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DiSantostefano RL, Simons G, Englbrecht M, Humphreys JH, Bruce IN, Bywall KS, Radawski C, Raza K, Falahee M, Veldwijk J. Can the General Public Be a Proxy for an "At-Risk" Group in a Patient Preference Study? A Disease Prevention Example in Rheumatoid Arthritis. Med Decis Making 2024; 44:189-202. [PMID: 38240281 PMCID: PMC10865770 DOI: 10.1177/0272989x231218265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 11/02/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND When selecting samples for patient preference studies, it may be difficult or impractical to recruit participants who are eligible for a particular treatment decision. However, a general public sample may not be an appropriate proxy. OBJECTIVE This study compares preferences for rheumatoid arthritis (RA) preventive treatments between members of the general public and first-degree relatives (FDRs) of confirmed RA patients to assess whether a sample of the general public can be used as a proxy for FDRs. METHODS Participants were asked to imagine they were experiencing arthralgia and had screening tests indicating a 60% chance of developing RA within 2 yrs. Using a discrete choice experiment, participants were offered a series of choices between no treatment and 2 unlabeled hypothetical treatments to reduce the risk of RA. To assess data quality, time to complete survey sections and comprehension questions were assessed. A random parameter logit model was used to obtain attribute-level estimates, which were used to calculate relative importance, maximum acceptable risk (MAR), and market shares of hypothetical preventive treatments. RESULTS The FDR sample (n = 298) spent more time completing the survey and performed better on comprehension questions compared with the general public sample (n = 982). The relative importance ranking was similar between the general public and FDR participant samples; however, other relative preference measures involving weights including MARs and market share differed between groups, with FDRs having numerically higher MARs. CONCLUSION In the context of RA prevention, the general public (average risk) may be a reasonable proxy for a more at-risk sample (FDRs) for overall relative importance ranking but not weights. The rationale for a proxy sample should be clearly justified. HIGHLIGHTS Participants from the general public were compared to first-degree relatives on their preferences for rheumatoid arthritis (RA) preventive treatments using a discrete choice experiment.Preferences were similar between groups in terms of the most important and least important attributes of preventive treatments, with effectiveness being the most important attribute. However, relative weights differed.Attention to the survey and predicted market shares of hypothetical RA preventive treatments differed between the general public and first-degree relatives.The general public may be a reasonable proxy for an at-risk group for patient preferences ranks but not weights in the disease prevention context; however, care should be taken in sample selection for patient preference studies when choosing nonpatients.
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Affiliation(s)
| | - G. Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - M. Englbrecht
- freelance healthcare data scientist, Eckental, Germany
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jennifer H. Humphreys
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian N. Bruce
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - C. Radawski
- Eli Lilly and Company, Indianapolis, IN, USA
| | - K. Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M. Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J. Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Simons G, Schölin Bywall K, Englbrecht M, Johansson EC, DiSantostefano RL, Radawski C, Veldwijk J, Raza K, Falahee M. Exploring preferences of at-risk individuals for preventive treatments for rheumatoid arthritis. Scand J Rheumatol 2023; 52:449-459. [PMID: 36178461 DOI: 10.1080/03009742.2022.2116805] [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] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Some immunomodulatory drugs have been shown to delay the onset of, or lower the risk of developing, rheumatoid arthritis (RA), if given to individuals at risk. Several trials are ongoing in this area; however, little evidence is currently available about the views of those at risk of RA regarding preventive treatment. METHOD Three focus groups and three interviews explored factors that are relevant to first degree relatives (FDRs) of RA patients and members of the general public when considering taking preventive treatment for RA. The semi-structured qualitative interview prompts explored participant responses to hypothetical attributes of preventive RA medicines. Transcripts of focus group/interview proceedings were inductively coded and analysed using a framework approach. RESULTS Twenty-one individuals (five FDRs, 16 members of the general public) took part in the study. Ten broad themes were identified describing factors that participants felt would influence their decisions about whether to take preventive treatment if they were at increased risk of RA. These related either directly to features of the specific treatment or to other factors, including personal characteristics, attitude towards taking medication, and an individual's actual risk of developing RA. CONCLUSION This research highlights the importance of non-treatment factors in the decision-making process around preventive treatments, and will inform recruitment to clinical trials as well as information to support shared decision making by those considering preventive treatment. Studies of treatment preferences in individuals with a confirmed high risk of RA would further inform clinical trial design.
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Affiliation(s)
- G Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - K Schölin Bywall
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - M Englbrecht
- Freelance Healthcare Data Scientist, Eckental, Germany
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - E C Johansson
- Patient Research Partner, Swedish Rheumatism Association, Stockholm, Sweden
| | | | - C Radawski
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J Veldwijk
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Simons G, Janssen E, Veldwijk J, Disantostefano R, Englbrecht M, Radawski C, Valor L, Humphreys J, Bruce IN, Hauber B, Raza K, Falahee M. POS0591 TREATMENTS TO PREVENT RHEUMATOID ARTHRITIS IN FIRST DEGREE RELATIVES: DEMOGRAPHIC AND PSYCHOLOGICAL PREDICTORS OF RISK TOLERANCES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThere is a growing research focus on the development of interventions to reduce risk of rheumatoid arthritis (RA) in at-risk groups.(1) RA patients’ first-degree relatives (FDRs) have an elevated risk of developing RA and are potential candidates for preventive interventions. Recent studies have quantified the preferences of at risk groups for preventive treatments.(2-4) Little is known about predictors of preference heterogeneity in this context.ObjectivesAssess the extent to which FDR characteristics and beliefs predict risk tolerances for preventive treatments.MethodsAdult FDRs of patients with confirmed RA in the UK were invited to take part in a web-based survey. FDRs enrolled in a UK prospective cohort (PREVeNT-RA) were also invited. Survey development, including attribute selection and presentation, was informed by qualitative research, ranking surveys, literature review, and expert opinion including patient research partners. Respondents received information about RA, questions to check comprehension, and an introduction to the survey. Participants were asked to imagine they were experiencing arthralgia and had positive autoantibody tests indicating a 60% chance of developing RA within two years. Using a probabilistic threshold technique, participants made choices between no treatment (no benefit and no risks) or a preventive treatment option. Treatment options were defined by a fixed level of benefit (reduction in risk of RA from 60% to 20%) and varying levels of risks (Table 1). For each treatment risk, participants made a series of choices where the risk was systematically increased or decreased until they switched their choice. This procedure was repeated for each of the remaining risks. Participants also completed items assessing demographics, perceived risk of developing RA, health literacy, subjective numeracy, the Brief Illness Perception Questionnaire (IPQ) and the Beliefs about Medicines Questionnaire General (BMQ-G). The maximum acceptable risk (MAR) respondents were willing to accept for a 40% (60% to 20%) point risk reduction in developing RA was summarized across participants using descriptive statistics. Associations between MARs and participants’ characteristics and illness/medication beliefs were assessed using interval regression. Independent variables were dichotomized and effects coded.Table 1.Attributes and levels of treatment optionsTreatment attributeLevels describing no treatment optionLevels describing treatment optionChance of developing RA60%20%Chance of mild side effects0%2%; 4%; 5%; 7% or 10%Chance of a serious infection due to treatment0%1%; 1.5%; 2%; 3% or 5%Chance of a serious side effect that is potentially irreversible0%0.001%; 0.01%; 0.02%; 0.05% or 0.1%Results289 FDRs (80 male) responded. The mean (SE) MAR for mild side effects, serious infection, and serious side effects was 29.08 (1.52), 9.09 (0.60) and 0.85 (0.27), respectively. Participants aged over 60 years were less tolerant of risk of serious infection than average (mean MAR - 2.06 (0.78)) and younger participants were more tolerant of risk of serious infection than average (mean MAR + 2.06 (0.78)). Risk of mild side effects was less acceptable to participants who perceived they were likely/very likely to develop RA (mean MAR - 3.34 (1.55)) than to those who did not (mean MAR + 3.34 (1.55)). Education level, health literacy, numeracy, IPQ and BMQ-G subscales were not predictors of risk tolerance.ConclusionAge and perceived risk of RA had a significant impact on FDRs’ tolerance for specific, but not all, included risks. Cognitive ability and beliefs about RA/medicine did not explain preference heterogeneity. This is informative for drug development and the development of tailored risk communication resources to support preventive approaches.References[1]Mankia et al. Ann Rheum Dis. 2021;80(10):1286-98.[2]Simons et al. Ann Rheum Dis. 2021;80:96-7.[3]Harrison et al. Plos One. 2009; 14(4): e0216075.[4]Finckh et al. Curr Rheumatol Rep. 2016;18: 51.AcknowledgementsOn behalf of the PREFER project. PREFER received funding from the IMI 2 Joint Undertaking (grant No. 115966), which receives support from the EU’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations (EFPIA). K. Raza is supported by the NIHR Birmingham Biomedical Research Centre.Disclosure of InterestsGwenda Simons: None declared, Ellen Janssen Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, Jorien Veldwijk: None declared, Rachael DiSantostefano Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, Matthias Englbrecht Speakers bureau: Abbvie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Mundipharma, Paid instructor for: Abbvie, Chugai, Roche, Consultant of: Abbvie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Christine Radawski Shareholder of: Eli Lilly, Employee of: Eli Lilly, Larissa Valor: None declared, Jenny Humphreys: None declared, Ian N. Bruce: None declared, Brett Hauber Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., Karim Raza Consultant of: Abbvie, Sanofi, Grant/research support from: Bristol Myers Squibb, Marie Falahee: None declared.
