Switzerland
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Health Sciences Research Unit, Nursing School of Coimbra, Coimbra, Portugal
| | - Tania Gudu
- Rheumatology, Sf Maria Hospital, Universitatea de Medicina si Farmacie Carol Davila, Bucuresti, Romania
| | - Eric Hachulla
- Internal Medicine, Univ. Lille & Lille Inflammation Research International Center, Hôpital Claude Huriez, Lille, France
| | | | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
- Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - György Nagy
- Immunology and Medicine, Semmelweis University Medical School, Budapest, Hungary
| | - Vasco C Romão
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Marloes van Onna
- Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
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Bijlsma JWJ. Shall we ever agree on using low dose glucocorticoids in treating rheumatoid arthritis? Rheumatology (Oxford) 2023:7127899. [PMID: 37071699 DOI: 10.1093/rheumatology/kead167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Box 85 500 3508, GA Utrecht, The Netherlands
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Butink MHP, Webers C, Verstappen SMM, Falzon L, Betteridge N, Wiek D, Woolf AD, Stamm TA, Burmester GR, Bijlsma JWJ, Christensen R, Boonen A. Non-pharmacological interventions to promote work participation in people with rheumatic and musculoskeletal diseases: a systematic review and meta-analysis from the EULAR taskforce on healthy and sustainable work participation. RMD Open 2023; 9:rmdopen-2022-002903. [PMID: 36596655 PMCID: PMC10098260 DOI: 10.1136/rmdopen-2022-002903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To summarise the evidence on effectiveness of non-pharmacological (ie, non-drug, non-surgical) interventions on work participation (sick leave, work status and presenteeism) in people with rheumatic and musculoskeletal diseases (RMDs). METHODS A systematic review of randomised controlled trials (RCTs) and longitudinal observational studies (LOS) was performed. Qualitative (RCTs/LOS) and quantitative (RCTs) evidence syntheses were conducted. Mixed-effects restricted maximum likelihood models were used to combine effect estimates, using standardised mean differences (SMDs) as the summary measure for each outcome domain separately, with a negative SMD favouring the intervention over comparator. Subgroup analyses were performed for type of RMD, risk status at baseline regarding adverse work outcomes and intervention characteristics. RESULTS Of 10 153 records, 64 studies (37 RCTs and 27 LOS; corresponding to k=71 treatment comparisons) were included. Interventions were mostly conducted in clinical settings (44 of 71, 62%). Qualitative synthesis suggested clear beneficial effects of 7 of 64 (11%) interventions for sick leave, 1 of 18 (6%) for work status and 1 of 17 (6%) for presenteeism. Quantitative synthesis (37 RCTs; k=43 treatment comparisons) suggested statistically significant but only small clinical effects on each outcome (SMDsick leave (95% CI)=-0.23 (-0.33 to -0.13; k=42); SMDwork status=-0.38 (-0.63 to -0.12; k=9); SMDpresenteeism=-0.25 (-0.39 to -0.12; k=13)). CONCLUSION In people with RMDs, empirical evidence shows that non-pharmacological interventions have small effects on work participation. Effectiveness depends on contextual factors such as disease, population risk status, intervention characteristics and outcome of interest, highlighting the importance of tailoring interventions.
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Affiliation(s)
- Maarten H P Butink
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Louise Falzon
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Dieter Wiek
- Patient Research Partner, EULAR/PARE, Zürich, Switzerland
| | - Anthony D Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, Frederiksberg Hospital Parker Institute, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands .,Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Metselaar JM, Middelink LM, Wortel CH, Bos R, van Laar JM, Vonkeman HE, Westhovens R, Lammers T, Yao SL, Kothekar M, Raut A, Bijlsma JWJ. Intravenous pegylated liposomal prednisolone outperforms intramuscular methylprednisolone in treating rheumatoid arthritis flares: A randomized controlled clinical trial. J Control Release 2021; 341:548-554. [PMID: 34896445 DOI: 10.1016/j.jconrel.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/18/2021] [Accepted: 12/05/2021] [Indexed: 11/17/2022]
Abstract
Glucocorticoids (GCs) are potent anti-inflammatory drugs but their use is limited by systemic exposure leading to toxicity. Targeted GC delivery to sites of inflammation via encapsulation in long-circulating liposomes may improve the therapeutic index. We performed a randomized, double-blind, active-controlled, multi-center study in which intravenously (i.v.) administered pegylated liposomal prednisolone sodium phosphate (Nanocort) was compared to equipotent intramuscular (i.m.) methylprednisolone acetate (Depo-Medrol®; i.e. a current standards-of-care for treating flares in rheumatoid arthritis patients). We enrolled 172 patients with active arthritis who met all eligibility criteria, eventually resulting in 150 patients randomized in three groups: (1) Nanocort 75 mg i.v. infusion plus i.m. saline injection; (2) Nanocort 150 mg i.v. infusion plus i.m. saline injection; and (3) Depo-Medrol® 120 mg i.m. injection plus i.v. saline infusion. Dosing in each group occurred at baseline and on day 15 (week 2). Study visits occurred at week 1, 2, 3, 4, 6, 8 and 12, to assess both efficacy and safety. The primary endpoint was the "European League Against Rheumatism" (EULAR) responder rate at week 1. Safety was determined by the occurrence of adverse events during treatment and 12 weeks of follow-up. Treatment with Nanocort was found to be superior to Depo-Medrol® in terms of EULAR response at week 1, with p-values of 0.007 (good response) and 0.018 (moderate response). Treatments were well tolerated with a comparable pattern of adverse events in the three treatment groups. However, the Nanocort groups had a higher incidence of hypersensitivity reactions during liposome infusion. Our results show that liposomal Nanocort is more effective than Depo-Medrol® in treating patients with rheumatoid arthritis flares and has similar safety. This is the first clinical study in a large patient population showing that i.v. administered targeted drug delivery with a nanomedicine formulation improves the therapeutic index of glucocorticoids.
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Affiliation(s)
- Josbert M Metselaar
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; Enceladus, Naarden, the Netherlands.
| | | | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente and University of Twente, Enschede, the Netherlands
| | - Rene Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center and University Hospital KU Leuven, Leuven, Belgium
| | - Twan Lammers
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Siu-Long Yao
- Sun Pharmaceutical Industries, Cranbury, NJ, USA
| | | | - Atul Raut
- Sun Pharmaceutical Industries, Mumbai, Maharashtra, India
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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Runhaar J, Özbulut Ö, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. Diagnostic criteria for early hip osteoarthritis: first steps, based on the CHECK study. Rheumatology (Oxford) 2021; 60:5158-5164. [PMID: 33576791 PMCID: PMC8566292 DOI: 10.1093/rheumatology/keab111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives Although there is a general focus on early diagnosis and treatment of hip OA, there are no validated diagnostic criteria for early-stage hip OA. The current study aimed to take the first steps in developing diagnostic criteria for early-stage hip OA, using factors obtained through history taking, physical examination, radiography and blood testing at the first consultation in individuals presenting with hip pain, suspicious for hip OA, in primary care. Methods Data of the 543 individuals with 735 symptomatic hips at baseline who had any follow-up data available from the prospective CHECK cohort study were used. A group of 26 clinical experts [general practitioners (GPs), rheumatologists and orthopaedic surgeons] evaluated standardized clinical assessment forms of all subjects on the presence of clinically relevant hip OA 5–10 years after baseline. Using the expert-based diagnoses as reference standard, a backward selection method was used to create predictive models based on pre-defined baseline factors from history taking, physical examination, radiography and blood testing. Results Prevalence of clinically relevant hip OA during follow-up was 22%. Created models contained four to eight baseline factors (mainly WOMAC pain items, painful/restricted movements and radiographic features) and obtained area under the curve between 0.62 (0.002) and 0.71 (0.002). Conclusion Based on clinical and radiographic features of hip OA obtained at first consultation at a GP for pain/stiffness of the hip, the prediction of clinically relevant hip OA within 5–10 years was ‘poor’ to ‘fair’.
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Affiliation(s)
- Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | - Ömer Özbulut
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | | | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Amsterdam
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam.,Department of Orthopedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. Diagnosis of early stage knee osteoarthritis based on early clinical course: data from the CHECK cohort. Arthritis Res Ther 2021; 23:217. [PMID: 34412670 PMCID: PMC8375192 DOI: 10.1186/s13075-021-02598-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early diagnosis of knee osteoarthritis (OA) is important in managing this disease, but such an early diagnostic tool is still lacking in clinical practice. The purpose of this study was to develop diagnostic models for early stage knee OA based on the first 2-year clinical course after the patient’s initial presentation in primary care and to identify whether these course factors had additive discriminative value over baseline factors. Methods We extracted eligible patients’ clinical and radiographic data from the CHECK cohort and formed the first 2-year course factors according to the factors’ changes over the 2 years. Clinical expert consensus-based diagnosis, which was made via evaluating patients’ 5- to 10-year follow-up data, was used as the outcome factor. Four models were developed: model 1, included clinical course factors only; model 2, included clinical and radiographic course factors; model 3, clinical baseline factors + clinical course factors; and model 4, clinical and radiographic baseline factors + clinical and radiographic course factors. All the models were built by a generalized estimating equation with a backward selection method. Area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI) were calculated for assessing model discrimination. Delong’s method compared AUCs. Results Seven hundred sixty-one patients with 1185 symptomatic knees were included in this study. Thirty-seven percent knees were diagnosed as OA at follow-up. Model 1 contained 6 clinical course factors; model 2: 6 clinical and 3 radiographic course factors; model 3: 6 baseline clinical factors combined with 5 clinical course factors; and model 4: 4 clinical and 1 radiographic baseline factors combined with 5 clinical and 3 radiographic course factors. Model discriminations are as follows: model 1, AUC 0.70 (95% CI 0.67–0.74); model 2, 0.74 (95% CI 0.71–0.77); model 3, 0.77 (95% CI 0.74–0.80); and model 4, 0.80 (95% CI 0.77–0.82). AUCs of model 3 and model 4 were slightly but significantly higher than corresponding baseline-factor models (model 3 0.77 vs 0.75, p = 0.031; model 4 0.80 vs 0.76, p = 0.003). Conclusions Four diagnostic models were developed with “fair” to “good” discriminations. First 2-year course factors had additive discriminative value over baseline factors. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02598-5.
