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Riek M, Scherer A, Möller B, Ciurea A, von Mühlenen I, Gabay C, Kyburz D, Brulhart L, von Kempis J, Mueller RB, Hasler P, Strahm T, von Känel S, Zufferey P, Dudler J, Finckh A. Serious infection risk of tofacitinib compared to biologics in patients with rheumatoid arthritis treated in routine clinical care. Sci Rep 2023; 13:17776. [PMID: 37853058 PMCID: PMC10584888 DOI: 10.1038/s41598-023-44841-w] [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: 12/14/2022] [Accepted: 10/12/2023] [Indexed: 10/20/2023] Open
Abstract
Recently, serious infections related to the use of tofacitinib (TOF) for treatment of rheumatoid arthritis (RA) have raised considerable interest. This study aimed to compare the risk for serious infections in patients with RA upon receiving TOF versus biologic disease-modifying antirheumatic drugs (bDMARDs) by age at treatment initiation. We identified adult RA patients exposed to TOF or bDMARDs using data collected by the Swiss registry for inflammatory rheumatic diseases (SCQM) from 2015 to 2018. The event of interest was the first non-fatal serious infection (SI) during drug exposure. Missing or incomplete SI dates were imputed as either the lower (left) or upper (right) limit of the known occurrence interval. The ratio of SI hazards (HR) of TOF versus bDMARDs was estimated as a function of age using covariate-adjusted Cox regression applied to each type of imputed time-to-SI. A total of 1687 patients provided time at risk for a first SI during study participation and drug exposure for 2238 different treatment courses, 345 for TOF and 1893 for bDMARDs. We identified 44 (left imputation) or 43 (right imputation), respectively, first SIs (12/12 on TOF versus 32/31 on bDMARDs). Left and right imputation produced similar results. For patients aged ≥ 69 years, the treatment HR started to be increased (lower limit of 95% confidence intervals (LLCIs) > 1). By the age of 76, the difference between TOF and bDMARDs started to be clinically relevant (LLCIs > 1.25). For patients aged < 65 years, the data were insufficient to draw conclusions. Our results suggest that we should expect an increased risk for SIs in older patients treated with TOF compared to bDMARDs supporting a cautious use of TOF in these patients.
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Affiliation(s)
- Myriam Riek
- SCQM Foundation, Aargauerstrasse 250, 8048, Zurich, Switzerland.
| | - Almut Scherer
- SCQM Foundation, Aargauerstrasse 250, 8048, Zurich, Switzerland
| | | | - Adrian Ciurea
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Cem Gabay
- Department of Internal Medicine, Rheumatology Division, University Hospitals Geneva, Geneva, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Laure Brulhart
- Rheumatology, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Johannes von Kempis
- Division of Rheumatology and Immunology, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | | | - Paul Hasler
- University Medical Department, Division of Rheumatology, University of Basel Medical Faculty, Kantonsspital Aarau, Aarau, Switzerland
| | - Tanja Strahm
- SCQM Foundation, Aargauerstrasse 250, 8048, Zurich, Switzerland
| | | | - Pascal Zufferey
- Centres Hospitaliers Universitaires Vaudois, Lausanne, Switzerland
| | - Jean Dudler
- Rhumatologie, HFR Fribourg, Hopital Cantonal, Fribourg, Switzerland
| | - Axel Finckh
- Department of Internal Medicine, Rheumatology Division, University Hospitals Geneva, Geneva, Switzerland
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Sirotti S, Terslev L, Filippucci E, Iagnocco A, Moller I, Naredo E, Vreju FA, Adinolfi A, Becce F, Hammer HB, Cazenave T, Cipolletta E, Christiansen SN, Delle Sedie A, Diaz M, Figus F, Mandl P, MacCarter D, Mortada MA, Mouterde G, Porta F, Reginato AM, Schmidt WA, Serban T, Wakefield RJ, Zufferey P, Sarzi-Puttini P, Zanetti A, Damiani A, Pineda C, Keen HI, D'Agostino MA, Filippou G. Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. Lancet Rheumatol 2023; 5:e474-e482. [PMID: 38251579 DOI: 10.1016/s2665-9913(23)00136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology. METHODS In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology. Following a previous systematic review to gather available evidence on existing scoring systems for CPPD, the novel scoring system was developed through a Delphi survey based on the expert opinion of the members of the OMERACT Ultrasound working group-CPPD subgroup. The reliability of the scoring system was then tested on a web-based and patient-based exercise. Intra-reader and inter-reader reliability of the new scoring system was assessed using weighted Light's κ coefficients. FINDINGS The four-grade semiquantitative scoring system consisted of: grade 0 (no findings consistent with CPPD), grade 1 (≤3 single spots or 1 small deposit), grade 2 (>3 single spots or >1 small deposit or ≥1 larger deposit occupying ≤50% of the structure under examination in the reference image-ie, the scanning view with the highest grade of depositions), and grade 3 (deposits that occupy more than 50% of the structure under examination in the reference image). The score should be applied to the knee (menisci and hyaline cartilage) and the triangular fibrocartilage complex of the wrist. The intra-reader and inter-reader reliabilities on static images were almost perfect (κ 0·90 [95% CI 0·79-1·00] and κ 0·84 [0·79-0·88]), and on the eight patients recruited (four [50%] female and four [50%] male) were substantial (κ 0·72 [95% CI 0·47 to 0·96] and 0·66 [0·61 to 0·71]). INTERPRETATION This OMERACT ultrasound scoring system for CPPD was reliable on both static images and patients. The scoring system might be a valuable tool for ensuring valid and comparable results in clinical trials and could help monitor the extent of crystal deposition in patients with CPPD in clinical practice. FUNDING The Italian Ministry of Health - Ricerca Corrente.