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Simons G, Veldwijk J, Disantostefano R, Englbrecht M, Radawski C, Valor L, Humphreys J, Bruce IN, Raza K, Falahee M. OP0276 PREFERENCES FOR TREATMENTS TO PREVENT RHEUMATOID ARTHRITIS: DISCRETE CHOICE SURVEY OF RHEUMATOID ARTHRITIS PATIENTS’ FIRST-DEGREE RELATIVES IN THE UNITED KINGDOM AND GERMANY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere is a growing research focus on the development of interventions to reduce risk of rheumatoid arthritis (RA) in at-risk individuals.(1) A recent survey of the general population asked to assume a 60% risk of RA established that hypothetical preventive treatments were acceptable to most participants.(2) However the preferences of individuals who actually have an elevated risk of RA, such as first-degree relatives (FDRs) of RA patients, are not well understood.ObjectivesTo quantify FDRs’ preferences for preventive treatments for RA.MethodsAdult FDRs in the UK and Germany were invited to take part in a web-based survey via patients with clinician-confirmed RA either during a rheumatology clinic visit or by mail. In addition, FDRs taking part in a UK-based prospective cohort (PREVeNT-RA) were invited via email. Participants received information about RA followed by questions to check comprehension, and an introduction to the survey including warm-up questions. They were asked to imagine they were experiencing arthralgia and had positive autoantibody tests indicating a 60% chance of developing RA in the next two years. Using a discrete choice experiment, participants were offered a series of 15 choices between no treatment and two unlabeled hypothetical treatments to reduce risk of RA. Treatments were defined by six attributes with varying levels, describing benefits, risks, and frequency/route of administration (Table 1). Attribute selection and presentation was informed by qualitative research, ranking surveys, systematic literature review, and expert opinion. Survey layout was informed by patient research partners and qualitative pre-testing. A two-class latent class analysis was used to estimate preferences and calculate relative importance of treatment attributes and predicted uptake. A panel mixed logit model was used to obtain maximum acceptable risk estimates.Table 1.Treatment attributes and levelsAttributeLevelsChance of developing RA reduced from 60% to10%; 20%; 30%; 40%How the treatment is takenA shallow injection under the skinA drip into the veinOne or two tabletsHow often the medication has to be takenDailyWeeklyMonthlyEvery 6 monthsChance of mild side effects2%; 5%; 10%Chance of a serious infection due to treatment0%; 1%; 5%Chance of a serious side effect that is potentially irreversible1 in 100,000 people20 in 100,000 people100 in 100,000 peopleResults356 FDRs (252 female, 289 in the UK) responded. While treatment effectiveness was the most important attribute in both classes (Figure 1), the importance of other attributes differed between classes, with method and frequency of treatment administration being more important in class 2 and risk of mild side effects only impacting treatment choice in class 1. Perceived risk of developing RA predicted class assignment; those with higher perceived risk were more likely to belong to class 1. On average, the predicted uptake of treatment profiles estimating prevention candidates: abatacept; atorvastatin; hydroxychloroquine; tolerogenic cell-based therapy; and no treatment would be 50%, 15%, 9%, 18% and 0%, respectively. Finally, the maximum acceptable risk participants were willing to accept were 81%, 25% and 3% point increases in risk of mild side effects, serious infection, and serious side effects, respectively, for medicines that would reduce their risk of developing RA in the upcoming two years from 60% to 20%.ConclusionEffective preventive treatments for RA were acceptable to FDRs asked to assume a 60% chance of developing RA. Mode and frequency of treatment administration had a greater impact on treatment choices for participants with a lower perceived risk of RA. These findings are informative for target product profile development, endpoint selection, benefit-risk assessment, regulatory approval, and development of informational resources for those at risk of RA.References[1]Mankia et al. Ann Rheum Dis. 2021;80(10):1286-98.[2]Simons et al. Ann Rheum Dis. 2021;80:96-7.AcknowledgementsOn behalf of the PREFER project. PREFER received funding from the IMI 2 Joint Undertaking (grant No. 115966), which receives support from the EU’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations (EFPIA). This abstract and its contents reflect the view of the presenter and not the view of PREFER, IMI, the European Union or EFPIA. K. Raza is supported by the NIHR Birmingham Biomedical Research Centre.Disclosure of InterestsGwenda Simons: None declared, Jorien Veldwijk: None declared, Rachael DiSantostefano Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, Matthias Englbrecht Speakers bureau: Abbvie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Munidpharma, Paid instructor for: Abbvie, Chugai, Roche, Consultant of: Abbvie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Christine Radawski Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Larissa Valor: None declared, Jenny Humphreys: None declared, Ian N. Bruce: None declared, Karim Raza Consultant of: Abbvie, Sanofi, Grant/research support from: Bristol Myers Squibb, Marie Falahee: None declared
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Kleinert S, Rapp P, Schuch F, Ronneberger M, Wendler J, Sternad P, Popp F, Bartz-Bazzanella P, Von der Decken CB, Karberg K, Gauler G, Wurth P, Spaethling-Mestekemper S, Kuhn C, Englbrecht M, Vorbrüggen W, Adler G, Welcker M. AB0494 COGNITIVE IMPAIRMENT IN AXIAL SPONDYLOARTHRITIS? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:There is some evidence that neuropsychiatric changes occur in systemic lupus(1) and rheumatoid arthritis(2). However, little is known regarding a possible disease-related impairment of cognitive abilities in axial spondyloarthritis (axSpA).Objectives:To evaluate patients with axSpA regarding cognitive impairments.Methods:Patients with axSpA attending two rheumatology practices were routinely evaluated by rheumatologists and underwent a computer-based memory and attention test (MAT) (3, 4) with subscale scores ranging from 0 (worst) to 15 (best). The results of short-term memory and working memory were compared to an age-, sex- and education-matched control group of healthy subjects. Descriptive results are presented as median (IQR) for interval data and n (%) for nominal data if not stated otherwise. Two-tailed Wilcoxon signed-rank tests including Bonferroni-Holm adjustment for multiple tests were conducted to investigate the magnitude of potential differences in cognitive abilities.Results:101 consecutive patients were tested (Table 1). After multiple testing adjustment for two subscales, Wilcoxon signed-rank tests returned significant findings for working memory (V = 539.5, p = 0.006, |r| = 0.204) but not for short-term memory (V = 1075, p = 0.351, |r| = 0.078). Regarding the scales’ anchors, descriptive results on pairwise differences suggested axSpA patients to have working memory scores that are on average 10.7% lower compared to control participants (mean Δ= -1.64, SD Δ= 5.95).Table 1.Patients and disease characteristicsn%MeanSDMedian25% Quantile75% QuantileAge10110051.111.6524260Age (female)4847.552.611.75444.561Age (male)5352.549.811.5514157< 13 years formal education4746.5≥ 13 years formal education5453.5HLA B27 positive n/N64/9263.4Disease duration (years)10110013.711.712421Disease duration (female, years)4847.511.69.99417.2Disease duration (male, years)5352.515.512.915523BASDAI9291.13.71.73.82.45BASFI9190.132.42.31.24.5BASMI7574.31.92.3103ASDAS98972.30.82.31.82.8Conclusion:The MAT computerized testing is a feasible test and was well accepted by patients. Results regarding working memory suggest that cognitive abilities needed to accomplish everyday tasks may be impaired in axSpA patients. Further work is needed to characterise possible causes of or associations with this cognitive impairment.References:[1]Zabala A, Salgueiro M, Saez-Atxukarro O, Ballesteros J, Ruiz-Irastorza G, Segarra R. Cognitive Impairment in Patients With Neuropsychiatric and Non-neuropsychiatric Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis. J Int Neuropsychol Soc. 2018:1-11.