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Affiliation(s)
- Qiuke Wang
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopaedics, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
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10
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Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. Towards developing diagnostic criteria for early knee osteoarthritis: data from the CHECK study. Rheumatology (Oxford) 2021; 60:2448-2455. [PMID: 33246329 PMCID: PMC8121451 DOI: 10.1093/rheumatology/keaa643] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/23/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives There is a general consensus that a shift in focus towards early diagnosis and treatment of knee OA is warranted. However, there are no validated and widely accepted diagnostic criteria for early knee OA available. The current study aimed to take the first steps towards developing diagnostic criteria for early knee OA. Methods Data of 761 individuals with 1185 symptomatic knees at baseline were selected from the CHECK study. For CHECK, individuals with pain/stiffness of the knee, aged 45–65 years, who had no prior consultation or a first consultation with the general practitioner for these symptoms in the past 6 months were recruited and followed for 10 years. A group of 36 experts (17 general practitioners and 19 secondary care physicians) evaluated the medical records in pairs to diagnose the presence of clinically relevant knee OA 5–10 years after enrolment. A backward selection methods was used to create predictive models based on pre-defined baseline factors from history taking, physical examination, radiography and blood testing, using the experts’ diagnoses as gold standard outcome. Results Prevalence of clinically relevant knee OA during follow-up was 37%. Created models contained 7–11 baseline factors and obtained an area under the curve between 0.746 (0.002) and 0.764 (0.002). Conclusion The obtained diagnostic models for early knee OA had ‘fair’ predictive ability in individuals presenting with knee pain in primary care. Further modelling and validation of the identified predictive factors is required to obtain clinically feasible and relevant diagnostic criteria for early knee OA.
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Affiliation(s)
- J Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden
| | - M Boers
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Amsterdam
| | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam.,Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Bijlsma JWJ. Response to: 'Correspondence on 'EULAR December 2020 View points on SARS-CoV-2 vaccination in patients with RMDs'' by Bugatti et al. Ann Rheum Dis 2021; 80:e157. [PMID: 33906856 DOI: 10.1136/annrheumdis-2021-220564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Verhoeven MMA, Tekstra J, Welsing PMJ, Pethö-Schramm A, Borm MEA, Bruyn GAW, Bos R, Griep EN, Klaasen R, van Laar JM, Lafeber FPJG, Bijlsma JWJ, de Hair MJH, Jacobs JWG. Effectiveness and safety over 3 years after the 2-year U-Act-Early trial of the strategies initiating tocilizumab and/or methotrexate. Rheumatology (Oxford) 2021; 59:2325-2333. [PMID: 31859346 PMCID: PMC7449801 DOI: 10.1093/rheumatology/kez602] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/15/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives U-Act-Early was a 2-year, randomized placebo controlled, double-blind trial, in which DMARD-naïve early RA patients were treated to the target of sustained remission (SR). Two strategies initiating tocilizumab (TCZ), with and without methotrexate (MTX), were more effective than a strategy initiating MTX. The aim of the current study was to determine longer-term effectiveness in daily clinical practice. Methods At the end of U-Act-Early, patients were included in a 3-year post-trial follow-up (PTFU), in which treatment was according to standard care and data were collected every 3 months during the first year and every 6 months thereafter. Primary end point was disease activity score assessing 28 joints (DAS28) over time. Mixed effects models were used to compare effectiveness between initial strategy groups, correcting for relevant confounders. Between the groups as randomized, proportions of patients were tested for DMARD use, SR and radiographic progression of joint damage. Results Of patients starting U-Act-Early, 226/317 (71%) participated in the PTFU. Over the total 5 years, mean DAS28 was similar between groups (P > 0.20). During U-Act-Early, biologic DMARD use decreased in both TCZ initiation groups and increased in the MTX initiation group, but during follow-up this trend did not continue. SR was achieved at least once in 99% of patients. Of the 226 patients, only 30% had any radiographic progression over 5 years, without significant differences between the groups. Conclusion Although in the short-term the strategies initiating TCZ yielded the most clinical benefit, in the longer-term differences in important clinical outcomes between the strategies disappeared, probably due to continuation of the treat-to-target principle.
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Affiliation(s)
- Maxime M A Verhoeven
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Janneke Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Reinhard Bos
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden
| | - Ed N Griep
- Department of Rheumatology, Antonius Hospital, Sneek
| | - Ruth Klaasen
- Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein J H de Hair
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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Ritschl V, Stamm TA, Aletaha D, Bijlsma JWJ, Böhm P, Dragoi RG, Dures E, Estévez-López F, Gossec L, Iagnocco A, Marques A, Moholt E, Nudel M, van den Bemt BJF, Viktil K, Voshaar M, de Thurah A, Carmona L. 2020 EULAR points to consider for the prevention, screening, assessment and management of non-adherence to treatment in people with rheumatic and musculoskeletal diseases for use in clinical practice. Ann Rheum Dis 2020; 80:707-713. [PMID: 33355152 DOI: 10.1136/annrheumdis-2020-218986] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-adherence to treatment could preclude reaching an optimal outcome. Thirty to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to the agreed treatment. OBJECTIVES The objective was to establish points to consider (PtCs) for the prevention, screening, assessment and management of non-adherence to (non-)pharmacological treatments in people with RMDs. METHODS An EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included healthcare providers (HCPs), comprising rheumatologists, nurses, pharmacists, psychologists, physiotherapists, occupational therapists and patient-representatives from 12 European countries. A review of systematic reviews was conducted in advance to support the TF in formulating the PtCs. The level of agreement among the TF was established by anonymous online voting. RESULTS Four overarching principles and nine PtCs were formulated. The PtCs reflect the phases of action on non-adherence. HCPs should assess and discuss adherence with patients on a regular basis and support patients to treatment adherence. As adherence is an agreed behaviour, the treatment has to be tailored to the patients' needs. The level of agreement ranged from 9.5 to 9.9 out of 10. CONCLUSIONS These PtCs can help HCPs to support people with RMDs to be more adherent to the agreed treatment plan. The basic scheme being prevent non-adherence by bonding with the patient and building trust, overcoming structural barriers, assessing in a blame-free environment and tailoring the solution to the problem.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Wien, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Peter Böhm
- Deutsche Rheuma-Liga Bundesverband e.V, Bonn, Germany
| | - Razvan Gabriel Dragoi
- Rehabilitation, Physical Medicine and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Emma Dures
- Department of Nursing and Midwifery, University of the West of England, Bristol, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Fernando Estévez-López
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Andrea Marques
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | - Ellen Moholt
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Bart J F van den Bemt
- Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud Univiersity Medical Center, Nijmegen, The Netherlands
| | - Kirsten Viktil
- Hospital Pharmacy, Diakonhjemmet Hospital Pharmacy, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Marieke Voshaar
- Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
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Teitsma XM, Devenport J, Jacobs JWG, Pethö-Schramm A, Borm MEA, Budde P, Bijlsma JWJ, Lafeber FPJG. Comprehensive exploratory autoantibody profiling in patients with early rheumatoid arthritis treated with methotrexate or tocilizumab. PLoS One 2020; 15:e0241189. [PMID: 33301475 PMCID: PMC7728181 DOI: 10.1371/journal.pone.0241189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background We sought to identify immunoglobin G autoantibodies predictive of early treatment response to methotrexate, the recommended first-line therapy for patients with newly diagnosed rheumatoid arthritis, and to the interleukin-6 receptor inhibitor biologic tocilizumab, initiated as the first disease-modifying anti-rheumatic drug. Materials and methods In baseline sera of a subset of patients with newly diagnosed rheumatoid arthritis in the U-Act-Early study, selected based on specific responder/non-responder criteria using the Disease Activity Score assessing 28 joints (DAS28) within the first 20 weeks, we measured immunoglobin G antibody reactivity against 463 protein antigens and performed supervised cluster analysis to identify predictive autoantibodies for treatment response. The analysis subset comprised 56 patients in the methotrexate arm (22 responders, 34 non-responders) and 50 patients in the tocilizumab arm (34 responders, 16 non-responders). For comparison, these analyses were also performed in 50 age- and gender-matched healthy controls. Results Increased reactivity in responders versus non-responders was found in the methotrexate arm against two antigens—DOT1-like histone lysine methyltransferase (p = 0.009) and tropomyosin (p = 0.003)—and in the tocilizumab arm against one antigen—neuro-oncological ventral antigen 2 (p = 0.039). Decreased reactivity was detected against two antigens in the methotrexate arm—G1 to S phase transition 2 (p = 0.023) and the zinc finger protein ZPR1 (p = 0.021). Reactivity against the identified antigens was not statistically significant in either treatment arm for patients with rheumatoid factor–positive versus–negative or anti-cyclic citrullinated test–positive versus test–negative rheumatoid arthritis (p ≥ 0.06). Conclusions Comprehensive profiling of baseline sera revealed several novel immunoglobin G autoantibodies associated with early treatment response to methotrexate and to tocilizumab in disease-modifying anti-rheumatic drug-naive patients with rheumatoid arthritis. These findings could eventually yield clinically relevant predictive markers, if corroborated in different patient cohorts, and may facilitate future benefit in personalised healthcare.
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Affiliation(s)
- Xavier M. Teitsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, Netherlands
- * E-mail:
| | - Jenny Devenport
- Pharmaceuticals Division, F. Hoffmann-La Roche, Basel, Switzerland
| | - Johannes W. G. Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, Netherlands
| | | | | | - Petra Budde
- Department of Medical Research, Oncimmune Germany GmbH, Dortmund, Germany
| | - Johannes W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, Netherlands
| | - Floris P. J. G. Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, Netherlands
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15
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Verhoeven MMA, Tekstra J, Jacobs JWG, Bijlsma JWJ, van Laar JM, Pethö-Schramm A, Borm MEA, Lafeber FPJ, Welsing PMJ. Is tocilizumab monotherapy as effective in preventing radiographic progression in rheumatoid arthritis as its combination with methotrexate? Arthritis Care Res (Hoboken) 2020; 74:889-895. [PMID: 33253497 PMCID: PMC9313860 DOI: 10.1002/acr.24524] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the effect of preventing radiographic progression (in its 3 components) of tocilizumab (TCZ) monotherapy with those of TCZ combined with methotrexate (TCZ+MTX), and to evaluate possible effect modifiers. METHODS Randomized trials comparing TCZ-monotherapy with TCZ+MTX combination therapy regarding radiographic progression were analyzed on individual patient (n=820) data level for early as well as established RA patients using mixed-effects models. Outcomes were: not having radiographic progression after 2 years (i.e., preventing radiographic progression), respectively in total Sharp van der Heijde (SvdH) score, in erosion score and in joint space narrowing (JSN) score. Effect modification by baseline joint damage, disease duration and DAS28 was studied. RESULTS Overall, TCZ+MTX was more effective in preventing radiographic progression regarding total SvdH scores compared to TCZ-monotherapy. However, in early RA patients with more joint damage (RR 1.02 vs. 0.91 for the less damage group), or a lower DAS28 (RR 1.04 vs. 0.92) at baseline, this advantage disappeared. In established RA, the advantage of TCZ+MTX over TCZ in preventing radiographic progression disappeared with a longer disease duration at baseline (RR 1.04 vs. 0.83). Results for erosion scores as outcome were in line, but were less clear for JSN. CONCLUSION Combination therapy with TCZ+MTX is more effective in preventing radiographic progression compared to TCZ-monotherapy, but the effectiveness of TCZ-monotherapy may approximate the effectiveness of TCZ+MTX in early RA patients with more joint damage and/or a lower DAS28 at baseline, and in established RA patients with longer disease duration.