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Affiliation(s)
- Silvia Sirotti
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Annamaria Iagnocco
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Ingrid Moller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; IIS-FJD, Universidad Autónoma of Madrid, Madrid, Spain
| | - Florentin A Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Antonella Adinolfi
- Rheumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Diaz
- Rheumatology Unit, University Hospital Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Fabiana Figus
- Rheumatology Service, ASL Torino 3, Collegno Pinerolo, Turin, Italy
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Daryl MacCarter
- Department of Rheumatology, North Valley Hospital, Whitefish, MT, USA
| | - Mohamed A Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Gael Mouterde
- Rheumatology Department & IDESP, CHU Montpellier, Montpellier University, Montpellier, France
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Rheumatology Section, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Anthony M Reginato
- Division of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK
| | - Pascal Zufferey
- Rheumatology Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piercarlo Sarzi-Puttini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Arianna Damiani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, WA, Australia
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Georgios Filippou
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy.
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Dumusc A, Alromaih F, Perreau M, Hügle T, Zufferey P, Dan D. Real-life drug retention rate and safety of rituximab when treating rheumatic diseases: a single-centre Swiss retrospective cohort study. Arthritis Res Ther 2023; 25:91. [PMID: 37264414 DOI: 10.1186/s13075-023-03076-w] [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: 11/07/2022] [Accepted: 05/25/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND In Switzerland, rituximab (RTX) is licenced for the treatment of rheumatoid arthritis (RA) and ANCA-associated vasculitis (AAV) but is frequently used off-label to treat other auto-immune diseases (AID), especially connective tissue diseases (CTD). We aimed to characterise the use of RTX in AID in a real-life Swiss setting and compare RTX retention rates and safety outcomes between patients treated for RA, CTD and AAV. METHODS A retrospective cohort study of patients who started RTX in the Rheumatology Department for RA or AID. The RTX retention rate was analysed using Kaplan-Meier survival curves. Occurrences of serious adverse events (SAE), low IgG levels and anti-drug antibodies (ADA) were reported. RESULTS Two hundred three patients were treated with RTX: 51.7% had RA, 29.6% CTD, 9.9% vasculitis and 8.9% other AIDs. The total observation time was 665 patient-years. RTX retention probability at 2 years (95%CI) was similar for RA and CTD 0.65 (0.55 to 0.73), 0.60 (0.47 to 0.72) and lower for vasculitis 0.25 (0.09 to 0.45). Survival curves for RTX retention matched closely (p = 0.97) between RA and CTD patients but were lower for patients with vasculitis due to a higher percentage of induced remission. Patients with vasculitis (95%) and CTD (75%) had a higher rate of concomitant glucocorticoid use than RA (60%). Moderate to severe hypogammaglobulinaemia was observed more frequently in patients with vasculitis (35%) than with RA (13%) or CTD (9%) and was associated with an increased risk of presenting a first infectious SAE (HR 2.01, 95% CI 1.04 to 3.91). The incidence rate of SAE was 23.3 SAE/100 patient-years (36% were infectious). When searched, ADAs were observed in 18% of the patients and were detected in 63% of infusions-related SAE. 10 patients died during RTX treatment and up to 12 months after the last RTX infusion, 50% from infection. CONCLUSION RTX retention rates are similar for patients with RA and CTD but lower for those with vasculitis due to more frequent remission. Patients treated with RTX for vasculitis present more SAE and infectious SAE than patients with RA and CTD, potentially due to a higher use of concomitant glucocorticoids and the occurrence of hypogammaglobulinaemia.
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Affiliation(s)
- Alexandre Dumusc
- Department of Rheumatology, Lausanne University Hospital, 1005, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, 1005, Lausanne, Switzerland.
| | - Fahad Alromaih
- Department of Rheumatology, Lausanne University Hospital, 1005, Lausanne, Switzerland
| | - Matthieu Perreau
- Faculty of Biology and Medicine, University of Lausanne, 1005, Lausanne, Switzerland
- Division of Immunology and Allergy, Lausanne University Hospital, 1005, Lausanne, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital, 1005, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005, Lausanne, Switzerland
| | - Pascal Zufferey
- Department of Rheumatology, Lausanne University Hospital, 1005, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005, Lausanne, Switzerland
| | - Diana Dan
- Department of Rheumatology, Lausanne University Hospital, 1005, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005, Lausanne, Switzerland
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Sirotti S, Becce F, Sconfienza LM, Terslev L, Naredo E, Zufferey P, Pineda C, Gutierrez M, Adinolfi A, Serban T, MacCarter D, Mouterde G, Zanetti A, Scanu A, Möller I, Novo-Rivas U, Largo R, Sarzi-Puttini P, Abhishek A, Choi HK, Dalbeth N, Pascart T, Tedeschi SK, D'Agostino MA, Iagnocco A, Keen HI, Scirè CA, Filippou G. Reliability and Diagnostic Accuracy of Radiography for the Diagnosis of Calcium Pyrophosphate Deposition: Performance of the Novel Definitions Developed by an International Multidisciplinary Working Group. Arthritis Rheumatol 2022; 75:630-638. [PMID: 36122187 DOI: 10.1002/art.42368] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/07/2022] [Accepted: 09/13/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD). METHODS Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologists twice assessed radiographic images for presence or absence of CPPD in menisci, hyaline cartilage, tendons, joint capsule, or synovial membrane, using the new definitions. In case of disagreement, a consensus decision was made and considered for the assessment of diagnostic performance. Histologic examination of postsurgical specimens under compensated polarized light microscopy was the reference standard. Prevalence-adjusted bias-adjusted kappa values were used to assess reliability, and diagnostic performance statistics were calculated. RESULTS Sixty-seven patients were enrolled for the reliability study. The interobserver reliability was substantial in most of the assessed structures when considering all 4 readers (κ range 0.59-0.90), substantial to almost perfect among radiologists (κ range 0.70-0.91), and moderate to almost perfect among rheumatologists (κ range 0.46-0.88). The intraobserver reliability was substantial to almost perfect for all the observers (κ range 0.70-1). Fifty-one patients were included in the accuracy study. Radiography demonstrated an overall specificity of 92% for CPPD, but sensitivity remained low for all sites and for the overall diagnosis (54%). CONCLUSION The new radiographic definitions of CPPD are highly specific against the gold standard of histologic diagnosis. When the described radiographic findings are present, these definitions allow for a definitive diagnosis of CPPD, rather than other calcium-containing crystal depositions; however, a negative radiographic finding does not exclude the diagnosis.