[2]Vitturi BK, Nascimento BAC, Alves BR, de Campos FSC, Torigoe DY. Cognitive impairment in patients with rheumatoid arthritis. J Clin Neurosci. 2019;69:81-7.[3]Adler G, Bektas M, Feger M, Lembach Y. [Computer-based assessment of memory and attention: evaluation of the memory and attention test (MAT)]. Psychiatr Prax. 2012;39(2):79-83.[4]Adler G, Lembach Y. Memory and selective attention in multiple sclerosis: cross-sectional computer-based assessment in a large outpatient sample. Eur Arch Psychiatry Clin Neurosci. 2015;265(5):439-43.Acknowledgements:This study was funded by the RHADAR GbR (A Network of Rheumatologists), Bahnhofstr. 32, 82152 Planegg, Germany. RHADAR GbR has received a grant for this study from Novartis Pharma GmbH.Disclosure of Interests:Stefan Kleinert Consultant of: Novartis, Abbvie, Grant/research support from: Novartis, Praxedis Rapp: None declared., Florian Schuch Speakers bureau: Novartis, Abbvie, Gilead, Consultant of: Novartis, Abbvie, Gilead, Monika Ronneberger: None declared., Joerg Wendler Speakers bureau: Roche, Pharma, JanssenCilag, Novartis, Abbvie, Consultant of: JanssenCilag, Patrizia Sternad: None declared., Florian Popp: None declared., Peter Bartz-Bazzanella: None declared., Cay-Benedict von der Decken: None declared., Kirsten Karberg Speakers bureau: Roche, Sanofi, Abbvie, Lilly, Georg Gauler Speakers bureau: Abbvie, Gilead, Novartis, Lilly, Consultant of: Lilly, Gilead, Abbvie, Patrick Wurth Speakers bureau: Abbvie, Lilly, UCB, Medac, Susanna Spaethling-Mestekemper Speakers bureau: Abbvie, BMS, Celgene, Gilead, GSK, Hexal, Lilly, MSD, Novartis, Pfizer, Sanofi, UCB, Christoph Kuhn: None declared., Matthias Englbrecht Speakers bureau: AbbVie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Mundipharma, Paid instructor for: AbbVie, Chugai, Roche, Consultant of: AbbVie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Wolfgang Vorbrüggen: None declared., Georg Adler: None declared., Martin Welcker Speakers bureau: Abbvie, Actelion, Amgen, Biogen,BMS, Berlin Chemie, Celgene, Galapagos, Gilead, GSK, Hexal, Janssen, Medac, MSD, Mundipharma, Mylan, Novartis, Pfizer, Roche, Sanofi, SOBI, UCB, Grant/research support from: Novartis, Abbvie.
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Simons G, Veldwijk J, DI Santostefano R, Englbrecht M, Radawski C, Valor L, Raza K, Falahee M. OP0160-HPR PREFERENCES FOR TREATMENTS TO PREVENT RHEUMATOID ARTHRITIS: DISCRETE CHOICE SURVEY OF GENERAL POPULATIONS IN UNITED KINGDOM, GERMANY, AND ROMANIA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:There is increasing research focus on intervention for rheumatoid arthritis (RA) at the earliest stages of disease development, including treatment to prevent RA in at-risk groups. Novel cellular therapies are in development, and the effectiveness of existing immunomodulatory agents to prevent RA in those at risk is under investigation. Quantitative evidence of likely uptake of preventive treatments, and preferences for benefits and risks of such treatments is limited.Objectives:To quantify preferences for preventive therapies for RA.Methods:A web-based survey (n = 2959) was administered to an age- and gender- stratified sample of adults in the general population from online survey panels in the UK, Germany, and Romania. After receiving information about RA, questions to check comprehension of background information, an introduction to the survey tasks and warm-up questions, participants were asked to imagine that they were experiencing arthralgia (without swelling) and had positive autoantibody tests indicating a 60% chance of developing RA in the next two years. Using a discrete choice experiment with a Bayesian D-efficient design, participants were offered a series of 15 choices between no treatment and two unlabeled hypothetical treatments to lower risk of RA development. Treatments were defined by six attributes with varying levels including benefits, risks, and frequency/route of administration (Table 1). One choice task with fixed levels described treatments representative of those under investigation for RA prevention (abatacept, hydroxychloroquine, atorvastatin and tolerogenic cell-based therapy). Attribute selection and presentation was informed by previous qualitative research, ranking surveys, systematic literature review, and expert opinion. Survey design was informed by patient research partners. The survey was pre-tested during qualitative interviews and revised. A pilot of the final survey with 100 respondents was conducted to obtain priors for the final experimental design. Random parameters logit (RPL) models were used to estimate relative importance of treatment attributes and likely treatment uptake rates in each country.Table 1.Treatment attributes and levelsAttributeLevelsChance of developing RA reduced from 60% to10%; 20%; 30%; 40%How the treatment is takenA shallow injection under the skinA drip into the veinOne or two tabletsHow often the medication has to be takenDailyWeeklyMonthlyEvery 6 monthsChance of mild side effects2%; 5%; 10%Chance of a serious infection due to treatment0%; 1%; 5%Chance of a serious side effect that is potentially irreversible1 in 100,000 people20 in 100,000 people100 in 100,000 peopleResults:Across all three countries, effectiveness was the treatment attribute that had most impact on treatment choice (Figure 1). Method of administration was second most important for respondents from the UK and Romania but less important for German respondents. Risks of serious infection and serious side effects were more important determinants of treatment choice for respondents in Romania than they were in the UK and Germany. Percentage choice of fixed profiles reflecting abatacept, atorvastatin, hydroxychloroquine, tolerogenic cell-based therapy and no treatment differed across countries (χ2=78.90; p<0.001): 28.3%, 20.6%, 22.2% 18.5% and 10.4% respectively in the UK; 31.3%, 18.8%, 11.2%, 23.4% and 15.3% in Germany; and 27.6%, 20.5%, 15.8%, 21.7% and 14.4% in Romania.Conclusion:This study suggests that effective preventive treatments for RA are acceptable to members of the general population told to assume up a 60% chance of developing RA. The relative importance of treatment attributes and likely uptake of fixed treatment profiles differed across countries. These findings are informative for the design of prevention trials, and the development of informational resources and efficient preventive strategies for those at risk of developing RA.Acknowledgements:On behalf of the PREFER project. PREFER received funding from the IMI 2 Joint Undertaking (grant No. 115966), which receives support from the EU’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations (EFPIA). K. Raza is supported by the NIHR Birmingham Biomedical Research Centre.Disclosure of Interests:Gwenda Simons: None declared, Jorien Veldwijk: None declared, Rachael Di Santostefano Shareholder of: Johnson & Johnson, Employee of: Janssen R&D (of Johnson & Johnson), Matthias Englbrecht Speakers bureau: AbbVie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Mundipharma, Paid instructor for: AbbVie, Chugai, Roche, Consultant of: AbbVie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Christine Radawski Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Larissa Valor: None declared, Karim Raza Consultant of: Personal fees from Abbvie, Pfizer, Sanofi, Lilly, Bristol Myers Squibb, UCB, Janssen, and Roche Chugai, Grant/research support from: Abbvie and Pfizer, M. Falahee: None declared
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Karg MV, Alber B, Kuhn C, Bohlinger K, Englbrecht M, Dormann H. [SARS-CoV-2, influenza and norovirus infection : A direct epidemiologic comparison]. Med Klin Intensivmed Notfmed 2021; 117:209-217. [PMID: 33559700 PMCID: PMC7871315 DOI: 10.1007/s00063-021-00783-7] [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: 08/21/2020] [Revised: 11/19/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