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16
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Ritschl V, Stamm TA, Aletaha D, Bijlsma JWJ, Böhm P, Dragoi R, Dures E, Estévez-López F, Gossec L, Iagnocco A, Negrón JB, Nudel M, Marques A, Moholt E, Skrubbeltrang C, Van den Bemt B, Viktil K, Voshaar M, Carmona L, de Thurah A. Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews informing the 2020 EULAR points to consider. RMD Open 2020; 6:e001432. [PMID: 33161377 PMCID: PMC7856118 DOI: 10.1136/rmdopen-2020-001432] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs). METHODS An overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews. RESULTS After reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. The number of factors that may influence adherence exceed 700. Among 53 intervention studies, 54.7% showed a small statistically significant effect on adherence, and all three multicomponent interventions, including different modes of patient education and delivered by a variety of healthcare providers, showed a positive result in adherence to medication. No single assessment provided a comprehensive measure of adherence to either medication or exercise. CONCLUSIONS The results underscore the complexity of non-adherence, its changing pattern and dependence on multi-level factors, the need to involve all stakeholders in all steps, the absence of a gold standard for screening and the requirement of multi-component interventions to manage it.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Peter Böhm
- Deutsche Rheuma-Liga Bundesverband e.V., Bonn, Germany
| | - Razvan Dragoi
- University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Emma Dures
- University of the West of England Bristol, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - José B Negrón
- Instituto de Investigación Social y Sanitaria, Puerto Rico
| | | | - Andréa Marques
- Centro Hospitalar e Universitário de Coimbra, Health Sciences Research Unit: Nursing, UICISA-E, Coimbra, Portugal
| | - Ellen Moholt
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway
| | | | - Bart Van den Bemt
- Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Kirsten Viktil
- University of Oslo, Oslo, Norway
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
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17
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort. J Clin Med 2020; 9:jcm9103374. [PMID: 33096821 PMCID: PMC7594082 DOI: 10.3390/jcm9103374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/18/2023] Open
Abstract
Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was “certainly no OA” and 100 was “certainly OA”). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically “certain” and “uncertain” knees, respectively. Student paired t-tests compared certainty scores. Results: Most diagnoses of GPs (86%) and SPs (82%) were “consistent” after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically “uncertain” knees. Radiographs added some certainty to “consistent” OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04). Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis.
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Affiliation(s)
- Qiuke Wang
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
- Correspondence: ; Tel.: +31(0)-10-7044192; Fax: +31(0)-10-7044766
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam Rheumatology & Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Johannes W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Sita M. A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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Lauper K, Bijlsma JWJ, Burmester GR. Trajectories of COVID-19 information in the Annals of the Rheumatic Diseases: the first months of the pandemic. Ann Rheum Dis 2020; 80:26-30. [PMID: 33055081 DOI: 10.1136/annrheumdis-2020-219217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Kim Lauper
- Division of Rheumatology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland .,Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Freie Universitität und Humboldt-University Berlin, Berlin, Germany
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Jurgens MS, Safy-Khan M, de Hair MJH, Bijlsma JWJ, Welsing PMJ, Tekstra J, Lafeber FPJG, Sasso EH, Jacobs JWG. The multi-biomarker disease activity test for assessing response to treatment strategies using methotrexate with or without prednisone in the CAMERA-II trial. Arthritis Res Ther 2020; 22:205. [PMID: 32907614 PMCID: PMC7487793 DOI: 10.1186/s13075-020-02293-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives The CAMERA-II trial compared two tight-control, treat-to-target strategies, initiating methotrexate with prednisone (MTX+pred) or MTX with placebo (MTX+plac), in early RA-patients. The multi-biomarker disease activity (MBDA) blood test objectively measures RA disease activity with a score of 1–100. In CAMERA-II, response profiles of the MBDA score, its individual biomarkers, and DAS28 were assessed. Methods We evaluated 92 patients from CAMERA-II of whom clinical data and serum for MBDA testing at baseline and ≥ 1 time-point from months 1, 2, 3, 4, 5, 6, 9, or 12 were available. Changes (∆) from baseline for DAS28 and MBDA score and comparisons of ∆DAS28 and ∆MBDA score over time within the MTX+pred versus the MTX+plac strategy were tested for significance with t tests. Changes in biomarker concentration from baseline to months 1–5 were tested with Wilcoxon signed rank test and tested for difference between treatment arms by Mann-Whitney U test. Results MBDA and DAS28 showed similar response profiles, with gradual improvement over the first 6 months in the MTX+plac group, and in the MTX+pred group faster improvement during month 1, followed by gradual improvement. The 12 MBDA biomarkers could be grouped into 4 categories of response profiles, with significant responses for 4 biomarkers during the MTX+plac strategy and 9 biomarkers during the MTX+pred strategy. Conclusions MBDA tracked treatment response in CAMERA-II similarly to DAS28. More individual MBDA biomarkers tracked treatment response to MTX+pred than to MTX+plac. Four response profiles could be observed. Trial registration CAMERA-II International Standard Randomised Controlled Trial Number: ISRCTN 70365169. Registered on 29 March 2006, retrospectively registered.
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Affiliation(s)
- M S Jurgens
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, G02.228, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - M Safy-Khan
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, G02.228, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | | | - J W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, G02.228, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - P M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, G02.228, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - J Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, G02.228, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, G02.228, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - E H Sasso
- Crescendo Bioscience, Inc., South San Francisco, CA, USA
| | - J W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, G02.228, PO Box 85500, 3508, GA, Utrecht, The Netherlands
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Verhoeven MMA, Tekstra J, van Laar JM, Pethö-Schramm A, Borm MEA, Bijlsma JWJ, Jacobs JWG, Lafeber FPJG, Welsing PMJ. Effect on Costs and Quality-adjusted Life-years of Treat-to-target Treatment Strategies Initiating Methotrexate, or Tocilizumab, or Their Combination in Early Rheumatoid Arthritis. J Rheumatol 2020; 48:495-503. [PMID: 32739893 DOI: 10.3899/jrheum.200067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Our study aimed to evaluate the cost effectiveness of initiating tocilizumab (TCZ) ± methotrexate (MTX) versus initiating MTX as treat-to-target treatment strategies over 5 years in early disease-modifying antirheumatic drug (DMARD)-naïve rheumatoid arthritis (RA). METHODS Data on resource use were collected with questionnaires at baseline, 3, 6, 12, and 24 months, and yearly thereafter, and were converted to costs using Dutch reference prices. Quality-adjusted life-years (QALY) were calculated using the EQ5D5L, with utility based on Dutch tariff or estimated by the Health Assessment Questionnaire. To account for missing cost data and QALY data and for sample uncertainty, first bootstraps (10,000 samples) were obtained. Second, single imputation using chained equations nested within these bootstrap samples was performed. An economic evaluation was performed for TCZ + MTX and TCZ, compared to MTX, as initial treatment in a treat-to-target strategy from a healthcare and societal perspective over 5 years. Several sensitivity analyses were performed. RESULTS Mean differences in QALY were small and not significant (TCZ + MTX vs MTX: 0.06, 95% CI -0.02 to 0.13; TCZ vs. MTX: -0.03, 95% CI -0.05 to 0.11). Limited savings in indirect nonhealthcare costs and productivity loss costs (for TCZ only) were observed, but these did not compensate for the higher medication costs. Sensitivity analyses did not materially change these findings, although lower-priced TCZ, or reserving TCZ as initial therapy for prognostically unfavorable RA patients, improved cost effectiveness considerably but did not individually lead to a strategy being cost effective. CONCLUSION Based on our analyses, early initiation of TCZ + MTX is not cost effective compared to MTX initiation in a step-up treat-to-target treatment strategy over 5 years in early RA patients.
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Affiliation(s)
- Maxime M A Verhoeven
- M.M. Verhoeven, PhD student, J. Tekstra, MD, PhD, J.M. van Laar, MD, PhD, J.W. Bijlsma, MD, PhD, J.W. Jacobs, MD, PhD, F.P. Lafeber, PhD, P.M. Welsing, PhD, Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands;
| | - Janneke Tekstra
- M.M. Verhoeven, PhD student, J. Tekstra, MD, PhD, J.M. van Laar, MD, PhD, J.W. Bijlsma, MD, PhD, J.W. Jacobs, MD, PhD, F.P. Lafeber, PhD, P.M. Welsing, PhD, Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jacob M van Laar
- M.M. Verhoeven, PhD student, J. Tekstra, MD, PhD, J.M. van Laar, MD, PhD, J.W. Bijlsma, MD, PhD, J.W. Jacobs, MD, PhD, F.P. Lafeber, PhD, P.M. Welsing, PhD, Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Johannes W J Bijlsma
- M.M. Verhoeven, PhD student, J. Tekstra, MD, PhD, J.M. van Laar, MD, PhD, J.W. Bijlsma, MD, PhD, J.W. Jacobs, MD, PhD, F.P. Lafeber, PhD, P.M. Welsing, PhD, Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes W G Jacobs
- M.M. Verhoeven, PhD student, J. Tekstra, MD, PhD, J.M. van Laar, MD, PhD, J.W. Bijlsma, MD, PhD, J.W. Jacobs, MD, PhD, F.P. Lafeber, PhD, P.M. Welsing, PhD, Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris P J G Lafeber
- M.M. Verhoeven, PhD student, J. Tekstra, MD, PhD, J.M. van Laar, MD, PhD, J.W. Bijlsma, MD, PhD, J.W. Jacobs, MD, PhD, F.P. Lafeber, PhD, P.M. Welsing, PhD, Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paco M J Welsing
- M.M. Verhoeven, PhD student, J. Tekstra, MD, PhD, J.M. van Laar, MD, PhD, J.W. Bijlsma, MD, PhD, J.W. Jacobs, MD, PhD, F.P. Lafeber, PhD, P.M. Welsing, PhD, Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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21
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Kerschbaumer A, Sepriano A, Smolen JS, van der Heijde D, Dougados M, van Vollenhoven R, McInnes IB, Bijlsma JWJ, Burmester GR, de Wit M, Falzon L, Landewé R. Efficacy of pharmacological treatment in rheumatoid arthritis: a systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis 2020; 79:744-759. [PMID: 32033937 PMCID: PMC7286044 DOI: 10.1136/annrheumdis-2019-216656] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To inform the 2019 update of the European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA). METHODS A systematic literature research (SLR) to investigate the efficacy of any disease-modifying antirheumatic drug (DMARD) (conventional synthetic (cs)DMARD, biological (b) and biosimilar DMARD, targeted synthetic (ts)DMARD) or glucocorticoid (GC) therapy in patients with RA was done by searching MEDLINE, Embase and the Cochrane Library for articles published between 2016 and 8 March 2019. RESULTS 234 abstracts were selected for detailed assessment, with 136 finally included. They comprised the efficacy of bDMARDs versus placebo or other bDMARDs, efficacy of Janus kinase (JAK) inhibitors (JAKi) across different patient populations and head-to-head of different bDMARDs versus JAKi or other bDMARDs. Switching of bDMARDs to other bDMARDs or tsDMARDs, strategic trials and tapering studies of bDMARDs, csDMARDs and JAKi were assessed. The drugs evaluated included abatacept, adalimumab, ABT-122, baricitinib, certolizumab pegol, SBI-087, CNTO6785, decernotinib, etanercept, filgotinib, golimumab, GCs, GS-9876, guselkumab, hydroxychloroquine, infliximab, leflunomide, mavrilimumab, methotrexate, olokizumab, otilimab, peficitinib, rituximab, sarilumab, salazopyrine, secukinumab, sirukumab, tacrolimus, tocilizumab, tofacitinib, tregalizumab, upadacitinib, ustekinumab and vobarilizumab. The efficacy of many bDMARDs and tsDMARDs was shown. Switching to another tumour necrosis factor inhibitor (TNFi) or non-TNFi bDMARDs after TNFi treatment failure is efficacious. Tapering of DMARDs is possible in patients achieving long-standing stringent clinical remission; in patients with residual disease activity (including patients in LDA) the risk of flares is increased during the tapering. Biosimilars are non-inferior to their reference products. CONCLUSION This SLR informed the task force regarding the evidence base of various therapeutic regimen for the development of the update of EULAR's RA management recommendation.