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Affiliation(s)
- Silvia Sirotti
- Rheumatology Department, Luigi Sacco University Hospital and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luca M Sconfienza
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, and IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Pascal Zufferey
- Rheumatology Department, University of Lausanne, CHUV, Lausanne, Switzerland
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Marwin Gutierrez
- Division of Rheumatology, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Antonella Adinolfi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Daryl MacCarter
- Rheumatology Department, North Valley Hospital, Whitefish, Montana
| | - Gael Mouterde
- Rheumatology Department, CHU Montpellier, Montpellier University, Montpellier, France
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Anna Scanu
- Department of Neurosciences, Physical Medicine and Rehabilitation School, University of Padova, Padova, Italy
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Ulrike Novo-Rivas
- Department of Radiology, Hospital Universitario Fundación Jiménez Diáz, Universidad Autónoma, Madrid, Spain
| | - Raquel Largo
- Joint and Bone Research Unit, Rheumatology Department, IIS-Fundación Jiménez Diáz, Universidad Autónoma, Madrid, Spain
| | - Piercarlo Sarzi-Puttini
- Rheumatology Department, Luigi Sacco University Hospital and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tristan Pascart
- Rheumatology Department, Groupe Hospitalier de l'Institut Catholique de Lille, Lille Catholic University, Lille, France
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Maria-Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, Australia
| | - Carlo A Scirè
- Società Italiana di Reumatologia, Epidemiology Research Unit, and School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Georgios Filippou
- IRCCS Istituto Ortopedico Galeazzi, Rheumatology Department, Milan, Italy
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Gessl I, Deimel T, Studenic P, Tamborrini G, Zufferey P, Aletaha D, Moeller B, Mandl P. AB0180 CLINICAL AND ULTRASOUND-BASED COMPOSITE DISEASE ACTIVITY INDICES AND RADIOGRAPHIC PROGRESSION IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2409] [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
BackgroundMusculoskeletal ultrasound (US) has been reported to predict radiographic progression in rheumatoid arthritis (RA).ObjectivesTo test the predictive value of composite disease activity indices (DAI) based on solely clinical as well as clinical and US (USDAI) information to predict radiographic progression in RA.MethodsData from the Swiss Clinical Quality Management (SCQM) database were extracted from patients with RA; USDAIs were created based on previous publications (1) (Table 1). In summary, the disease activity score in 28 joints (DAS28) and the simplified disease activity index (SDAI) were modified by supplementing or replacing the clinical swollen JC with joints showing signs of power Doppler (PD) and/or grey scale (GS) synovitis. Series with two standard x-rays of the hands (difference ≥ 183 days) and ≥1 visit with clinical and US data in between were analyzed. Progression was defined as an increase of ≥6.27 points of the Ratingen-Rau x-ray score. Receiver operating curve (ROC) analyses were used to assess predictive ability of every DAI for radiographic progression. As a subanalysis, ROCs using the median DAIs of series with ≥2 DAIs between two x-rays were run. Clinical DAS28/SDAIs were compared to their respective USDAI counterpart with the highest area under the curves (AUC).Table 1.Area under the curves (AUC) of receiver operating characteristic curves for the predictive value of the composite disease activity indices for radiographic progression. DAI disease activity index; DAS28, disease activity score for 28 joints; GS, grey scale; PD, power Doppler; SDAI, simplified disease activity index; SJC: swollen joint count; + positiveDisease activity indexesAll seriesSeries with ≥ 2 DAIs95% CI95% CIAUCLowerUpperAUCLowerUpperDAS28.58.52.58.62.45.78DAS28_GSSJC replaced by GS+ joints.56.49.56.62.44.80DAS28_PDSJC replaced by PD+ joints.60.53.60.63.46.81DAS28_GSPDSJC replaced by GS AND PD+ joints.57.50.57.62.44.80DAS28_plus_GSSJC supplemented by GS+ joints.57.50.57.62.44.8ßDAS28_plus_PDSJC supplemented by PD+ joints.59.52.59.61.43.79DAS28_plus_GSPDSJC supplemented by GS AND PD+ joints.57.50.57.62.44.79SDAI.57.50.57.48.26.70SDAI_GSSJC replaced by GS+ joints.53.46.53.47.23.71SDAI_PDSJC replaced by PD+ joints.58.52.58.51.27.75SDAI_GSPDSJC replaced by GS AND PD+ joints.53.46.53.47.23.71SDAI_plus_GSSJC supplemented by GS+ joints.54.47.54.47.23.70SDAI_plus_PDSJC supplemented by PD+ joints.58.51.58.48.25.72SDAI_plus_GSPDSJC supplemented by GS AND PD+ joints.54.47.54.46.23.70ResultsWe included 649 series in 475 patients. Progression was observed in 84/649 (12.9%) series. Mean difference between the x-rays was 27.6±18.0 months. Mean age was 56.3±12.7 years, 474/649 (73%) series were from female patients. There was no significant difference between the AUC of the ROC of SDAI vs. SDAI_PD (p=0.19) nor between DAS28 vs. DAS28_PD: (p=0.17) (Figure 1A, Table 1). Similarly, when analyzing only series with ≥2 DAIs (143 series) we observed no difference between the AUC of the ROC of SDAI vs. SDAI-PD (p=0.28) nor between that of DAS28 vs. DAS28_PD (p=0.23) (Figure 1B, Table 1).Figure 1.Receiver operating characteristic (ROC) curve of clinical and ultrasound-based composite disease activity indices (A) overall and (B) for the subgroup with series with ≥ disease activity indices. DAS, disease activity score; GS, grey scale; PD, power Doppler; SDAI, simplified disease activity index;ConclusionThe predictability of radiographic progression by disease activity measures was generally limited. The composite USDAIs containing sonographic JC were not superior for predicting radiographic progression compared to their clinical counterparts although there was a trend for higher predictive value for indices containing PD.References[1]Mandl P, Balint P, Brault Y et al. Arthritis Care Res 2013;65:879-87.Disclosure of InterestsIrina Gessl: None declared, Thomas Deimel: None declared, Paul Studenic: None declared, Giorgio Tamborrini: None declared, Pascal Zufferey: None declared, Daniel Aletaha Speakers bureau: Abbvie, Amgen, Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, Sanofi, Burkhard Moeller: None declared, Peter Mandl Speakers bureau: from AbbVie, Janssen and Novartis, Grant/research support from: from AbbVie, BMS, Novartis, Janssen, MSD and UCB