Hintergrund Hospitalisierungsraten, Notaufnahmeprävalenzen und Fallsterblichkeiten (CFP) stationärer SARS-CoV-2-Patienten und wie sich diese von anderen pandemischen oder saisonalen Viruserkrankungen, wie Influenza A/B oder Norovirusinfektionen unterscheiden, wurden bisher nicht untersucht. Diese Arbeit gibt einen Überblick aus einer Kommune darüber und vergleicht diesen auch mit den negativ getesteten stationären Verdachtsfällen. Methoden Im Rahmen retrospektiver Kohortenanalysen von 67.000 Krankenhausfällen eines Klinikums mit umfassender Notfallversorgung und Meldedaten des regionalen Gesundheitsamts wurden für die Virusinfektionen SARS-CoV‑2, Influenza A/B und Norovirus Genotyp 1/2 Hospitalisierungsraten, Notaufnahmeprävalenzen und CFP berechnet. Ergebnisse In Fürth (Stadt‑/Landkreis) wurden 0,34 % der Bevölkerung, 824 Personen, bis 07.05.2020 positiv auf SARS-CoV‑2 getestet, wovon 162 (19,7 %) stationär behandelt wurden. 91 der Infizierten verstarben (CFP 11,0 %), davon 48 stationär. In der aktuellen Grippe‑/Norovirussaison wurden 992 Einwohner als influenzapositiv und 135 als noroviruspositiv gemeldet, davon 202 (20,3 %) bzw. 125 (91,9 %) stationär behandelt. Die Notaufnahmeprävalenzen waren 4,1 %, 2,0 % und 0,6 %. Die CFP der SARS-CoV-2-, influenza- und noroviruspositiven Krankenhauspopulationen betrugen 29,1 %, 3,0 % und 1,6 %, die der testnegativen Verdachtsfälle 5,9 %, 4,8 % und 6,9 % bei einer Krankenhausmortalität von 2,1 % für 2020. Schlussfolgerungen Bei gleichen Hospitalisierungsraten von SARS-CoV-2- und Influenzapatienten unterschieden sich die CFP massiv, während die CFP der testnegativen Verdachtsfälle aller 3 Infektionserkrankungen sich nicht signifikant unterschieden.
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Affiliation(s)
- M V Karg
- Zentrale Notaufnahme, Klinikum Fürth, Jakob-Henle-Str. 1, 90766, Fürth, Deutschland.
| | - B Alber
- Institut für Labormedizin, Klinikum Fürth, Fürth, Deutschland
| | - C Kuhn
- Gesundheitsamt, Landratsamt Fürth, Zirndorf, Deutschland
| | - K Bohlinger
- Gesundheitsamt, Landratsamt Fürth, Zirndorf, Deutschland
| | | | - H Dormann
- Zentrale Notaufnahme, Klinikum Fürth, Jakob-Henle-Str. 1, 90766, Fürth, Deutschland.
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Bayat S, Simon D, Pecherstorfer C, Ellmann H, Figueiredo C, Englbrecht M, Hueber A, Kleyer A, Rech J, Schett G. SAT0556 FINE STRUCTURE ANALYSIS OF THE INTER-RELATION BETWEEN TOPHUS DEPOSITION AND BONE LESIONS IN GOUT USING A COMBINATION OF DUAL ENERGY AND HIGH-RESOLUTION CT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Deposition of uric acid crystals cause an inflammatory reaction, which can lead to structural bone changes, if such deposits form adjacent to cortical bone [1, 2]. Both erosions and bony spurs can form in conjunction with tophus deposition. The exact spatial inter-relation between tophi and structural bone lesions in humans in vivo is not fully characterized.Objectives:To spatially relate structural bone changes (erosions, osteophytes) to the deposition of monosodium urate crystals in the first metatarsophalangeal (MTP1) joint in patients with tophaceous gout.Methods:Tophaceous gout patients with clinically detected tophi at the MTP1 joint underwent simultaneous dual energy computed tomography (DECT) and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the feet. Tophi detected by DECT and erosions and osteophytes detected by HR-pQCT were overlayed to define their exact anatomical relation. Furthermore, feet of sex- and age-matched healthy controls (HC) were scanned to define the normal architecture of the MTP1 joint.Results:Gout patients (N=20) had significantly higher numbers (5 (0–17 vs. 1 (1– 2)) and volumes (45.32 mm3(7.26–550.32) vs. 0.82 mm3(0.15–21.8)) of bone erosions as well as significantly higher numbers (10.5 (0-26) vs. 1 (0-10)) and sizes of osteophytes (4.93 mm (0.77-7.19 mm vs. 0.93 mm (0.05-7.61 mm))than healthy controls (N=20). Erosions were in direct spatial relation to bone erosions, while osteophytic responses were more widespread and affected bone regions on the MTP1, which were not directly adjacent to tophi. Median tophus volume detected by DECT (0.12 mm3(0.01–2.53)) was associated with the total volume of erosions (r=0.597, p=0.005).Conclusion:This study demonstrates that bone changes in gout are substantial and not only include erosions but also widespread architectural bone remodeling associated osteophyte formation. While there is a direct spatial relation between tophi and bone erosions the anabolic bone responses in gout are more widespread.References:[1]Dalbeth, N. et al. Ann Rheum Dis. 2015 Jun;74(6):1030-6.[2]Dalbeth, N. et al. Arthritis Res Ther. 2012; 14(4): R165.Data are based on high-resolution peripheral quantitative computed tomography (HR-pQCT) of metatarsophalangeal joints I in gout patients (grey boxplots) and healthy controls (white boxplots). (A) number of bone erosions, (B) volume of bone erosions, (C) number of osteophytes and (D) size of osteophytes. Data are shown as medians and inter-quartile ranges (boxes).Distribution of (A) tophi based on dual-energy computed tomography (DECT) as well as (B) bone erosions and (C) osteophytes based on high-resolution peripheral quantitative computed tomography (HR-pQCT) of metatarsophalangeal (MTP) I head in gout patients. Data are shown for the different regions of the MTPI head including the plantar, medial, dorsal and lateral region of the metatarsal head, as well as the medial and lateral sesamoid bones. Data indicate percentage of patients with tophi, erosions and osteophytes in respective region.Disclosure of Interests:Sara Bayat Speakers bureau: Novartis, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Caroline Pecherstorfer: None declared, Hanna Ellmann: None declared, Camille Figueiredo: None declared, Matthias Englbrecht: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB
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Knitza J, Mohn J, Bergmann C, Kampylafka E, Hagen M, Bohr D, Araujo E, Englbrecht M, Simon D, Kleyer A, Meinderink T, Vorbrüggen W, Von der Decken CB, Kleinert S, Ramming A, Distler J, Bartz-Bazzanella P, Schett G, Hueber A, Welcker M. AB1346-HPR REAL-WORLD EFFECTIVENESS AND PERCEIVED USEFULNESS OF SYMPTOM CHECKERS IN RHEUMATOLOGY: INTERIM REPORT FROM THE PROSPECTIVE MULTICENTER BETTER STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Symptom checkers (SC) promise to reduce diagnostic delay, misdiagnosis and effectively guide patients through healthcare systems. They are increasingly used, however little evidence exists about their real-life effectiveness.Objectives:The aim of this study was to evaluate the diagnostic accuracy, usage time, usability and perceived usefulness of two promising SC, ADA (www.ada.com) and Rheport (www.rheport.de). Furthermore, symptom duration and previous symptom checking was recorded.Methods:Cross-sectional interim clinical data from the first of three recruiting centers from the prospective, real-world, multicenter bETTeR-study (DKRS DRKS00017642) was used. Patients newly presenting to a secondary rheumatology outpatient clinic between September and December 2019 completed the ADA and Rheport SC. The time and answers were recorded and compared to the patient’s actual diagnosis. ADA provides up to 5 disease suggestions, Rheport calculates a risk score for rheumatic musculoskeletal diseases (RMDs) (≥1=RMD). For both SC the sensitivity, specificity was calculated regarding RMDs. Furthermore, patients completed a survey evaluating the SC usability using the system usability scale (SUS), perceived usefulness, previous symptom checking and symptom duration.Results:Of the 129 consecutive patients approached, 97 agreed to participate. 38% (37/97) of the presenting patients presented with an RMD (Figure 1). Mean symptom duration was 146 weeks and a mean number of 10 physician contacts occurred previously, to evaluate current symptoms. 