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Affiliation(s)
| | - Alexandre Sepriano
- Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | | | | | | | | | | | | | - Robert Landewé
- Amsterdam Rheumatology Center, Amsterdam, The Netherlands
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22
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Oude Voshaar MAH, Das Gupta Z, Bijlsma JWJ, Boonen A, Chau J, Courvoisier DS, Curtis JR, Ellis B, Ernestam S, Gossec L, Hale C, Hornjeff J, Leung KYY, Lidar M, Mease P, Michaud K, Mody GM, Ndosi M, Opava CH, Pinheiro GRC, Salt M, Soriano ER, Taylor WJ, Voshaar MJH, Weel AEAM, de Wit M, Wulffraat N, van de Laar MAFJ, Vonkeman HE. International Consortium for Health Outcome Measurement Set of Outcomes That Matter to People Living With Inflammatory Arthritis: Consensus From an International Working Group. Arthritis Care Res (Hoboken) 2020; 71:1556-1565. [PMID: 30358135 PMCID: PMC6900179 DOI: 10.1002/acr.23799] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 05/01/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023]
Abstract
Objective The implementation of value‐based health care in inflammatory arthritis requires a standardized set of modifiable outcomes and risk‐adjustment variables that is feasible to implement worldwide. Methods The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary working group that consisted of 24 experts from 6 continents, including 6 patient representatives, to develop a standard set of outcomes for inflammatory arthritis. The process followed a structured approach, using a modified Delphi process to reach consensus on the following decision areas: conditions covered by the set, outcome domains, outcome measures, and risk‐adjustment variables. Consensus in areas 2 to 4 were supported by systematic literature reviews and consultation of experts. Results The ICHOM Inflammatory Arthritis Standard Set covers patients with rheumatoid arthritis (RA), axial spondyloarthritis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA). We recommend that outcomes regarding pain, fatigue, activity limitations, overall physical and mental health impact, work/school/housework ability and productivity, disease activity, and serious adverse events be collected at least annually. Validated measures for patient‐reported outcomes were endorsed and linked to common reporting metrics. Age, sex at birth, education level, smoking status, comorbidities, time since diagnosis, and rheumatoid factor and anti‐citrullinated protein antibody lab testing for RA and JIA should be collected as risk‐adjustment variables. Conclusion We present the ICHOM inflammatory arthritis Standard Set of outcomes, which enables health care providers to implement the value‐based health care framework and compare outcomes that are important to patients with inflammatory arthritis.
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Affiliation(s)
| | - Zofia Das Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | | | - Annelies Boonen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeffrey Chau
- Hong Kong Psoriatic Arthritis Association, Hong Kong, China
| | | | | | | | | | - Laure Gossec
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | - Katy Y Y Leung
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | | | - Phillip Mease
- Providence St. Joseph Health System, University of Washington, Seattle
| | - Kaleb Michaud
- University of Nebraska Medical Center Omaha, and the National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | | | | | | | - Matthew Salt
- International Consortium for Health Outcomes Measurement, London, UK
| | - Enrique R Soriano
- Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Maarten de Wit
- VU University Medical Centre, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nico Wulffraat
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mart A F J van de Laar
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
| | - Harald E Vonkeman
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
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23
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Safy-Khan M, Jacobs JWG, de Hair MJH, Welsing PMJ, Edwardes MD, Teitsma XM, Luder Y, Devenport J, van Laar JM, Pethoe-Schramm A, Bijlsma JWJ. Effect on efficacy and safety trial outcomes of also enrolling patients on ongoing glucocorticoid therapy in rheumatoid arthritis clinical trials of tocilizumab or adalimumab or methotrexate monotherapy. Ann Rheum Dis 2020; 79:460-463. [PMID: 32033935 DOI: 10.1136/annrheumdis-2019-216537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND In rheumatoid arthritis (RA) trials, inclusion of patients on background treatment with glucocorticoids (GCs) might impact efficacy and safety outcomes. OBJECTIVES To determine if inclusion of patients on background GC use influenced efficacy and safety outcomes of RA randomised clinical trials on initiation of tocilizumab (TCZ) or adalimumab (ADA) or methotrexate (MTX) monotherapy. METHODS Data of four double-blind RA randomised controlled trials (AMBITION, ACT-RAY, ADACTA and FUNCTION) with in total four TCZ, one ADA and two MTX monotherapy arms were analysed. Analyses of covariance of changes from baseline to week 24 in efficacy endpoints and radiographic progression up to week 104 were performed, correcting for relevant covariates. Incidence rates of serious adverse events (SAEs) were assessed. RESULTS No statistically significant differences were found in efficacy parameters between background GC users and non-GC users, except for less radiographic progression associated with GC usage in one MTX arm. SAE rates were not statistically significantly different between GC users and non-GC users in the treatment arms. CONCLUSION No effect of including patients on background GC treatment on efficacy and safety trial outcomes was found, with the exception of reduced radiological joint damage in one MTX arm.
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Affiliation(s)
- Mary Safy-Khan
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Paco M J Welsing
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
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24
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Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, Sepriano A, van Vollenhoven RF, de Wit M, Aletaha D, Aringer M, Askling J, Balsa A, Boers M, den Broeder AA, Buch MH, Buttgereit F, Caporali R, Cardiel MH, De Cock D, Codreanu C, Cutolo M, Edwards CJ, van Eijk-Hustings Y, Emery P, Finckh A, Gossec L, Gottenberg JE, Hetland ML, Huizinga TWJ, Koloumas M, Li Z, Mariette X, Müller-Ladner U, Mysler EF, da Silva JAP, Poór G, Pope JE, Rubbert-Roth A, Ruyssen-Witrand A, Saag KG, Strangfeld A, Takeuchi T, Voshaar M, Westhovens R, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020; 79:685-699. [PMID: 31969328 DOI: 10.1136/annrheumdis-2019-216655] [Citation(s) in RCA: 1545] [Impact Index Per Article: 386.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field. METHODS An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items. RESULTS The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high. CONCLUSIONS These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Robert B M Landewé
- Amsterdam University Medical Center, Amsterdam, The Netherlands.,Zuyderland Medical Center, Heerlen, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Maxime Dougados
- Rhumatologie B, Hopital Cochin, 27 rue du Fbg Saint-Jacques, Paris, France
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maarten de Wit
- EULAR Patient Research Partner; Department Medical Humanities, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - John Askling
- Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alejandro Balsa
- Servicio de Reumatologia Hospital Universitario La Paz, Instituto de Investigacion IdiPAZ, Madrid, Spain
| | - Maarten Boers
- Department of Epidemiology and Biostatistics and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Maya H Buch
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, and IRCCS S Matteo Foundation, Pavia, Italy
| | | | - Diederik De Cock
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Maurizio Cutolo
- Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine - University of Genoa, Genoa, Italy
| | - Christopher John Edwards
- Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Yvonne van Eijk-Hustings
- Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands
| | - Paul Emery
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Axel Finckh
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris and Pitié Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France
| | - Jacques-Eric Gottenberg
- Strasbourg University Hospital and University of Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg, France
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marios Koloumas
- European League Against Rheumatism, Zurich, Switzerland.,Cyprus League against Rheumatism, Nikosia, Cyprus
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China
| | - Xavier Mariette
- Université Paris-Sud, AP-HP, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | - Jose A P da Silva
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, and Coimbra Institute for Clinical and Biomedical Research (i-CRB), Faculty of Medicine of Coimbra, Coimbra, Portugal
| | - Gyula Poór
- National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary
| | - Janet E Pope
- University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine, London, Ontario, Canada
| | | | | | - Kenneth G Saag
- Department of Medicine, Division of Rheumatology, University of Alabama at Birmingham, Brmingham, Alabama, USA
| | - Anja Strangfeld
- Programme Area Epidemiology, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
| | - Tsutomu Takeuchi
- Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - Marieke Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium
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25
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Mahler EAM, den Broeder AA, den Broeder N, Bijlsma JWJ, Snijders GF, van den Hoogen FHJ, van den Ende CHM. Short-term clinical worsening is a clear predictor for worsening at 2 years in established knee and hip osteoarthritis. Clin Exp Rheumatol 2019; 37:414-421. [PMID: 30299244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Our aim was to estimate the proportion of knee and hip OA patients showing worsening at 2 years, and to examine the additional predictive value of failure of optimised non-surgical treatment during 3 months for worsening at 2 years. METHODS Data of patients participating in the longitudinal CONTROL-PRO study (patients fulfilling clinical ACR criteria for knee or hip OA) were used. Measurements of pain, functioning and patient global assessments were performed at baseline, 3 months and 2 years. Worsening at 2 years was defined as fulfilling the recently validated clinical worsening criteria for knee and hip OA, or total joint replacement (TJR). Logistic regression was performed with worsening at 2 years as the dependent variable. RESULTS The 297 included patients were predominantly women (66%) with a mean age of 55 years. At 2 years, 61% showed worsening (knee 59%; hip 71%) and 24% had undergone a TJR (knee 19%; hip 51%). Clinical worsening at 3 months appeared to be a clear independent predictor for worsening at 2 years (OR 2.8 95% CI 1.5-5.2) with a moderate discriminative ability (AUC 0.68 95% CI 0.57-0.70). Similar results were obtained when only TJR at 2 years was used as the outcome measure (OR 4.1 95% CI 2.0-8.4) with good AUC (0.82 95% CI 0.76-0.87). CONCLUSIONS Our findings suggest that re-assessment of symptoms after optimised non-surgical treatment could be meaningful in clinical decision making for TJR. Furthermore, this information could be used to identify subgroups of patients potentially eligible for novel and advanced treatment options.