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Sirotti S, Adinolfi A, Damiani A, Becce F, Cazenave T, Cipolletta E, Christiansen SN, Delle Sedie A, Diaz M, Figus F, Filippucci E, Hammer HB, Mandl P, Maccarter D, Micu M, Möller I, Mortada MA, Mouterde G, Naredo E, Porta F, Reginato A, Sakellariou G, Schmidt WA, Scirè CA, Serban T, Vlad V, Vreju FA, Wakefield R, Zufferey P, Sarzi-Puttini P, Iagnocco A, Pineda C, Keen H, D’agostino MA, Terslev L, Filippou G. OP0168 DEVELOPMENT OF AN ULTRASOUND SCORING SYSTEM FOR CPPD EXTENT: RESULTS FROM A DELPHI PROCESS AND WEB-RELIABILITY EXERCISE BY THE OMERACT US WORKING GROUP. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3309] [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
BackgroundUltrasound (US) has proven to be an excellent imaging technique for detecting calcium pyrophosphate (CPP) deposition disease (CPPD); it is also widely available and inexpensive and can be performed during the clinic visit making it the preferred imaging modality for many rheumatologists. However, no validated grading systems have yet been developed allowing for a quantification of the extent of crystal deposition in CPPD.ObjectivesThe aim of this study was to develop a scoring system for the quantification of CPP deposition at a patient level according to the OMERACT framework.MethodsAs part of the OMERACT methodology, we performed a systematic literature review (SLR) and meta-analysis aimed to estimate the prevalence of CPP deposition in peripheral joints by imaging, in order to identify relevant joints for CPPD monitoring. A preliminary survey was also circulated among the members of the OMERACT US – CPPD working group to collect their own suggestions according to their personal experience. Subsequently, a Delphi survey was prepared and circulated between members of the group, including statements that reflected both the results of the SLR and of the preliminary survey. In total, 32 statements were generated regarding the type of scoring for single structures, the sites to be included, the final scoring at patient level, and the scanning technique. Participants were asked to reply on a 5-point Likert scale (1, strongly disagree to 5, strongly agree) and agreement was achieved when 4 and 5 grades reached 75% or more of concordance. In case of disagreement, new statements were proposed according to the members’ suggestions and circulated for voting in a subsequent round. After agreement of a scoring system, the validation process began. Two rounds of a web-based exercise on static images were conducted on 120 images representing equally all sites under investigation and all degrees of crystal deposition, to assess the intra- and inter-reader reliability of the new scoring system. Representative images of the scoring system were visible throughout the entire exercise in order to facilitate the scoring of the lesions.ResultsThree Delphi rounds were needed to reach agreement on all items. 32/41 members of the OMERACT US-CPPD working group replied in the first round, 26/32 in the second, and 25/26 in the third round. Twenty statements were approved in the first round, 3 in the second, and 3 in the third round. Only the knees (menisci and hyaline cartilage) and the triangular fibrocartilage of the wrist were included in the final score, using a four-grade system (0-3). It was decided that each anatomical structure should be scored separately and then also summed in order to define the joint score. The sum of the assessed joints was the total score at patient level. The final scoring system with the definitions and the relative technical notes is represented in Figure 1. 33/41 members participated to the reliability exercise. The inter-reader reliability of the scoring was substantial (kappa of 0.72), and the intra-reader reliability was almost perfect (kappa of 0.82).ConclusionThis is the first study for developing a scoring system for the extent of CPP crystal deposition in patients with CPPD. The scoring system demonstrated to be reliable in static images. The next step of the validation process is to assess the reliability of the scoring system in a patient-based exercise. This study represents a fundamental step in the OMERACT process of validating US as an outcome measure instrument, and above proposed scoring system will hopefully provide a useful tool for clinical practice and research.Disclosure of InterestsNone declared
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Sirotti S, Becce F, Sconfienza LM, Terslev L, Zanetti A, Naredo E, Zufferey P, Gutierrez M, Adinolfi A, Serban T, Maccarter D, Mouterde G, Scanu A, Möller I, Scirè CA, Sarzi-Puttini P, Novo-Rivas U, Abhishek A, Choi H, Dalbeth N, Tedeschi S, Iagnocco A, Pineda C, Keen H, D’agostino MA, Filippou G. POS0276 TRADITION VS INNOVATION! CONVENTIONAL RADIOGRAPHY AND ULTRASOUND IN THE DIAGNOSIS OF CPPD: INSTRUCTIONS FOR USE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3272] [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