56% (54/96) had previously checked their symptoms on the internet using search engines, spending a mean of 6 hours. Rheport showed a sensitivity of 49% (18/37) and specificity of 58% (35/60) concerning RMDs. ADA’s top 1 and top 5 disease suggestions concerning RMD showed a sensitivity of 43% (16/37) and 54% (20/37) and a specificity of 58% (35/60) and 52% (31/60), respectively. ADA listed the correct diagnosis of the patients with RMDs first or within the first 5 disease suggestions in 19% (7/37) and 30% (11/37), respectively. The average perceived usefulness for checking symptoms using ADA, internet search engines and Rheport was 3.0, 3.5 and 3.1 on a visual analog scale from 1-5 (5=very useful). 61% (59/96) and 64% (61/96) would recommend using ADA and Rheport, respectively. The mean SUS score of ADA and Rheport was 72/100 and 73/100. The mean usage time for ADA and Rheport was 8 and 9 minutes, respectively.Conclusion:This is the first prospective, real-world, multicenter study evaluating the diagnostic accuracy and other features of two currently used SC in rheumatology. These interim results suggest that diagnostic accuracy is limited, however SC are well accepted among patients and in some cases, correct diagnosis can be provided out of the pocket within few minutes, saving valuable time.Figure:Acknowledgments:This study was supported by an unrestricted research grant from Novartis.Disclosure of Interests:Johannes Knitza Grant/research support from: Research Grant: Novartis, Jacob Mohn: None declared, Christina Bergmann: None declared, Eleni Kampylafka Speakers bureau: Novartis, BMS, Janssen, Melanie Hagen: None declared, Daniela Bohr: None declared, Elizabeth Araujo Speakers bureau: Novartis, Lilly, Abbott, Matthias Englbrecht Grant/research support from: Roche Pharma, Chugai Pharma Europe, Consultant of: AbbVie, Roche Pharma, RheumaDatenRhePort GbR, Speakers bureau: AbbVie, Celgene, Chugai Pharma Europe, Lilly, Mundipharma, Novartis, Pfizer, Roche Pharma, UCB, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Timo Meinderink: None declared, Wolfgang Vorbrüggen: None declared, Cay-Benedict von der Decken: None declared, Stefan Kleinert Shareholder of: Morphosys, Grant/research support from: Novartis, Consultant of: Novartis, Speakers bureau: Abbvie, Novartis, Celgene, Roche, Chugai, Janssen, Andreas Ramming Grant/research support from: Pfizer, Novartis, Consultant of: Boehringer Ingelheim, Novartis, Gilead, Pfizer, Speakers bureau: Boehringer Ingelheim, Roche, Janssen, Jörg Distler Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Peter Bartz-Bazzanella: None declared, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Martin Welcker Grant/research support from: Abbvie, Novartis, UCB, Hexal, BMS, Lilly, Roche, Celgene, Sanofi, Consultant of: Abbvie, Actelion, Aescu, Amgen, Celgene, Hexal, Janssen, Medac, Novartis, Pfizer, Sanofi, UCB, Speakers bureau: Abbvie, Aescu, Amgen, Biogen, Berlin Chemie, Celgene, GSK, Hexal, Mylan, Novartis, Pfizer, UCB
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Freier D, Englbrecht M, Höhne-Zimmer V, Detert J, Burmester GR. [Higher prevalence of depressive and anxiety symptoms in early arthritis patients in comparison to the normal population]. Z Rheumatol 2019; 78:820-831. [PMID: 30511171 DOI: 10.1007/s00393-018-0571-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many studies and registry data confirm that depression, often associated with anxiety disorders is very often found in patients with rheumatoid arthritis (RA). To what extent these psychiatric disorders are already relevant at a very early stage of the disease, has currently not been adequately investigated. METHODS In this study 176 patients with early joint symptoms (<1 year) were surveyed in an early arthritis consultation (EAC). The hospital anxiety and depression scale (HADS) was completed by the patients to examine the prevalence of depressive and anxiety symptoms. The results were compared to normative data of the general German population and between the diagnosis groups. RESULTS With 47.7% the prevalence of global distress for EA patients was almost twice as high compared to the corresponding group from the general population. This was also confirmed for depressive and anxiety symptoms. The EA patients without confirmed evidence of musculoskeletal inflammatory rheumatic disease (RD) showed nearly the same point prevalence as patients with confirmed RD. In multiple logistic regression the health assessment questionnaire (HAQ) was positively associated with global distress (odds ratio, OR 3.63) while the visual analogue scale (VAS) for global disease activity was positively associated with symptoms of depression (OR 1.03). Female EA patients (OR 5.45) appear to have a higher probability for experiencing corresponding symptoms, whereas patients over 60 years old appear to have less anxiety than younger patients (OR 0.11). CONCLUSION The high prevalence of symptoms of depression and anxiety in EA patients compared to the general population is a challenge for rheumatologists, orthopedists and general practitioners, particularly with respect to the differentiation of possible psychosomatic components in noninflammatory joint complaints. The results suggest that screening for psychiatric problems in patients with rheumatism should be evaluated as soon as possible as these can have a great impact on the perception of pain and physical functional status from the very beginning.
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Affiliation(s)
- D Freier
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - M Englbrecht
- Medizinische Klink 3 - Rheumatologie und Immunologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) und Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - V Höhne-Zimmer
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - J Detert
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - G-R Burmester
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Gallenkamp J, Spanier G, Wörle E, Englbrecht M, Kirschfink M, Greslechner R, Braun R, Schäfer N, Bauer RJ, Pauly D. A novel multiplex detection array revealed systemic complement activation in oral squamous cell carcinoma. Oncotarget 2017; 9:3001-3013. [PMID: 29423024 PMCID: PMC5790441 DOI: 10.18632/oncotarget.22963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/18/2017] [Accepted: 11/11/2017] [Indexed: 11/25/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is one of the most common tumors within the oral cavity. Early diagnosis and prognosis tools are urgently needed. This study aimed to investigate the activation of the complement system in OSCC patients as potential biomarker. Therefore, an innovative complement activation array was developed. Characterized antibodies detecting the complement activation specific epitopes C3a, C5a and sC5b-9 along with control antibodies were implemented into a suspension bead array. Human serum from a healthy (n = 46) and OSCC patient (n = 57) cohort were used to investigate the role of complement activation in oral tumor progression. The novel multiplex assay detected C3a, C5a and sC5b-9 from a minimal sample volume of human tears, aqueous humor and blood samples. Limits of detection were 0.04 ng/mL for C3a, 0.03 ng/mL for C5a and 18.9 ng/mL for sC5b-9, respectively. Biological cut-off levels guaranteed specific detections from serum. The mean serum concentration of a healthy control cohort was 680 ng/mL C3a, 70 ng/mL C5a and 2247 ng/mL sC5b-9, respectively. The assay showed an intra-assay precision of 2.9-6.4% and an inter-assay precision of 9.2-18.2%. Increased systemic C5a (p < 0.0001) and sC5b-9 (p = 0.01) concentrations in OSCC patients were determined using the validated multiplex complement assay. Higher C5a concentrations correlated with tumor differentiation and OSCC extension state. Systemic sC5b-9 determination provided a novel biomarker for infiltrating tumor growth and C3a levels were associated with local tumor spreading. Our study suggests that systemic complement activation levels in OSCC patients may be useful to assess disease progression.