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Affiliation(s)
- Elien A M Mahler
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nathan den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gijs F Snijders
- Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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26
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Verhoeven MMA, Welsing PMJ, Bijlsma JWJ, van Laar JM, Lafeber FPJG, Tekstra J, Jacobs JWG. Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review. Curr Rheumatol Rep 2019; 21:24. [PMID: 31016409 PMCID: PMC6478774 DOI: 10.1007/s11926-019-0821-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA. RECENT FINDINGS Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative "risk" was 1.73 [95%CI 1.59-1.88] for bDMARD-based remission induction strategies and 1.20 [95%CI 1.03-1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid "bridging therapy" was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.
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Affiliation(s)
- M M A Verhoeven
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands.
| | - P M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
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Roodenrijs NMT, van der Goes MC, Welsing PMJ, Tekstra J, van Laar JM, Lafeber FPJG, Bijlsma JWJ, Jacobs JWG. Is prediction of clinical response to methotrexate in individual rheumatoid arthritis patients possible? A systematic literature review. Joint Bone Spine 2019; 87:13-23. [PMID: 30981868 DOI: 10.1016/j.jbspin.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To identify, by a systematic literature review, predictors of clinical response to methotrexate treatment in rheumatoid arthritis patients, which would facilitate personalised treatment. METHODS PubMed and Embase databases were searched for original articles. Additionally, congress abstracts of European League Against Rheumatism and American College of Rheumatology annual meetings of the past 2 years were screened. Articles describing predictors of clinical response to methotrexate after 3 to 6 months were included, since this reflects the time span used to determine treatment effectiveness and decide on treatment changes in treat-to-target recommendations. RESULTS Thirty articles were included, containing 100 different predictors and 11 predictive models. Nineteen predictors and 2 predictive models were studied in multiple cohorts. Female gender was found to be a predictor of non-response in two studies (odds ratios 0.55 and 0.54), but these findings could not be replicated in two other studies. In two studies, smoking predicted non-response (adjusted odds ratios 0.35 and 0.60), although this was inconsistent over all response criteria assessed. Rheumatoid factor positivity predicted non-response in two studies (adjusted hazard ratio 0.61, adjusted odds ratio 0.4), but this was not found in three other studies. Heterogeneity in studies prohibited further comparison of predictive values between studies. Additionally, a validated epigenetic model was found (area under the curve 0.90 and 0.91). CONCLUSIONS No predictors were identified reliably predicting clinical response to methotrexate after 3 to 6 months in the individual patient: clinical predictors were weak. However, a promising epigenetic model was found that needs further validation.
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Affiliation(s)
- Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Janneke Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Unger J, Putrik P, Buttgereit F, Aletaha D, Bianchi G, Bijlsma JWJ, Boonen A, Cikes N, Dias JM, Falzon L, Finckh A, Gossec L, Kvien TK, Matteson EL, Sivera F, Stamm TA, Szekanecz Z, Wiek D, Zink A, Dejaco C, Ramiro S. Workforce requirements in rheumatology: a systematic literature review informing the development of a workforce prediction risk of bias tool and the EULAR points to consider. RMD Open 2018; 4:e000756. [PMID: 30714580 PMCID: PMC6336097 DOI: 10.1136/rmdopen-2018-000756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/08/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To summarise the available information on physician workforce modelling, to develop a rheumatology workforce prediction risk of bias tool and to apply it to existing studies in rheumatology. METHODS A systematic literature review (SLR) was performed in key electronic databases (1946-2017) comprising an update of an SLR in rheumatology and a hierarchical SLR in other medical fields. Data on the type of workforce prediction models and the factors considered in the models were extracted. Key general as well as specific need/demand and supply factors for workforce calculation in rheumatology were identified. The workforce prediction risk of bias tool was developed and applied to existing workforce studies in rheumatology. RESULTS In total, 14 studies in rheumatology and 10 studies in other medical fields were included. Studies used a variety of prediction models based on a heterogeneous set of need/demand and/or supply factors. Only two studies attempted empirical validation of the prediction quality of the model. Based on evidence and consensus, the newly developed risk of bias tool includes 21 factors (general, need/demand and supply). The majority of studies revealed high or moderate risk of bias for most of the factors. CONCLUSIONS The existing evidence on workforce prediction in rheumatology is scarce, heterogeneous and at moderate or high risk of bias. The new risk of bias tool should enable future evaluation of workforce prediction studies. This review informs the European League Against Rheumatism points to consider for the conduction of workforce requirement studies in rheumatology.
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Affiliation(s)
- Julia Unger
- Department of Health Studies, Institute of Occupational Therapy, FH JOANNEUM University of Applied Sciences, Bad Gleichenberg, Austria
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute, Maastricht, The Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charitè University Medicine, Berlin, Germany
| | - Daniel Aletaha
- Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Gerolamo Bianchi
- Division of Rheumatology, ASL3-Azienda Sanitaria Genovese, Genova, Italy
| | - Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute, Maastricht, The Netherlands
| | - Nada Cikes
- Division of Clinical Immunology & Rheumatology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - João Madruga Dias
- Department of Rheumatology, Centro Hospitalar Médio Tejo, Torres Novas, Portugal
| | - Louise Falzon
- Columbia University Medical Center, New York City, New York, USA
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Laure Gossec
- Rheumatology Department, Sorbonne Université, Paris, and Pitié Salpêtrière Hhospital APHP, Paris, France
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Eric L Matteson
- Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario de Elda, Elda, Spain
| | - Tanja A Stamm
- Section for Outcomes Research, Medical Unversity Viennna, Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - Zoltan Szekanecz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Dieter Wiek
- EULAR Standing Committee of PARE, Zurich, Switzerland
| | - Angela Zink
- Department of Rheumatology and Clinical Immunology, Charitè University Medicine, Berlin, Germany
- Deutsches Rheuma-Forschungszentrum, Berlin, Germany
| | - Christian Dejaco
- Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Styria, Austria
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Centre, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
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Teitsma XM, Jacobs JWG, Concepcion AN, Pethö-Schramm A, Borm MEA, van Laar JM, Bijlsma JWJ, Lafeber FPJG. Explorative analyses of protein biomarkers in patients with early rheumatoid arthritis achieving sustained drug-free remission after treatment with tocilizumab- or methotrexate-based strategies: from transcriptomics to proteomics. Clin Exp Rheumatol 2018; 36:976-983. [PMID: 29745885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Previously, we identified networks of co-expressed genes related to achieving sustained drug-free remission (sDFR). The aim of the present exploratory analysis was to identify inflammatory proteins associated with achieving sDFR and their enriched biological pathways, and compare these pathways with those found in the previous transcriptomic analyses. METHODS Serum samples were used from 60 patients who participated in the U-Act-Early trial and were treated-to-target with tocilizumab plus methotrexate, or tocilizumab or methotrexate; 37 achieved sDFR (≥3 months drug-free) and 23 did not (controls). Luminex® multi-analyte profiling (xMAP)® was used to measure 85 proteins. Partial least square discriminant analyses (PLSDA) identified proteins associated with achieving sDFR within each strategy arm, which were thereafter used for pathway analyses. RESULTS PLSDA identified 9, 14 and 13 relevant proteins in the tocilizumab plus methotrexate, tocilizumab and methotrexate arm, respectively and pathway analyses thereafter identified respectively 49, 88 and 117 significantly enriched gene ontology (GO) terms. When comparing these terms with those previously found in the transcriptomic analyses, corresponding pathways were related in the tocilizumab arm to activity of leukocytes; in the methotrexate arm to response of stimuli and regulation of the Janus kinase signal transducer and activator of transcription (JAK-STAT) pathway. In the tocilizumab plus methotrexate arm, no corresponding enriched pathways were found. CONCLUSIONS Multiple proteins were associated with achieving sDFR and several biological pathways corresponded, mainly in the methotrexate arm, with our previous transcriptomic findings potentially providing further insights into gene expression and protein translation in newly diagnosed RA patients.
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Affiliation(s)
- Xavier M Teitsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands.
| | - Johannes W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Arno N Concepcion
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
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Teitsma XM, Yang W, Jacobs JWG, Pethö-Schramm A, Borm MEA, Harms AC, Hankemeier T, van Laar JM, Bijlsma JWJ, Lafeber FPJG. Baseline metabolic profiles of early rheumatoid arthritis patients achieving sustained drug-free remission after initiating treat-to-target tocilizumab, methotrexate, or the combination: insights from systems biology. Arthritis Res Ther 2018; 20:230. [PMID: 30322408 PMCID: PMC6235217 DOI: 10.1186/s13075-018-1729-2] [Citation(s) in RCA: 23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/20/2018] [Indexed: 12/26/2022] Open
Abstract
Background We previously identified, in newly diagnosed rheumatoid arthritis (RA) patients, networks of co-expressed genes and proteomic biomarkers associated with achieving sustained drug-free remission (sDFR) after treatment with tocilizumab- or methotrexate-based strategies. The aim of this study was to identify, within the same patients, metabolic pathways important for achieving sDFR and to subsequently study the complex interactions between different components of the biological system and how these interactions might affect the therapeutic response in early RA. Methods Serum samples were analyzed of 60 patients who participated in the U-Act-Early trial (ClinicalTrials.gov number NCT01034137) and initiated treatment with methotrexate, tocilizumab, or the combination and who were thereafter able to achieve sDFR (n = 37); as controls, patients were selected who never achieved a drug-free status (n = 23). Metabolomic measurements were performed using mass spectrometry on oxidative stress, amine, and oxylipin platforms covering various compounds. Partial least square discriminant analyses (PLSDA) were performed to identify, per strategy arm, relevant metabolites of which the biological pathways were studied. In addition, integrative analyses were performed correlating the previously identified transcripts and proteins with the relevant metabolites. Results In the tocilizumab plus methotrexate, tocilizumab, and methotrexate strategy, respectively, 19, 13, and 12 relevant metabolites were found, which were subsequently used for pathway analyses. The most significant pathway in the tocilizumab plus methotrexate strategy was “histidine metabolism” (p < 0.001); in the tocilizumab strategy it was “arachidonic acid metabolism” (p = 0.018); and in the methotrexate strategy it was “arginine and proline metabolism” (p = 0.022). These pathways have treatment-specific drug interactions with metabolites affecting either the signaling of interleukin-6, which is inhibited by tocilizumab, or affecting protein synthesis from amino acids, which is inhibited by methotrexate. Conclusion In early RA patients treated-to-target with a tocilizumab- or methotrexate-based strategy, several metabolites were found to be associated with achieving sDFR. In line with our previous observations, by analyzing relevant transcripts and proteins within the same patients, the metabolic profiles were found to be different between the strategy arms. Our metabolic analysis further supports the hypothesis that achieving sDFR is not only dependent on predisposing biomarkers, but also on the specific treatment that has been initiated. Trial registration ClinicalTrials.gov, NCT01034137. Registered on January 2010 Electronic supplementary material The online version of this article (10.1186/s13075-018-1729-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xavier M Teitsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
| | - Wei Yang
- Leiden Academic Center for Drug Research, Leiden University, 2300 RA, Leiden, Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | | | | | - Amy C Harms
- Leiden Academic Center for Drug Research, Leiden University, 2300 RA, Leiden, Netherlands.,Netherlands Metabolomic Centre, Einsteinweg 55, 2333 CC, Leiden, Netherlands
| | - Thomas Hankemeier
- Leiden Academic Center for Drug Research, Leiden University, 2300 RA, Leiden, Netherlands.,Netherlands Metabolomic Centre, Einsteinweg 55, 2333 CC, Leiden, Netherlands
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
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Abhishek A, Iagnocco A, Bijlsma JWJ, Doherty M, Lioté F. Cross-sectional survey of the undergraduate rheumatology curriculum in European medical schools: a EULAR School of Rheumatology initiative. RMD Open 2018; 4:e000743. [PMID: 30271621 PMCID: PMC6157535 DOI: 10.1136/rmdopen-2018-000743] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives To survey the undergraduate rheumatic and musculoskeletal diseases (RMDs) curriculum content in a sample of medical schools across Europe. Methods The undergraduate musculoskeletal diseases and disability curriculum of University of Nottingham, UK, was used as a template to develop a questionnaire on curriculum content. The questionnaire elicited binary (yes/no) responses and included the option to provide additional information as free text. The survey was mailed to members of the European League Against Rheumatism (EULAR) School of Rheumatology (Undergraduate Classroom) and to EULAR Standing Committee on Education and Training members in January 2017, with a reminder in February 2017. Results Responses were received from 21 schools belonging to 11 countries. Assessment of gait, hyperalgesic tender site response and hypermobility were not included in many curricula. Similarly, interpretation of investigations undertaken on synovial fluid was taught in only 16 schools. While disease-modifying anti-rheumatic drugs and biological agents, and urate-lowering treatment were included in the curricula of 20 and 21 institutions, respectively, only curricula from 18 schools included core non-pharmacological interventions. Osteoarthritis, gout, rheumatoid arthritis, spondyloarthropathy, polymyalgia rheumatica and lupus were included in the curriculum of all institutions. However, common RMDs such as calcium pyrophosphate deposition, fibromyalgia, giant cell arteritis and bone and joint infection were included in 19 curricula. Conclusion This survey highlights areas of similarities and differences in undergraduate curricula across Europe. It is hoped that the results of this survey will catalyse the development and agreement of a minimum core European Curriculum for undergraduate education in RMDs.