BackgroundConventional radiography (CR) is widely used as the first-line investigation for calcium pyrophosphate deposition (CPPD) disease, given its widespread use and the low cost. Next to it a series of advanced imaging techniques have been evaluated for accuracy and reliability. Among them, ultrasound (US) has been thoroughly tested and demonstrated to be accurate and reliable for CPPD diagnosis. However, even if there are data on the diagnostic accuracy of US and CR alone, it is not clear if performing both diagnostic tests and in which sequential order provides an added value for the diagnosis of CPPD.ObjectivesThe aim of this study was to assess which diagnostic test performs better for the diagnosis of CPPD and if a combination of the two exams provides an additional value.MethodsThis is an ancillary study of the criterion validity of US in CPPD study1. Consecutive patients with knee osteoarthritis requiring total joint replacement were enrolled in 8 centres. Participants underwent US and CR of the affected knee prior to surgery. US was performed by experienced sonographers following the same scanning protocol described in the main study, while CR were performed in weight bearing AP and lateral views and were read by 2 experienced radiologists that reached a consensus on the presence/absence of CPPD. The evaluation of CPPD at the level of menisci and hyaline cartilage (HC) was based on the OMERACT definitions for US and on the new definitions developed by the ACR/EULAR CPPD classification criteria working group for CR [paper under submission]. Patients were classified as having CPPD considering histological examination as reference standard. Diagnostic indexes were calculated for US and CR alone and combined. Poisson models with robust estimation were used to estimate the best sequence of these diagnostic methods for a more accurate diagnosis of CPPD.Results51 pts were enrolled (63% F, mean age 74y ± 8). Diagnostic indexes of US and CR alone and combined are indicated in Table 1. Compared to histology, US demonstrated to be a sensitive tool for identification of CPPD at the knee, with a good sensitivity in all sites and in the overall evaluation. Instead, CR was less sensitive, but it was a highly specific exam for CPPD identification. Combining US and CR led to a higher sensitivity compared with CR alone, but a lower specificity compared to both CR and US alone, and it offered no additional increase in diagnostic accuracy. The Figure 1 shows the results of the appropriate sequence of use of US and CR in patients with suspected CPPD: in case of a positive CR at any of the 3 sites (menisci and HC) no additional exam is necessary, and the same in case of a positive US in at least two sites; however in case of a negative CR, US could help in a statistically significant way to identify CPPD patients, and further in case of a positive US in a single site CR can offer additional information.Table 1.diagnostic indexes of US, CR and US + CR in the identification of CPPD. MM: medial meniscus, LM: lateral meniscus, HC: hyaline cartilage, SN: sensitivity, SP: specificity, PPV: positive predictive value, NPV: negative predictive value, ACC: accuracy.USSNSPPPVNPVACCMM0.880.810.820.880.84LM0.880.730.760.860.80HC0.780.860.820.830.82Overall0.920.640.730.890.78CRMM0.32110.610.67LM0.400.960.910.630.69HC0.480.930.850.680.73Overall0.540.920.880.660.73US + CRMM0.880.810.820.880.84LM0.920.690.740.900.80HC0.870.820.800.890.84Overall0.920.560.670.880.75Figure 1.evaluation of sequence of US and CRConclusionUS confirmed a high diagnostic accuracy in identifying patients affected by CPPD at knee level, while CR demonstrated a high specificity but a low sensitivity. Performing both diagnostic tests could make sense in case of a negative CR or in case of an inconclusive US (only one positive site). To our knowledge, this is the first study that investigates the role of the combination of the two exams in CPPD. Further studies in a large number of patients and in different joints would be helpful to address this point.References[1]Filippou G. et al, Ann Rheum Dis, 2020Disclosure of InterestsNone declared
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Micheroli R, Scherer A, Bürki K, Zufferey P, Nissen MJ, Brulhart L, Möller B, Ziswiler HR, Ciurea A, Tamborrini G. Does tenosynovitis of the hand detected by B-mode ultrasound predict loss of clinical remission in rheumatoid arthritis? Results from a real-life cohort. J Ultrason 2022; 22:e21-e27. [PMID: 35449701 PMCID: PMC9009346 DOI: 10.15557/jou.2022.0004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The role of US-detected tenosynovitis (USTS) in the management of rheumatoid arthritis remains controversial. The aim of this study was to investigate whether tenosynovitis can predict a flare in rheumatoid arthritis patients in remission in a real-life cohort. Methods Rheumatoid arthritis patients from the Swiss Clinical Quality Management cohort were included in this study if they were in clinical remission, defined by 28-joint disease activity score (DAS28-ESR) <2.6, and had an available B-mode tenosynovitis score. The patients were stratified according to the presence or absence of tenosynovitis (USTS+ vs. USTS–). Cox proportional hazard models were used for time-to-event analysis until the loss of remission, after adjustment for multiple confounders. The impact of baseline US performed early in remission and the advent of flares at different fixed time periods after baseline were investigated in sensitivity analysis. Results Tenosynovitis was detected in 10% of 402 rheumatoid arthritis patients in remission. At baseline, USTS+ patients in remission had significantly higher DAS28-ESR (mean (SD): USTS– 1.8 (0.5) versus USTS+ 2.0 (0.5); p = 0.0019) and higher additional disease activity parameters, such as physician global assessment, and simplified- and clinical-disease activity index. Joint synovitis detected by B-mode US was associated with tenosynovitis (mean (SD) 7.2 (6.3) in USTS– versus 9.0 (5.4) in USTS+, respectively; p = 0.02). A disease flare was observed in 69% of remission phases, with no differences in the time to loss of remission between USTS+ and USTS– groups. Conclusion While US-detected tenosynovitis was associated with higher disease activity parameters in rheumatoid arthritis patients in clinical remission, it was not able to predict a flare.