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Affiliation(s)
- Juliane Gallenkamp
- University Hospital Regensburg, Department of Oral and Maxillofacial Surgery, Regensburg, Germany
| | - Gerrit Spanier
- University Hospital Regensburg, Department of Oral and Maxillofacial Surgery, Regensburg, Germany
| | - Elisabeth Wörle
- University Hospital Regensburg, Department of Ophthalmology, Regensburg, Germany
| | - Markus Englbrecht
- University Hospital Regensburg, Department of Ophthalmology, Regensburg, Germany
| | | | - Roman Greslechner
- University Hospital Regensburg, Department of Ophthalmology, Regensburg, Germany
| | - Regine Braun
- University Hospital Regensburg, Department of Ophthalmology, Regensburg, Germany
| | - Nicole Schäfer
- University Hospital Regensburg, Department of Ophthalmology, Regensburg, Germany
| | - Richard J Bauer
- University Hospital Regensburg, Department of Oral and Maxillofacial Surgery, Regensburg, Germany.,Center for Medical Biotechnology, Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Diana Pauly
- University Hospital Regensburg, Department of Ophthalmology, Regensburg, Germany
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Hirschmann S, Atreya R, Englbrecht M, Neurath MF. Safety and efficacy of intravenous cyclophosphamide pulse therapy in therapy refractory Crohn's disease patients. J Physiol Pharmacol 2017; 68:57-67. [PMID: 28456770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/24/2017] [Indexed: 06/07/2023]
Abstract
A major challenge in the management of persistently active Crohn's disease patient's refractory to treatment regimen following the current guidelines is the induction of remission, which is a prerequisite for subsequent maintenance therapy. The aim of this study was to evaluate both the clinical and endoscopic benefit of intravenous cyclophosphamide pulse therapy in patients with active and therapy refractory Crohn's disease. Nine patients with acute moderate to severe Crohn's disease, not responding to conventional as well as biological therapy regimen received 3 - 9 cycles of monthly treatments with intravenous cyclophosphamide (680 - 1000 mg) in an uncontrolled setting and were retrospectively analyzed. Eight of nine patients (88.9%) had a clinical response (measured by a decrease in the Harvey-Bradshaw index, HBI ≥ 3) and two of nine patients (22.2%) achieved clinical remission (HBI ≤ 4) at week 8 after two applications of intravenous cyclophosphamide therapy. These response and remission rates remained unchanged after individual completion of cyclophosphamide therapy. Median HBI decreased from 18 (7 - 25) at the beginning of therapy to 7 (3 - 18) at week 8. 5 of 9 patients (56%) showed endoscopic response (defined by a reduction of ulcers) and one patient (11%) reached endoscopic remission (defined by the absence of ulcers) after the last application of cyclophosphamide. Arthralgia, which was present in 4 of 9 (44%) patients, was unchanged in most patients after cyclophosphamide therapy, although one patient described a marked reduction in joint pain. Cyclophosphamide pulse therapy was well tolerated during the whole treatment course in all subjects. One patient with long-standing Crohn's disease was diagnosed with a high-grade intraepithelial neoplasia in the rectum and underwent surgical intervention, where the diagnosis of an early stage adenocarcinoma was made. We concluded that intravenous cyclophosphamide pulse therapy was well tolerated by most patients and effective for inducing clinical and endoscopic response and remission in patients with therapy refractory Crohn's disease. In patients who are unresponsive to available therapies, including available biological treatment options, cyclophosphamide therefore represents a potential option to induce therapeutic response, which must then be maintained by other treatment modalities.
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Affiliation(s)
- S Hirschmann
- Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany
| | - R Atreya
- Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany
| | - M Englbrecht
- Medical Clinic 3, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany
| | - M F Neurath
- Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany.
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Englbrecht M, Alten R, Aringer M, Baerwald C, Burkhardt H, Eby N, Flacke JP, Fliedner G, Gauger B, Henkemeier U, Hofmann M, Kleinert S, Kneitz C, Krüger K, Lüthje R, Pohl C, Schett G, Schmalzing M, Tausche AK, Tony H, Wendler J. FRI0142 High Prevalence of Depression in Patients with Rheumatoid Arthritis - Data from The Large Cross-Sectional Vadera II Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Faustini F, Simon D, Oliveira I, Kleyer A, Haschka J, Englbrecht M, Cavalcante A, Kraus S, Tabosa T, Figueiredo C, Hueber A, Kocijan R, Cavallaro A, Schett G, Sticherling M, Rech J. THU0372 Subclinical Joint Inflammation in Psoriasis Patients without Concomitant Psoriatic Arthritis- A Cross-Sectional and Longitudinal Analysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simon D, Nas K, Faustini F, Kleyer A, Haschka J, Englbrecht M, Hueber A, Kocijan R, Sticherling M, Schett G, Rech J. AB0946 S100A8 but Not S100A9 Level Is Related To The Extent of Erosive Bone Damage in Psoriatic Arthritis Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hagen M, Figueiredo C, Cobra J, Reiser M, Haschka J, Englbrecht M, Hueber A, Manger B, Kleyer A, Finzel S, Tony HP, Wendler J, Kleinert S, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nuesslein H, Alten R, Henes J, Krueger K, Schett G, Rech J. SAT0065 Effects of Dmard Tapering on Treatment Costs in Rheumatoid Arthritis Patients- An Analysis from The Prospective Randomized Controlled Retro- Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Simon D, Kleyer A, Stemmler F, Simon C, Hueber A, Kampylafka E, Englbrecht M, Figueiredo C, Engelke K, Berlin A, Haschka J, Rech J, Schett G. SAT0543 Accurate Determination of Periarticular Bone Composition in Healthy Individuals and Comparison To Acpa-Positive Rheumatoid Arthritis Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ellmann H, Bayat S, d`Òliveira I, Englbrecht M, Araujo E, Mendonca S, Cavallaro A, Lell M, Manger B, Schett G, Rech J. THU0510 A Longitudinal Dual Energy Computed Tomography Study on The Effect of Urate Lowering Therapies on The Reduction of Tophus Burden in Patients with Chronic Gout. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wohlfahrt T, Weber S, Englbrecht M, Dees C, Beyer C, Distler O, Schett G, Distler J, Ramming A. SAT0021 Type 2 Innate Lymphoid Cells Are Rapidly and Persistently Recruited in Experimental Fibrosis and Their Counts Correlate with The Severity of Skin and Lung Fibrosis in Systemic Sclerosis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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dOliveira I, Mensing W, Figueiredo C, Englbrecht M, Haschka J, Hueber A, Kleyer A, Cavallaro A, Schett G, Rech J. FRI0082 Subclinical MRI Inflammation Does Not Predict Relapse Risk in Rheumatoid Arthritis Patients Tapering Dmards. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Figueiredo C, Simon D, Englbrecht M, Haschka J, Kleyer A, Bayat S, Hueber A, Pereira R, Rech J, Schett G. FRI0515 Quantification and Impact of Secondary Osteoarthritis in Patients with Anti-Citrullinated Protein Antibodies Positive Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Haschka J, Englbrecht M, Hueber A, Manger B, Kleyer A, Reiser M, Finzel S, Tony HP, Kleinert S, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Wendler J, Schuch F, Ronneberger M, Lorenz HM, Nuesslein H, Alten R, Demary W, Henes J, Schett G, Rech J. SAT0056 Retro – Study of Reduction of Therapy in Patients with Rheumatoid Arthritis in Ongoing Remission. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simon D, Faustini F, Englbrecht M, Kleyer A, Kocijan R, Haschka J, Figueiredo C, Kraus S, Hueber A, Sticherling M, Schett G, Rech J. FRI0560 Comparison of Bone Microstructure of Psoriatic Arthritis and Psoriasis Patients – An HR-PQCT Study of Anabolic and Catabolic Bone Changes. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schett G, Araujo E, Bayat S, Petsch C, Englbrecht M, Faustini F, Kleyer A, Hueber A, Cavallaro A, Lell M, Dalbeth N, Manger B, Rech J. SAT0308 Tophus Resolution with Pegloticase – A Prospective Dual Energy Computed Tomography Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hewlett S, Nicklin J, Kirwan J, Cramp F, Dures E, Greenwood R, Fransen J, Englbrecht M, Schett G, Petersson I, Hagel S, Carmona L, Redondo M, Molto A, Bode C, van de Laar M, Gossec L. FRI0367 Fatigue is an Internationally Valid Concept: The Bristol RA Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) in 6 EU Countries. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Albrecht K, Englbrecht M, Baerwald C, Feist E, Fleck M, Gromnica-Ihle E, Köhler L, Kötter I, Kneitz C, Krüger K, Kuipers J, Nüßlein H, Rubbert-Roth A, Wollenhaupt J, Schneider M, Manger B, Müller-Ladner U, Tarner I. Nationale und multinationale evidenzbasierte Empfehlungen für die medikamentöse Schmerztherapie der entzündlichen Gelenkerkrankungen: systematische Literaturrecherche und Expertenmeinung in der 3e Initiative. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1387730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K. Albrecht
- Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie der Justus-Liebig-Universität Gießen, Abt. für Rheumatologie, Klinische Immunologie, Osteologie und Physikalische Medizin, Kerckhoff-Klinik, Bad Nauheim
| | - M. Englbrecht
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen
| | - C. Baerwald
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig
| | - E. Feist
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin
| | - M. Fleck
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum, Bad Abbach
| | - E. Gromnica-Ihle
- Internistin/Rheumatologin, Chefärztin Rheumaklinik Berlin-Buch a.D
| | - L. Köhler
- Internist/Rheumatologe, Rheumatologische Facharztpraxis, Hannover
| | - I. Kötter
- Robert-Bosch-Krankenhaus, Abt. für Allgemeine Innere Medizin und Nephrologie, und rheumatologische Schwerpunktpraxis, Stuttgart
| | - C. Kneitz
- Klinik für Innere Medizin II, Klinikum Südstadt, Rostock
| | - K. Krüger
- Internist/Rheumatologe, Praxiszentrum St. Bonifatius, München
| | - J. Kuipers
- Klinik für Internistische Rheumatologie, Rotes Kreuz Krankenhaus, Bremen
| | - H. Nüßlein
- Internist/Rheumatologe, Rheumatologische Praxis, Nürnberg
| | | | - J. Wollenhaupt
- Abteilung für Rheumatologie, Allgemeines Krankenhaus Eilbek, Hamburg
| | - M. Schneider
- Poliklinik für Rheumatologie, Universitätsklinikum Düsseldorf
| | - B. Manger
- Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie der Justus-Liebig-Universität Gießen, Abt. für Rheumatologie, Klinische Immunologie, Osteologie und Physikalische Medizin, Kerckhoff-Klinik, Bad Nauheim
| | - U. Müller-Ladner
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen
| | - I. Tarner
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen
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Abstract
BACKGROUND The importance of depressive diseases in the treatment of rheumatism patients cannot be denied. It is well-known from publications in the English speaking literature that the proportion of depressive diseases lies between 10% and 45% in patients with rheumatoid arthritis (RA). However, clearly increased numbers can also be seen in a direct comparison with corresponding prevalence rates in the normal population for other diseases included in the category of rheumatism. OBJECTIVE This manuscript focusses on the possibilities and challenges in measuring states of depressive mood that might serve as an indicator of depressive diseases in the context of treatment of rheumatism. MATERIAL AND METHODS A search of the current literature was carried out and the results were evaluated. RESULTS Starting from appropriate background knowledge, the current state of science is discussed while subsequently taking a closer look at a choice of internationally recognized assessment tools which are feasible for use in rheumatology. Finally, this overview is accompanied by hints for hands-on practice and suggestions on how to respond to conspicuous test results indicative of a depressive mood. DISCUSSION AND CONCLUSION The potential benefits of appropriate screening with measurement instruments are considered to be high for rheumatism patients. The measurement tools presented must be suitably selected for the individual purpose and for each rheumatology institution. In view of test application consideration must be given not only to the total score but also to the individual responses to test items. In cases of conspicuous test results the further approach must be agreed together with the patient and by choosing adequate treatment options for the situation. In cases of acute suicidal tendencies acceptance, care and support are of key importance, while the precautionary presentation in a specialist clinic must be initiated.
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Affiliation(s)
- M Englbrecht
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland,
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Simon D, Faustini F, Englbrecht M, Kleyer A, Kocijan R, Haschka J, Kraus S, Hueber A, Sticherling M, Schett G, Rech J. SAT0182 Magnetic Resonance Imaging (MRI) of Hands of Psoriasis Patients: High Incidence of Inflammation. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simon D, Faustini F, Englbrecht M, Kleyer A, Kocijan R, Haschka J, Finzel S, Kraus S, Hueber A, Sticherling M, Schett G, Rech J. FRI0227 Analysis of Periarticular Bone Changes in Patients with Cutaneous Psoriasis without Associated Psoriatic Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Petsch C, Araujo E, Englbrecht M, Hueber A, Lell M, Schett G, Manger B, Rech J. SAT0127 Gout and RA: not Such A Rare Coexistence after All? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gossec L, Kirwan J, Paternotte S, Balanescu A, Boumpas D, de Wit M, Dijkmans BA, Englbrecht M, Gogus F, Heiberg T, Martin Mola E, Matucci Cerinic M, Otsa K, Sokka-Isler T, Dougados M, Kvien TK. FRI0071 Does psychological status drive patient global assessment for rheumatoid arthritis patients who do not have any clinical signs of inflammation? an exploratory analysis of near-remission using the rheumatoid arthritis impact of disease (RAID) score. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Araujo EG, Finzel S, Schreiber DA, Kleyer A, Englbrecht M, Schett G. SAT0283 High Incidence of Flare After Discontinuation of Disease Modifying Anti-Rheumatic Drugs in Patients with Psoriatic Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.2008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The social recognition of depression in general and as a comorbidity in illnesses such as rheumatoid arthritis (RA) has essentially changed in recent years. Previous studies have shown that the occurrence of depression in RA patients is closely related to the individual ways of coping with disease and the corresponding impact of disease on daily life. Patients who are experiencing feelings of helplessness while facing the illness are prone to depressive disorders, especially if effective strategies for managing the impact of disease are lacking. Tools for early recognition of depression include instruments such as patient questionnaires or interview protocols which should be interpreted with caution due to the overlap of symptoms arising from RA and depression. A supplemental cognitive behavioral intervention in addition to medication with antidepressive drugs provides an opportunity to identify the underlying cause of depression and learn about effective coping strategies to at least partially maintain self-control of RA.
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Affiliation(s)
- M Englbrecht
- Medizinische Klinik 3 (Rheumatologie & Immunologie), Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland.