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Affiliation(s)
- Abhishek Abhishek
- Academic Rheumatology, Faculty of Medicine and Health Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Annamaria Iagnocco
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Doherty
- Academic Rheumatology, Faculty of Medicine and Health Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frédéric Lioté
- Université Paris Diderot, USPC, UFR de Médecine, Paris, France.,Service de Rhumatologie (centre Viggo Petersen), Hôpital Lariboisière (AP-HP), Paris, France
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Teitsma XM, Jacobs JWG, de Jong PHP, Hazes JMW, Weel AEAM, Welsing PMJ, Pethö-Schramm A, Borm MEA, van Laar JM, Bijlsma JWJ, Lafeber FPJG. Adding baseline protein biomarkers to clinical predictors does not enhance prediction of treatment response to a methotrexate strategy in early rheumatoid arthritis. Ann Rheum Dis 2018; 78:142-144. [DOI: 10.1136/annrheumdis-2018-213767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/20/2018] [Accepted: 08/08/2018] [Indexed: 11/03/2022]
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Cuppen BVJ, Rossato M, Fritsch-Stork RDE, Concepcion AN, Linn-Rasker SP, Bijlsma JWJ, van Laar JM, Lafeber FPJG, Radstake TR. RNA sequencing to predict response to TNF-α inhibitors reveals possible mechanism for nonresponse in smokers. Expert Rev Clin Immunol 2018; 14:623-633. [PMID: 29808722 DOI: 10.1080/1744666x.2018.1480937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several studies have employed microarray-based profiling to predict response to tumor necrosis factor-alpha inhibitors (TNFi) in rheumatoid arthritis (RA); yet efforts to validate these targets have failed to show predictive abilities acceptable for clinical practice. METHODS The eighty most extreme responders and nonresponders to TNFi therapy were selected from the observational BiOCURA cohort. RNA sequencing was performed on mRNA from peripheral blood mononuclear cells (PBMCs) collected before initiation of treatment. The expression of pathways as well as individual gene transcripts between responders and nonresponders was investigated. Promising targets were technically replicated and validated in n = 40 new patients using qPCR assays. RESULTS Before therapy initiation, nonresponders had lower expression of pathways related to interferon and cytokine signaling, while also showing higher levels of two genes, GPR15 and SEMA6B (p = 0.02). The two targets could be validated, however, additional analyses revealed that GPR15 and SEMA6B did not independently predict response, but were rather dose-dependent markers of smoking (p < 0.0001). CONCLUSIONS The study did not identify new transcripts ready to use in clinical practice, yet GPR15 and SEMA6B were recognized as candidate explanatory markers for the reduced treatment success in RA smokers.
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Affiliation(s)
- Bart V J Cuppen
- a Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Marzia Rossato
- b Laboratory of Translational Immunology , University Medical Center Utrecht , Utrecht , The Netherlands.,c Department of Biotechnology , University of Verona , Verona , Italy
| | - Ruth D E Fritsch-Stork
- a Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands.,d 1st Medical Department & Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling , Hanusch Hospital , Vienna , Austria.,e Sigmund Freud University , Vienna , Austria
| | - Arno N Concepcion
- a Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
| | | | - Johannes W J Bijlsma
- a Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Jacob M van Laar
- a Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floris P J G Lafeber
- a Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Timothy R Radstake
- a Rheumatology & Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands.,b Laboratory of Translational Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
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Teitsma XM, Jacobs JWG, Welsing PMJ, de Jong PHP, Hazes JMW, Weel AEAM, Pethö-Schramm A, Borm MEA, van Laar JM, Lafeber FPJG, Bijlsma JWJ. Inadequate response to treat-to-target methotrexate therapy in patients with new-onset rheumatoid arthritis: development and validation of clinical predictors. Ann Rheum Dis 2018; 77:1261-1267. [PMID: 29760159 DOI: 10.1136/annrheumdis-2018-213035] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify and validate clinical baseline predictors associated with inadequate response (IR) to methotrexate (MTX) therapy in newly diagnosed patients with rheumatoid arthritis (RA). METHODS In U-Act-Early, 108 disease-modifying antirheumatic drug (DMARD)-naive patients with RA were randomised to initiate MTX therapy and treated to target until sustained remission (disease activity score assessing 28 joints (DAS28) <2.6 with four or less swollen joints for ≥24 weeks) was achieved. If no remission, hydroxychloroquine was added to the treatment regimen (ie, 'MTX+') and replaced by tocilizumab if the target still was not reached thereafter. Regression analyses were performed to identify clinical predictors for IR, defined as needing addition of a biological DMARD, to 'MTX+'. Data from the treatment in the Rotterdam Early Arthritis Cohort were used for external validation of the prediction model. RESULTS Within 1 year, 56/108 (52%) patients in U-Act-Early showed IR to 'MTX+'. DAS28 (adjusted OR (ORadj) 2.1, 95% CI 1.4 to 3.2), current smoking (ORadj 3.02, 95% CI 1.1 to 8.0) and alcohol consumption (ORadj 0.4, 95% CI 0.1 to 0.9) were identified as baseline predictors. The area under the receiver operator characteristic curve (AUROC) of the prediction model was 0.75 (95% CI 0.66 to 0.84); the positive (PPV) and negative predictive value (NPV) were 65% and 80%, respectively. When applying the model to the validation cohort, the AUROC slightly decreased to 0.67 (95% CI 0.55 to 0.79) and the PPV and NPV to 54% and 80%, respectively. CONCLUSION Higher DAS28, current smoking and no alcohol consumption are predictive factors for IR to step-up 'MTX+' in DMARD-naive patients with new-onset RA. TRIAL REGISTRATION NCT01034137; Post-results, ISRCTN26791028; Post-results.
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Affiliation(s)
- Xavier M Teitsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pascal H P de Jong
- Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Angelique E A M Weel
- Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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van Pelt PA, Dolhain RJEM, Kruize AA, Ammerlaan JJW, Hazes JW, Bijlsma JWJ, Wulffraat NM. Disease activity and dropout in young persons with juvenile idiopathic arthritis in transition of care: a longitudinal observational study. Clin Exp Rheumatol 2018; 36:163-168. [PMID: 29461957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/05/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Reaching a certain age, juvenile idiopathic arthritis (JIA) patients in paediatric care are transferred to adult care. An increased disease activity after transfer and increased dropout has been suggested, however, evidence is scarce. Our aim is to determine whether the process of transition is associated with increased disease-activity and dropout, and to identify associated factors. METHODS During a 3-year prospective transition cohort study, paediatric patients (14-17yrs) were transferred to adult care. Paediatric (10-13yrs) and adult JIA patients (18-27yrs) were used as control groups. Demographic and disease-related items were obtained yearly. Non-parametric tests were used to compare differences between the groups and mixed models to evaluate disease activity over time, measured by JADAS27 and DAS28. Dropout was defined as not attending the clinic for 2 consecutive visits. RESULTS Groups did not differ regarding baseline variables of subtype, gender, uveitis, ANA-, RF- or HLA B27-positivity and current or past DMARD use. Median disease activity was not different between groups during follow-up. Transfer was not associated with disease activity. Dropout rate was 12%, and was significantly higher in patients under transition (22%) compared with paediatric (3%) and adult care (10%). Patients who dropped out had significantly lower disease activity at baseline and were using less MTX, but did not differ regarding subtype, ANA, RF and HLA-B27. CONCLUSIONS The process of transition in JIA is not associated with an increase in disease activity, however, this period carries a risk for drop out especially in patients with low disease activity.
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Affiliation(s)
- Philomine A van Pelt
- Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht; and Department of Rheumatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Judy J W Ammerlaan
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Johanna W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
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Teitsma XM, Jacobs JWG, Welsing PMJ, Pethö-Schramm A, Borm MEA, van Laar JM, Lafeber FPJG, Bijlsma JWJ. Radiographic joint damage in early rheumatoid arthritis patients: comparing tocilizumab- and methotrexate-based treat-to-target strategies. Rheumatology (Oxford) 2017; 57:309-317. [DOI: 10.1093/rheumatology/kex386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Indexed: 11/14/2022] Open
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Safy M, Jacobs JWG, Ijff ND, Bijlsma JWJ, van Laar JM, de Hair MJH. Response to eLetter: 'Discussion of methotrexate dosage' by Maguire et al. Ann Rheum Dis 2017; 77:e48. [PMID: 28993345 DOI: 10.1136/annrheumdis-2017-212380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Mary Safy
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands
| | - J W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands
| | - Nicole D Ijff
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands
| | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands
| | - J M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands
| | - Maria J H de Hair
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands
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Ammerlaan JW, van Os-Medendorp H, de Boer-Nijhof NC, Prakken B, Bijlsma JWJ, Kruize AA. The most important needs and preferences of patients for support from health care professionals: A reflective practice on (transitional) care for young adults with Juvenile Idiopathic Arthritis. Patient Educ Couns 2017; 100:1961-1964. [PMID: 28363359 DOI: 10.1016/j.pec.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/09/2017] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
In this manuscript, presented as a Reflective Practice, the learning experiences and reflections of a healthcare team on redeveloping the transitional care for young adults with a juvenile rheumatic disease are described. In this process of redeveloping care, the healthcare team experienced that small step, driven by patient stories and involvement of patients in all phases from development to evaluation, led to meaningful results. The eHealth interventions, developed to support the transition and to increase self-management were found to be feasible and evaluated positively by the young adult group. But the healthcare team also experienced that the focus on the patient alone, is not enough to implement self-management interventions and sustain patient centered care in daily practice. How healthcare professionals personally think and feel about patient centered care is essential and needs to be discussed in daily care.It determines the way of being present with attention and commitment in daily health care. It affects the hands, head and heart. A daily reflection on shared answers of the patient and the health care professional to the question 'what is the most important to you?'may help to implement patient centered care in health practice.