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Affiliation(s)
- Raphael Micheroli
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | - Almut Scherer
- Statistics Group, SCQM Foundation, Zurich, Switzerland
| | - Kristina Bürki
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | - Pascal Zufferey
- Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Laure Brulhart
- Department of Rheumatology, Réseau hospitalier neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Burkhard Möller
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern, Switzerland
| | | | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | - Giorgio Tamborrini
- Ultrasound Center UZR, Basel Switzerland and Department of Rheumatology, University Hospital, Basel, Switzerland
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Finckh A, Tellenbach C, Herzog L, Scherer A, Moeller B, Ciurea A, von Muehlenen I, Gabay C, Kyburz D, Brulhart L, Müller R, Hasler P, Zufferey P. Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland. RMD Open 2021; 6:rmdopen-2020-001174. [PMID: 32385143 PMCID: PMC7299517 DOI: 10.1136/rmdopen-2020-001174] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/08/2020] [Revised: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 01/11/2023] Open
Abstract
Background Multiple biologic and targeted synthetic disease-modifying rheumatic drugs (b/tsDMARDs) are approved for the management of rheumatoid arthritis (RA), including TNF inhibitors (TNFi), bDMARDs with other modes of action (bDMARD-OMA) and Janus kinase inhibitors (JAKi). Combination of b/tsDMARDs with conventional synthetic DMARDs (csDMARDs) is recommended, yet monotherapy is common in practice. Objective To compare drug maintenance and clinical effectiveness of three alternative treatment options for RA management. Methods This observational cohort study was nested within the Swiss RA Registry. TNFi, bDMARD-OMA (abatacept or anti-IL6 agents) or the JAKi tofacitinib (Tofa) initiated in adult RA patients were included. The primary outcome was overall drug retention. We further analysed secondary effectiveness outcomes and whether concomitant csDMARDs modified effectiveness, adjusting for potential confounding factors. Results 4023 treatment courses of 2600 patients were included, 1862 on TNFi, 1355 on bDMARD-OMA and 806 on Tofa. TNFi was more frequently used as a first b/tsDMARDs, at a younger age and with shorter disease duration. Overall drug maintenance was significantly lower with TNFi compared with Tofa [HR 1.29 (95% CI 1.14 to 1.47)], but similar between bDMARD-OMA and Tofa [HR 1.09 (95% CI 0.96 to 1.24)]. TNFi maintenance was decreased when prescribed without concomitant csDMARDs [HR: 1.27 (95% CI 1.08 to 1.49)], while no difference was observed for bDMARD-OMA or Tofa maintenance with respect to concomitant csDMARDs. Conclusion Tofa drug maintenance was comparable with bDMARDs-OMA and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for bDMARD-OMA or Tofa.
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Affiliation(s)
- A Finckh
- Department of Internal Medicine Specialties, University Hospitals Geneva, Geneva, Switzerland
| | - C Tellenbach
- Statistics Group, SCQM Foundation, Zurich, Switzerland
| | - L Herzog
- Statistics Group, SCQM Foundation, Zurich, Switzerland.,Zurich University of Applied Sciences, Institute of Data Analysis and Process Design (IDP), Winterthur, Switzerland
| | - A Scherer
- Statistics Group, SCQM Foundation, Zurich, Switzerland
| | - B Moeller
- Inselspital und Universitätsspital Bern, Bern, Switzerland
| | - A Ciurea
- University Hospital Zurich, Zurich, Switzerland
| | | | - C Gabay
- Department of Internal Medicine Specialties, University Hospitals Geneva, Geneva, Switzerland
| | - D Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - L Brulhart
- Rheumatology, Réseau hospitalier neuchâtelois, La Chaux-de-Fonds,Switzerland
| | - R Müller
- Kantonsspital Aarau, Aarau, Switzerland
| | - P Hasler
- Kantonsspital Aarau, Aarau, Switzerland
| | - P Zufferey
- Centres Hospitaliers Universitaires Vaudois, Lausanne, Switzerland
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Dumusc A, Pazar Maldonado B, Benaim C, Zufferey P, Aubry-Rozier B, So A. Anakinra compared to prednisone in the treatment of acute CPPD crystal arthritis: A randomized controlled double-blinded pilot study. Joint Bone Spine 2020; 88:105088. [PMID: 33445133 DOI: 10.1016/j.jbspin.2020.105088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Alexandre Dumusc
- Rheumatology Department, Lausanne University Hospital, avenue Pierre-Decker 4, 1005 Lausanne, Switzerland.
| | - Borbala Pazar Maldonado
- Rheumatology Department, Lausanne University Hospital, avenue Pierre-Decker 4, 1005 Lausanne, Switzerland
| | - Charles Benaim
- Physical Medicine and Rehabilitation Department, Lausanne University Hospital, 1005 Lausanne, Switzerland
| | - Pascal Zufferey
- Rheumatology Department, Lausanne University Hospital, avenue Pierre-Decker 4, 1005 Lausanne, Switzerland
| | - Bérengère Aubry-Rozier
- Rheumatology Department, Lausanne University Hospital, avenue Pierre-Decker 4, 1005 Lausanne, Switzerland
| | - Alexander So
- Rheumatology Department, Lausanne University Hospital, avenue Pierre-Decker 4, 1005 Lausanne, Switzerland
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Möller B, Aletaha D, Andor M, Atkinson A, Aubry-Rozier B, Brulhart L, Dan D, Finckh A, Grobéty V, Mandl P, Micheroli R, Nissen MJ, Nydegger AM, Scherer A, Tamborrini G, Ziswiler HR, Zufferey P. Synovitis in rheumatoid arthritis detected by grey scale ultrasound predicts the development of erosions over the next three years. Rheumatology (Oxford) 2020; 59:1556-1565. [PMID: 31630207 PMCID: PMC7310093 DOI: 10.1093/rheumatology/kez460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/30/2019] [Revised: 07/30/2019] [Indexed: 01/20/2023] Open
Abstract
Objectives To evaluate grey scale US (GSUS) and power Doppler US synovitis (PDUS), separately or in combination (CombUS), to predict joint damage progression in RA. Methods In this cohort study nested in the Swiss RA register, all patients with sequential hand radiographs at their first US assessment were included. We analysed the summations of semi-quantitative GSUS, PDUS and CombUS assessments of both wrists and 16 finger joints (maximum 54 points) at their upper limit of normal, their 50th, 75th or 87.5th percentiles for the progression of joint damage (ΔXray). We adjusted for clinical disease activity measures at baseline, the use of biological DMARDs and other confounders. Results After a median of 35 months, 69 of 250 patients with CombUS (28%), 73 of 259 patients with PDUS (28%) and 75 of 287 patients with available GSUS data (26%) demonstrated joint damage progression. PDUS beyond upper limit of normal (1/54), GSUS and CombUS each at their 50th (9/54 and 10/54) and their 75th percentiles (14/54 and 15/54) were significantly associated with ΔXray in crude and adjusted models. In subgroup analyses, GSUS beyond 14/54 and CombUS higher than 15/54 remained significantly associated with ΔXray in patients on biological DMARDs, while clinical disease activity measures had no significant prognostic power in this subgroup. Conclusion Higher levels of GSUS and CombUS are associated with the development of erosions. GSUS appears to be an essential component of synovitis assessment and an independent predictor of joint damage progression in patients on biological DMARDs.