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Englbrecht M, Kruckow M, Finzel S, Hueber A, Rech J, Schett G. SAT0106 The relation of patient-reported characteristics to physical function and emotional well-being: What are the major implications to know? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hecht CF, Englbrecht M, Schmidt S, Rech J, Engelke K, Araujo E, Schett G, Finzel S. FRI0481 Anti- citrullinated protein antibodies but not rheumatoid factor are associated with larger bone erosions in ra patients- a cross-sectional hr-pqct study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sahinbegovic E, Zwerina J, Parschalk B, Schett G, Englbrecht M. THU0054 Urinary tract infections in patient with rheumatic disease: A retrospective study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Albrecht A, Finzel S, Rech J, Englbrecht M, Schett G. SAT0386 The structural basis of MRI bone erosions- an assessment by micro computed tomography. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kocijan R, Finzel S, Englbrecht M, Kleyer A, Rech J, Schett G. SAT0515 Seropositive Rheumatoid Arthritis has a Distinctive Bone Phenotype at the Ultra-Distal Radius Compared to Seronegative Rheumatoid Arthritis and Psoriatic Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Regensburger A, Koch P, Kraus S, Hecht C, Englbrecht M, Rech J, Schett G, Faustini F, Finzel S. FRI0471 A comparative analysis of erosion repair in rheumatoid arthritis (RA) patients by magnetic resonance imaging (MRI) and hr-pqct. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Herz B, Finzel S, Albrecht A, Rech J, Englbrecht M, Welsch G, Schett G. SAT0387 Visualization of cartilage as a new imaging biomarker for the quantification of joint damage in rheumatoid arthritis using DGEMRIC and T2-mapping in high-resolution magnet resonance imaging. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schmidt S, Finzel S, Rech J, Englbrecht M, Said-Nahal R, Breban M, Schett G. THU0039 Evidence of HLA-B27 in healthy individuals and patients with uveitis is a risk factor for alterations in bone metabolism. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sendlbeck M, Araujo EG, Schett G, Englbrecht M. FRI0081 Three of a kind (and even rarer than the poker hand): a comparison of single-item pain scales frequently used in rheumatoid arthritis patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zwerina J, Dallos T, Sahinbegovic E, Stamm T, Aigner E, Manger B, Englbrecht M, Datz C, Schett G. AB0979 A clinical and radiographic study comparing hand involvement in idiopathic osteoarthritis and hemochromatosis arthropathy. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Englbrecht M, Rech J, Finzel S, Reisch A, Ronneberger M, Weiss S, Manger B, Schett G. AB0314 Often used but rarely investigated: Psychometric properties of common pain measures in rheumatoid arthritis – preliminary results from an outpatient cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dallos T, Sahinbegovic E, Stamm T, Aigner E, Axmann R, Stadlmayr A, Englbrecht M, Datz C, Schett G, Zwerina J. Idiopathic hand osteoarthritis vs haemochromatosis arthropathy--a clinical, functional and radiographic study. Rheumatology (Oxford) 2013; 52:910-5. [DOI: 10.1093/rheumatology/kes392] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Finzel S, Englbrecht M. [Psoriatic arthritis : a permanent challenge for rheumatologists and patients--Part 1: epidemiology, pathogenesis and clinical course]. Z Rheumatol 2011; 70:685-97. [PMID: 21912984 DOI: 10.1007/s00393-011-0860-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psoriatic arthritis is still one of the big challenges in rheumatology due to the great variety of symptoms. Treatment frequently requires an interdisciplinary collaboration of general practitioners, dermatologists and rheumatologists who are able to recognize the onset of disease early by means of classification criteria and new imaging techniques followed by the implementation of appropriate antirheumatic treatment. During recent years new immunological pathways have been discovered leading to an increasing number of potential therapies, which increases the chance to find effective individualized treatment. However, tracking back the onset of the disease to specific causes is still a challenge which is made even more complex due to the absence of specific serum parameters.
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Affiliation(s)
- S Finzel
- Medizinische Klinik III (Rheumatologie & Immunologie), Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland.
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Gossec L, Paternotte S, Aanerud GJ, Balanescu A, Boumpas DT, Carmona L, de Wit M, Dijkmans BAC, Dougados M, Englbrecht M, Gogus F, Heiberg T, Hernandez C, Kirwan JR, Mola EM, Cerinic MM, Otsa K, Schett G, Scholte-Voshaar M, Sokka T, von Krause G, Wells GA, Kvien TK. Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative. Ann Rheum Dis 2011; 70:935-42. [PMID: 21540201 DOI: 10.1136/ard.2010.142901] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE A patient-derived composite measure of the impact of rheumatoid arthritis (RA), the rheumatoid arthritis impact of disease (RAID) score, takes into account pain, functional capacity, fatigue, physical and emotional wellbeing, quality of sleep and coping. The objectives were to finalise the RAID and examine its psychometric properties. METHODS An international multicentre cross-sectional and longitudinal study of consecutive RA patients from 12 European countries was conducted to examine the psychometric properties of the different combinations of instruments that might be included within the RAID combinations scale (numeric rating scales (NRS) or various questionnaires). Construct validity was assessed cross-sectionally by Spearman correlation, reliability by intraclass correlation coefficient (ICC) in 50 stable patients, and sensitivity to change by standardised response means (SRM) in 88 patients whose treatment was intensified. RESULTS 570 patients (79% women, mean ± SD age 56 ± 13 years, disease duration 12.5 ± 10.3 years, disease activity score (DAS28) 4.1 ± 1.6) participated in the validation study. NRS questions performed as well as longer combinations of questionnaires: the final RAID score is composed of seven NRS questions. The final RAID correlated strongly with patient global (R=0.76) and significantly also with other outcomes (DAS28 R=0.69, short form 36 physical -0.59 and mental -0.55, p<0.0001 for all). Reliability was high (ICC 0.90; 95% CI 0.84 to 0.94) and sensitivity to change was good (SRM 0.98 (0.96 to 1.00) compared with DAS28 SRM 1.06 (1.01 to 1.11)). CONCLUSION The RAID score is a patient-derived composite score assessing the seven most important domains of impact of RA. This score is now validated; sensitivity to change should be further examined in larger studies.
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Affiliation(s)
- L Gossec
- Paris Descartes University, Medicine Facility, APHP, Rheumatology B Department, Cochin Hospital, Paris, France.
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Finzel S, Rech J, Schmidt S, Engelke K, Englbrecht M, Stach C, Schett G. Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion. Ann Rheum Dis 2011; 70:1587-93. [DOI: 10.1136/ard.2010.148395] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Finzel S, Englbrecht M, Engelke K, Stach C, Schett G. A comparative study of periarticular bone lesions in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 2010; 70:122-7. [DOI: 10.1136/ard.2010.132423] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Englbrecht M, Wang Y, Ronneberger M, Manger B, Vastesaeger N, Veale DJ, Schett G. Measuring joint involvement in polyarticular psoriatic arthritis: an introduction of alternatives. Arthritis Care Res (Hoboken) 2010; 62:977-83. [PMID: 20191568 DOI: 10.1002/acr.20161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the reliability of 3 different simplified joint counts with the gold standard 66 swollen/68 tender joint count (JC66/68) for assessing clinical response in patients with polyarticular psoriatic arthritis (PsA). METHODS The 28-joint count (JC28), in the same way that it is used in rheumatoid arthritis, and 2 measures including distal interphalangeal (DIP) joints (the 32-joint count [JC32], including all finger joints as well as wrists and knees, and 36-joint count [JC36], which additionally included elbows and ankles), were compared with the JC66/68 in 182 patients using data from the Infliximab Multinational Psoriatic Arthritis Controlled Trial 2 trial database. Pearson's correlation coefficients were calculated to compare the swollen and tender JC28, JC32, and JC36 with the corresponding results of the total JC66/68. American College of Rheumatology (ACR) responses based on the individual measures were compared, and their ability in predicting a clinical response of ACR 20% improvement (ACR20) based on the JC66/68 was assessed by calculating the area under the receiver operating characteristic curve via logistic regression and the maximum Youden indices at weeks 14 and 24. RESULTS All simplified joint counts were highly correlated to the standard JC66/68 both for tenderness and swelling at each individual visit (Pearson's correlation coefficients consistently >0.8, n = 182-200; P < 0.0001). Logistic regression for ACR20 response showed that area under the curve was constantly >0.91, with comparable results for Youden indices of the simplified joint counts. CONCLUSION All simplified joint counts considered seemed sufficiently sensitive and specific to measure clinical response in trial patients with polyarticular PsA when compared with the JC66/68, no matter whether DIP joints were included (the JC36 and JC32) or excluded (the JC28). Further research will be needed to clarify this issue.
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Affiliation(s)
- M Englbrecht
- Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
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