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Affiliation(s)
- Judy W Ammerlaan
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Harmieke van Os-Medendorp
- University Medical Center Utrecht, Department Dermatology/Allergology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Nienke C de Boer-Nijhof
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Berent Prakken
- University Medical Center Utrecht, Department Pediatric Rheumatology, HPN KC.02.085.0, P.O. Box 85090, Utrecht 3508 AB, the Netherlands.
| | - Johannes W J Bijlsma
- University Medical Center Utrecht, Department Rheumatology & Clinical Immunology, HPN F02.127, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Aike A Kruize
- University Medical Center Utrecht, Department Rheumatology & Clinical Immunology, HPN F02.127, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
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Teitsma XM, Jacobs JWG, Welsing PMJ, Pethö-Schramm A, Borm MEA, Hendriks L, Denissen NHAM, van Laar JM, Lafeber FPJG, Bijlsma JWJ. Patient-reported outcomes in newly diagnosed early rheumatoid arthritis patients treated to target with a tocilizumab- or methotrexate-based strategy. Rheumatology (Oxford) 2017; 56:2179-2189. [DOI: 10.1093/rheumatology/kex319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 01/01/2023] Open
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Teitsma XM, Jacobs JWG, Mokry M, Borm MEA, Pethö-Schramm A, van Laar JM, Bijlsma JWJ, Lafeber FPJ. Identification of differential co-expressed gene networks in early rheumatoid arthritis achieving sustained drug-free remission after treatment with a tocilizumab-based or methotrexate-based strategy. Arthritis Res Ther 2017; 19:170. [PMID: 28728565 PMCID: PMC5520225 DOI: 10.1186/s13075-017-1378-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methotrexate is endorsed to be used as first-line treatment in rheumatoid arthritis (RA). However, a large proportion of patients need additional treatment with a biological disease-modifying anti-rheumatic drug (DMARD) to adequately suppress their disease activity. A better understanding of genotypes could help to distinguish between patients with different pathogenic mechanisms. The aim of this study was therefore to identify networks of genes within DMARD-naive early RA patients associated with achieving sustained drug-free remission (sDFR) after initiating tocilizumab plus methotrexate, tocilizumab, or methotrexate therapy. METHODS Samples were used from 60 patients from the U-Act-Early study who received tocilizumab plus methotrexate, tocilizumab, or methotrexate therapy, and who achieved sDFR (≥3 months in drug-free remission until the end of the study, n = 37) after therapy was tapered and subsequently stopped, or who were not able to discontinue the therapy as controls (n = 23). Whole blood samples were collected and ribonucleic acid (RNA) was isolated from positive cluster of differentiation 4 (CD4+) and CD14+ cells and analysed using high-throughput sequencing. Weighted gene co-expression network analyses were performed to identify clusters (i.e. modules) of differently expressed genes associated with achieving sDFR and which were subsequently used for pathway analyses. RESULTS Network analyses within CD4+ cells identified two significant modules in the tocilizumab plus methotrexate arm and four modules in the tocilizumab and methotrexate arms, respectively (p ≤ 0.039). Important pathways in the module best correlating with achieving sDFR were in the tocilizumab plus methotrexate arm related to processes involved with transcription and translation; in the tocilizumab arm, pathways were related to migration of white blood cells and G-protein coupled receptors, and in the methotrexate arm pathways were involved with the response to a bacterial or biotic (i.e. biological material)-related stimulus. No relevant networks could be identified in the sequenced CD14+ cells. CONCLUSIONS Within networks of co-expressed genes, several pathways were found related to achieving sDFR after initiating therapy with tocilizumab, methotrexate, or the combination. Between the three strategy arms, we identified different networks of predisposing genes which indicates that specific gene expression profiles, depending on the treatment strategy chosen, are associated with a higher chance of achieving sDFR. TRIAL REGISTRATION Clinicaltrials.gov, NCT01034137 . Registered on 16 December 2009.
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Affiliation(s)
- Xavier M Teitsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands
| | - Michal Mokry
- Epigenomics Facility, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands.,Division of Paediatrics, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands
| | | | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands
| | - Floris P J Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands
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Rubbert-Roth A, Jacobs JWG, Bijlsma JWJ, Welsing PMJ. A disconnect between disease activity and functional ability already in patients with early rheumatoid arthritis, depending on large joint involvement. Ann Rheum Dis 2017. [PMID: 28646081 DOI: 10.1136/annrheumdis-2017-211485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
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W J Bijlsma J, Buttgereit F. Adverse events of glucocorticoids during treatment of rheumatoid arthritis: lessons from cohort and registry studies. Rheumatology (Oxford) 2017; 55:ii3-ii5. [PMID: 27856654 DOI: 10.1093/rheumatology/kew344] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
Glucocorticoids have now been used for >65 years in the treatment of RA. There is good evidence for their disease-modifying effect, especially in early RA. When used in a dosage of 7.5-10 mg/day, most adverse effects can be handled quite well, although monitoring for and awareness of infections are important. Adverse events may have been overreported, due to bias by indication, but pose an important drawback in the use of these very effective anti-inflammatory and immune-modulatory drugs. Daily dosages >7.5-10 mg and use for a prolonged period (years) of time are associated with a dose-dependent increased mortality. Still, the benefit:risk ratio for low-dosage glucocorticoid in patients with RA is acceptable and in many ways is comparable with other synthetic and biologic DMARDs.
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Affiliation(s)
- Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charite University Medicine Berlin, Berlin, Germany
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Burmester GR, Bijlsma JWJ, Cutolo M, McInnes IB. Managing rheumatic and musculoskeletal diseases — past, present and future. Nat Rev Rheumatol 2017; 13:443-448. [DOI: 10.1038/nrrheum.2017.95] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Amann J, Wessels AM, Breitenfeldt F, Huscher D, Bijlsma JWJ, Jacobs JWG, Buttgereit F. Quantifying cutaneous adverse effects of systemic glucocorticoids in patients with rheumatoid arthritis: a cross-sectional cohort study. Clin Exp Rheumatol 2017; 35:471-476. [PMID: 28094753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES EULAR guidelines state that adverse effects (AEs) of glucocorticoid (GC) therapy should be considered and discussed with the patient before treatment is initiated. However, reliable quantitative data, especially on cutaneous AEs of low-to-medium dose GCs are lacking. We performed a study assessing the occurrence of cutaneous AEs of GCs and its association with current and cumulative GC doses in patients with rheumatoid arthritis (RA). METHODS In a cross-sectional study performed in 2 outpatient rheumatology centres, 381 RA patients were enrolled. They were classed into 4 groups, according their mean daily dose during the past 12 months: 0 mg (n=87), <5mg (n=108), 5-7.5 mg (n=130), and >7.5 mg (n=56) of prednisone equivalent. AEs of GC on the skin were assessed by physical examination using a predefined scoring system, and by patients' self-assessments. Data were analysed according GC dose categories and cumulative doses. RESULTS Cushingoid habitus, easy bruising, skin atrophy, and impaired wound healing as reported by patients occurred significantly more frequently in those using a GC the past 12 months, compared to those not using a GC. At physicians' assessments, only Cushingoid habitus and ecchymosis were more prevalent in GC users. The prevalence of these AEs was statistically significantly positively associated with current and cumulative GC dose. There was low occurrence of abnormal stretch marks, acne, perioral dermatitis, alopecia and hirsutism, which were not correlated with GC use. CONCLUSIONS Certain GC-associated cutaneous AEs are common in RA, but other AEs of GC occur infrequently at the low-to-medium GC doses used in RA.
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Affiliation(s)
- Jonna Amann
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Anne-Marie Wessels
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands
| | - Friederike Breitenfeldt
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Dörte Huscher
- German Rheumatism Research Center Berlin, Epidemiology, Berlin, Germany
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands.
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
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Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D'Agostino MA, Doherty M, Fodor D, Kloppenburg M, Miese F, Naredo E, Porcheret M, Iagnocco A. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76:1484-1494. [DOI: 10.1136/annrheumdis-2016-210815] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 11/04/2022]
Abstract
The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
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Miloslavsky EM, Naden RP, Bijlsma JWJ, Brogan PA, Brown ES, Brunetta P, Buttgereit F, Choi HK, DiCaire JF, Gelfand JM, Heaney LG, Lightstone L, Lu N, Murrell DF, Petri M, Rosenbaum JT, Saag KS, Urowitz MB, Winthrop KL, Stone JH. Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis. Ann Rheum Dis 2017; 76:543-546. [PMID: 27474764 DOI: 10.1136/annrheumdis-2016-210002] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/11/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop a Glucocorticoid Toxicity Index (GTI) to assess glucocorticoid (GC)-related morbidity and GC-sparing ability of other therapies. METHODS Nineteen experts on GC use and outcome measures from 11 subspecialties participated. Ten experts were from the USA; nine from Canada, Europe or Australia. Group consensus methods and multicriteria decision analysis (MCDA) were used. A Composite GTI and Specific List comprise the overall GTI. The Composite GTI reflects toxicity likely to change during a clinical trial. The Composite GTI toxicities occur commonly, vary with GC exposure, and are weighted and scored. Relative weights for items in the Composite GTI were derived by group consensus and MCDA. The Specific List is designed to capture GC toxicity not included in the Composite GTI. The Composite GTI was evaluated by application to paper cases by the investigators and an external group of 17 subspecialists. RESULTS Thirty-one toxicity items were included in the Composite GTI and 23 in the Specific List. Composite GTI evaluation showed high inter-rater agreement (investigators κ 0.88, external raters κ 0.90). To assess the degree to which the Composite GTI corresponds to expert clinical judgement, participants ranked 15 cases by clinical judgement in order of highest to lowest GC toxicity. Expert rankings were then compared with case ranking by the Composite GTI, yielding excellent agreement (investigators weighted κ 0.87, external raters weighted κ 0.77). CONCLUSIONS We describe the development and initial evaluation of a comprehensive instrument for the assessment of GC toxicity.