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Affiliation(s)
- Burkhard Möller
- Rheumatology, Immunology and Allergy, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Daniel Aletaha
- Medical Department III, Rheumatology, Medical University Vienna, Vienna, Austria
| | | | - Andrew Atkinson
- Rheumatology, Immunology and Allergy, Inselspital, University Hospital of Bern, Bern, Switzerland.,SCQM statistics group, Zurich
| | | | | | - Diana Dan
- Rheumatology, Lausanne University Hospital, Lausanne
| | - Axel Finckh
- Rheumatology, University Hospitals of Geneva, Geneva
| | | | - Peter Mandl
- Medical Department III, Rheumatology, Medical University Vienna, Vienna, Austria
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Filippou G, Scanu A, Adinolfi A, Toscano C, Gambera D, Largo R, Naredo E, Calvo E, Herrero-Beaumont G, Zufferey P, Bonjour CM, MacCarter DK, Makman S, Weber Z, Figus F, Möller I, Gutierrez M, Pineda C, Clavijo Cornejo D, Garcia H, Ilizaliturri V, Mendoza Torres J, Pichardo R, Rodriguez Delgado LC, Filippucci E, Cipolletta E, Serban T, Cirstoiu C, Vreju FA, Grecu D, Mouterde G, Govoni M, Punzi L, Damjanov NS, Keen HI, Bruyn GA, Terslev L, D'Agostino MA, Scirè CA, Iagnocco A. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis 2020; 80:261-267. [PMID: 32988839 DOI: 10.1136/annrheumdis-2020-217998] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/03/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the discriminatory ability of ultrasound in calcium pyrophosphate deposition disease (CPPD), using microscopic analysis of menisci and knee hyaline cartilage (HC) as reference standard. METHODS Consecutive patients scheduled for knee replacement surgery, due to osteoarthritis (OA), were enrolled. Each patient underwent ultrasound examination of the menisci and HC of the knee, scoring each site for presence/absence of CPPD. Ultrasound signs of inflammation (effusion, synovial proliferation and power Doppler) were assessed semiquantitatively (0-3). The menisci and condyles, retrieved during surgery, were examined microscopically by optical light microscopy and by compensated polarised microscopy. CPPs were scored as present/absent in six different samples from the surface and from the internal part of menisci and cartilage. Ultrasound and microscopic analysis were performed by different operators, blinded to each other's findings. RESULTS 11 researchers from seven countries participated in the study. Of 101 enrolled patients, 68 were included in the analysis. In 38 patients, the surgical specimens were insufficient. The overall diagnostic accuracy of ultrasound for CPPD was of 75%-sensitivity of 91% (range 71%-87% in single sites) and specificity of 59% (range 68%-92%). The best sensitivity and specificity were obtained by assessing in combination by ultrasound the medial meniscus and the medial condyle HC (88% and 76%, respectively). No differences were found between patients with and without CPPD regarding ultrasound signs of inflammation. CONCLUSION Ultrasound demonstrated to be an accurate tool for discriminating CPPD. No differences were found between patents with OA alone and CPPD plus OA regarding inflammation.
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Affiliation(s)
- Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy .,Rheumatology Department, Luigi Sacco University Hospital, Milano, Italy
| | - Anna Scanu
- Department of Medicine-DIMED, Rheumatology Unit, University of Padova, Padova, Italy
| | - Antonella Adinolfi
- Rheumatology Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Carmela Toscano
- Rheumatology Department, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Dario Gambera
- Orthopedics Department, Rugani Hospital, Monteriggioni, Italy
| | - Raquel Largo
- Joint and Bone Research Unit, Rheumatology Department, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Emilio Calvo
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Pascal Zufferey
- Rheumatology Department, University of Lausanne, CHUV, Lausanne, Switzerland
| | | | - Daryl K MacCarter
- Rheumatology Department, North Valley Hospital, Whitefish, Montana, USA
| | - Stanley Makman
- Rheumatology Department, North Valley Hospital, Whitefish, Montana, USA
| | - Zachary Weber
- Rheumatology Department, North Valley Hospital, Whitefish, Montana, USA
| | - Fabiana Figus
- Rheumatology Unit, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Torino, Italy
| | - Ingrid Möller
- Rheumatology, Instituto Poal de Reumatologia, Barcelona, Spain
| | - Marwin Gutierrez
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | - Carlos Pineda
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | | | - Hector Garcia
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | - Victor Ilizaliturri
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | | | - Raul Pichardo
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Teodora Serban
- Rheumatology Department, Carol Davila University, Bucharest, Romania
| | - Catalin Cirstoiu
- Rheumatology Department, Carol Davila University, Bucharest, Romania
| | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Dan Grecu
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gaël Mouterde
- Rheumatology, University of Montpellier, Montpellier, France
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Leonardo Punzi
- Department of Medicine, Ospedale SS Giovanni e Paolo Venezia, Venezia, Italy
| | - Nemanja S Damjanov
- Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia.,Institute of Rheumatology, University of Belgrade, Belgrade, Serbia
| | - Helen Isobel Keen
- Medicine and Pharmacology Department, The University of Western Australia, Murdoch, Perth, Australia
| | - George Aw Bruyn
- Department of Rheumatology, Reumakliniek Lelystad, Lelystad, The Netherlands