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Affiliation(s)
- Eli M Miloslavsky
- Rheumatology, Allergy and Immunology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ray P Naden
- Maternal-Fetal Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Paul A Brogan
- Institute of Child Health, University College London, UCL Inst of Child Health, London, UK
| | - E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Paul Brunetta
- Late Stage Immunology Product Development, Genentech, Inc., South San Francisco, USA
| | - Frank Buttgereit
- Department of Rheumatology and Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Hyon K Choi
- Department of Rheumatology, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Liz Lightstone
- Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, Imperial College London, London, UK
| | - Na Lu
- Department of Rheumatology, Massachusetts General Hospital, Boston, USA
| | - Dedee F Murrell
- University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Petri
- Department of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Kenneth S Saag
- UAB Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Murray B Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, Canada
| | | | - John H Stone
- Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Rheumatology Clinic, Boston, Massachusetts, USA
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Cuppen BVJ, Jacobs JWG, Ter Borg EJ, Marijnissen ACA, Bijlsma JWJ, Lafeber FPJG, van Laar JM. Necessity of TNF-alpha inhibitor discontinuation in rheumatoid arthritis is predicted by smoking and number of previously used biological DMARDs. Clin Exp Rheumatol 2017; 35:221-228. [PMID: 27749223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Despite the success of TNF-alpha inhibitor (TNFi) treatment in rheumatoid arthritis (RA), a substantial number of patients necessitate discontinuation. Prediction thereof would be clinically relevant and guide the decision whether to start TNFi treatment. METHODS Data were used from the observational BiOCURA cohort, in which patients initiating biological treatment were enrolled and followed up for one year. In the model development cohort (n=192), a model predicting TNFi discontinuation was built using Cox-regression with backward selection (p<0.05). The parameters of the model were tested again in a model refinement cohort (n=60), for significance (p<0.05) and consistency of effect. In addition, we performed a systematic review to put our study results into perspective. RESULTS Of the 252 patients who initiated TNFi treatment, 103 (41%) had to discontinue treatment. Discontinuation was predicted at baseline by female gender, current smoking, high visual analogue scale of general health, and higher number of previously used biological disease-modifying anti-rheumatic drugs (bDMARDs). At refinement, smoking status and number of previously used bDMARDs remained with re-estimated hazard ratios (HRs) in the total cohort of 1.74 (95%-CI 1.15-2.63, p<0.01) and 1.40 (95%-CI 1.1-1.68, p<0.01), respectively. Using these two predictors, we developed a simple score predicting discontinuation (PPV=72.3%). From literature, predictors were pack years of smoking, number of previously used bDMARDs, lack of any concomitant DMARD therapy and in particular lack of concomitant methotrexate (MTX). CONCLUSIONS TNFi discontinuation is predicted by current smoking and number of previously used bDMARDs, as well as by pack years of smoking and lack of any concomitant DMARD/MTX therapy.
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Affiliation(s)
- Bart V J Cuppen
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands.
| | - Johannes W G Jacobs
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | | | - Anne C A Marijnissen
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | - Jacob M van Laar
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
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Ammerlaan JW, van Os-Medendorp H, de Boer-Nijhof N, Maat B, Scholtus L, Kruize AA, Bijlsma JWJ, Geenen R. Preferences and needs of patients with a rheumatic disease regarding the structure and content of online self-management support. Patient Educ Couns 2017; 100:501-508. [PMID: 27776789 DOI: 10.1016/j.pec.2016.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/19/2016] [Accepted: 10/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Aim of this study was to investigate preferences and needs regarding the structure and content of a person-centered online self-management support intervention for patients with a rheumatic disease. METHODS A four step procedure, consisting of online focus group interviews, consensus meetings with patient representatives, card sorting task and hierarchical cluster analysis was used to identify the preferences and needs. RESULTS Preferences concerning the structure involved 1) suitability to individual needs and questions, 2) fit to the life stage 3) creating the opportunity to share experiences, be in contact with others, 4) have an expert patient as trainer, 5) allow for doing the training at one's own pace and 6) offer a brief intervention. Hierarchical cluster analysis of 55 content needs comprised eleven clusters: 1) treatment knowledge, 2) societal procedures, 3) physical activity, 4) psychological distress, 5) self-efficacy, 6) provider, 7) fluctuations, 8) dealing with rheumatic disease, 9) communication, 10) intimate relationship, and 11) having children. CONCLUSION A comprehensive assessment of preferences and needs in patients with a rheumatic disease is expected to contribute to motivation, adherence to and outcome of self-management-support programs. PRACTICE IMPLICATIONS The overview of preferences and needs can be used to build an online-line self-management intervention.
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Affiliation(s)
- Judy W Ammerlaan
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Harmieke van Os-Medendorp
- University Medical Hospital Utrecht, Department Dermatology and Allergology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Nienke de Boer-Nijhof
- Dutch Arthritis Foundation, Unit Volunteer at Dutch Arthritis Foundation, P.O. Box 59091, 1040 KB Amsterdam, The Netherlands.
| | - Bertha Maat
- Dutch Arthritis Foundation, Unit Volunteer at Dutch Arthritis Foundation, P.O. Box 59091, 1040 KB Amsterdam, The Netherlands.
| | - Lieske Scholtus
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN D02.244, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Aike A Kruize
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN F02.127, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Johannes W J Bijlsma
- University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, HPN F02.127, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Rinie Geenen
- Utrecht University, Department of Psychology, P.O. Box 80140, 3508 GA Utrecht, The Netherlands.
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Cuppen BVJ, Pardali K, Kraan MC, Marijnissen ACA, Yrlid L, Olsson M, Bijlsma JWJ, Lafeber FPJG, Fritsch-Stork RDE. Polymorphisms in the multidrug-resistance 1 gene related to glucocorticoid response in rheumatoid arthritis treatment. Rheumatol Int 2017; 37:531-536. [PMID: 28132103 PMCID: PMC5357283 DOI: 10.1007/s00296-017-3653-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/10/2017] [Indexed: 11/27/2022]
Abstract
A substantial proportion of rheumatoid arthritis (RA)-patients experience an insufficient response to glucocorticoids, an important therapeutic agent in RA. The multidrug-resistance 1 (MDR1) gene product P-glycoprotein (P-gp) is an efflux pump that actively transports substrates, such as glucocorticoids, out of the cell. We investigated if the variation in response might be explained by single-nucleotide polymorphisms (SNPs) in the MDR1 gene. RA-patients treated with intravenous methylprednisolone pulses (n = 18) or oral prednisone/prednisolone (n = 22) were included in a prospective cohort, and clinical response was measured after 5 and 30 days, respectively. The C1236T, G2677A/T, and C3435T SNPs were determined, and the functionality of P-gp was assessed by flow cytometry (Rhodamine efflux assay). Carriage of the G2677A/T SNP was significantly associated with response (OR = 6.18, p = 0.035), the other SNPs showed trends. Stratified for received treatment, the effect was only present in methylprednisolone treated patients. Mutant allele carriage significantly decreased functionality of P-gp in B cells, though had a smaller impact in other PBMC subtypes. Carriage of a MDR1 SNP was related to a response to methylprednisolone in this study, which his suggests that RA-patients carrying wild-type alleles might benefit from P-gp inhibition or administration of glucocorticoid analogues that are non-P-gp substrates.
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Affiliation(s)
- Bart V J Cuppen
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, 3508 GA, Utrecht, The Netherlands.
| | - Katerina Pardali
- Respiratory and Inflammation iMed, AstraZeneca, Pepparedsleden 1, 431 83, Mölndal, Sweden.
| | - Maarten C Kraan
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, 3508 GA, Utrecht, The Netherlands.,Respiratory and Inflammation iMed, AstraZeneca, Pepparedsleden 1, 431 83, Mölndal, Sweden
| | - Anne C A Marijnissen
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, 3508 GA, Utrecht, The Netherlands
| | - Linda Yrlid
- Respiratory and Inflammation iMed, AstraZeneca, Pepparedsleden 1, 431 83, Mölndal, Sweden
| | - Marita Olsson
- Respiratory and Inflammation iMed, AstraZeneca, Pepparedsleden 1, 431 83, Mölndal, Sweden
| | - Johannes W J Bijlsma
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, 3508 GA, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, 3508 GA, Utrecht, The Netherlands
| | - Ruth D E Fritsch-Stork
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, 3508 GA, Utrecht, The Netherlands.,1st Medical Department and Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, Hanusch Hospital, Vienna, Austria.,Sigmund Freud University, Vienna, Austria
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50
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Fu J, Cuppen BVJ, Welsing PMJ, van Wietmarschen H, Harms AC, Berger R, Koval S, Fritsch-Stork RDE, Bijlsma JWJ, Hankemeier T, van der Greef J, Lafeber FPJG. Differences between serum polar lipid profiles of male and female rheumatoid arthritis patients in response to glucocorticoid treatment. Inflammopharmacology 2016; 24:397-402. [PMID: 27682325 PMCID: PMC5119840 DOI: 10.1007/s10787-016-0284-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/21/2016] [Indexed: 01/18/2023]
Abstract
Objective As there are pharmacological differences between males and females, and glucocorticoid (GC) treatment is associated with increased cardiovascular mortality rate in rheumatoid arthritis (RA) patients, it is important to study serum polar lipid profiles of male and female patients in response to GC therapy. Gender differences may require an adjustment to the treatment strategy for a selection of patients. Methods Serum samples from 281 RA patients were analysed using a targeted lipidomics platform. The differences in GC use and gender on polar lipid profiles were cross sectionally examined by multiple linear regressions, while correcting for confounding factors. Results Differences in polar lipids between GC users and non-GC users in females and males were merely restricted to lysophospholipids (lysophosphatidylcholines and lysophosphatidylethanolamines). Lysophospholipids in female patients treated with GCs were significantly higher than female patients not treated with GCs (p = 6.0 E−6), whereas no significant difference was observed in male GC users versus non-users (p = 0.397). Conclusion The lysophospholipid profiles in response to GCs were significantly different between male and female RA patients, which may have implications for the cardiovascular risk of GC treatment. Electronic supplementary material The online version of this article (doi:10.1007/s10787-016-0284-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junzeng Fu
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands. .,Sino-Dutch Center for Preventive and Personalized Medicine, P.O. Box 360, 3700 AJ, Zeist, The Netherlands.
| | - Bart V J Cuppen
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Paco M J Welsing
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Herman van Wietmarschen
- Sino-Dutch Center for Preventive and Personalized Medicine, P.O. Box 360, 3700 AJ, Zeist, The Netherlands
| | - Amy C Harms
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Ruud Berger
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Slavik Koval
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Ruth D E Fritsch-Stork
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,1st Medical Department and Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria.,Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria
| | - Johannes W J Bijlsma
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Thomas Hankemeier
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Jan van der Greef
- Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.,Sino-Dutch Center for Preventive and Personalized Medicine, P.O. Box 360, 3700 AJ, Zeist, The Netherlands.,TNO, Netherlands Organization for Applied Scientific Research, Microbiology and Systems Biology, Zeist, The Netherlands.,Netherlands Metabolomics Center, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Floris P J G Lafeber
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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