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Maria-Antonietta D'Agostino
- Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-Le-Bretonneux, France.,Rheumatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Annamaria Iagnocco
- Rheumatology Unit, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Torino, Italy
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Micheroli R, Tellenbach C, Scherer A, Bürki K, Niederman K, Nissen MJ, Zufferey P, Exer P, Möller B, Kyburz D, Ciurea A. Effectiveness of secukinumab versus an alternative TNF inhibitor in patients with axial spondyloarthritis previously exposed to TNF inhibitors in the Swiss Clinical Quality Management cohort. Ann Rheum Dis 2020; 79:1203-1209. [DOI: 10.1136/annrheumdis-2019-215934] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022]
Abstract
ObjectiveTo compare effectiveness of treatment with secukinumab (SEC) with that of alternative tumour necrosis factor inhibitors (TNFis) in patients with axial spondyloarthritis (axSpA) after withdrawal from one or more TNFis.MethodsPatients diagnosed as having axSpA in the Swiss Clinical Quality Management cohort were included if they had initiated SEC (n=106) or an alternative TNFi (n=284) after experiencing TNFi failure. Drug retention was investigated with matching weights propensity score (PS) analyses and multiple adjusted Cox proportional hazards models. Matching weights PS-based analyses and multiple-adjusted logistic regression analyses were used to assess the proportion of patients reaching 50% reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) at 1 year.ResultsSEC was more often used as third-line or later-line biological drug (76% vs 40% for TNFi). Patients starting SEC had higher BASDAI, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index and C reactive protein levels. A comparable risk of drug discontinuation was found for SEC versus TNFi (HR 1.14, 95% CI 0.78 to 1.68 in the PS-based analysis and HR 1.16, 95% CI 0.79 to 1.71 in the multiple-adjusted analysis). No significant difference in BASDAI50 responses at 1 year was demonstrated between the two modes of biological drug action, with CI of estimates being, however, wide (OR for SEC vs TNFi 0.76, 95% CI 0.26 to 2.18 and 0.78, 95% CI 0.24 to 2.48 in the PS-based and the covariate-adjusted model, respectively).ConclusionOur data suggest a comparable effectiveness of SEC versus an alternative TNFi after prior TNFi exposure.
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Filippou G, Scanu A, Adinolfi A, Toscano C, Gambera D, Largo R, Naredo E, Calvo E, Herrero-Beaumont G, Zufferey P, Madelaine-Bonjour C, Maccarter D, Makman S, Weber Z, Figus F, Möller I, Gutierrez M, Pineda C, Clavijo Cornejo D, García H, Ilizaliturri V, Mendoza Torres J, Pichardo R, Rodriguez Delgado LC, Filippucci E, Cipolletta E, Serban T, Cirstoiu C, Vreju FA, Grecu D, Mouterde G, Govoni M, Punzi L, Damjanov N, Terslev L, Scirè CA, Iagnocco A. OP0317 ACCURACY OF THE OMERACT DEFINITIONS FOR IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS WITH ULTRASOUND: FINAL RESULTS OF THE OMERACT US IN CPPD SUB-TASK FORCE STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The OMERACT Ultrasound (US) in calcium pyrophosphate deposition disease (CPPD) sub-task force has been working on the use of US in CPPD since 2014 first creating definitions for CPPD identification and then assessing the reliability[1].Objectives:Objective of this study is to assess the diagnostic accuracy (truth) of US in CPPD.Methods:Consecutive patients waiting to undergo knee replacement surgery due to osteoarthritis were enrolled in 12 centres from 6 countries. Each patient underwent US examination of the knee, focusing on the menisci and the hyaline cartilage, the day prior to surgery, scoring each site for presence/absence of CPP as defined previously[1]. After surgery, the menisci and the condyles were retrieved and examined microscopically. Six samples were collected, both from the surface and from the internal part of menisci and cartilage trying to cover a large part of it. All slides were observed under transmitted light microscopy and by compensated polarised microscopy. A dichotomous score was given for the presence/absence of CPP. US and microscopic analysis were performed by different operators, blind to each other’s findings. Sensitivity and specificity of US were calculated using microscopic findings as the gold standard.Results:101 patients have been enrolled in the study. 33 patients have been excluded due to loss of anatomical pieces at surgery. The mean age of the remaining 68 pts was 71yo (±8), 44 women, 34 were affected by CPPD according to microscopy. Overall and per site diagnostic US accuracy results are presented in table 1Diagnostic accuracySensitivitySpecificityPositive Predictive valueNegative Predictive valueGlobal0.750.910.590.690.87Medial meniscus0.820.870.770.770.87Lateral meniscus0.750.830.680.680.83Medial cartilage0.860.790.920.880.85Lateral cartilage0.820.710.880.770.84Medial side (combined cartilage and meniscus)0.820.880.760.790.87Lateral side (combined cartilage and meniscus)0.780.880.690.730.86Conclusion:Our results demonstrate that US is an accurate exam for identification of CPPD. The best combination of sensitivity and specificity is achieved by examining the medial aspect of the knee.References:[1]Filippou G, Scirè CA, Adinolfi A,et al.Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force.Ann Rheum Dis2018;:annrheumdis-2017-212542. doi:10.1136/annrheumdis-2017-212542Disclosure of Interests:Georgios Filippou: None declared, Anna Scanu: None declared, Antonella Adinolfi: None declared, Carmela Toscano: None declared, Dario Gambera: None declared, Raquel Largo: None declared, Esperanza Naredo: None declared, Emilio Calvo: None declared, Gabriel Herrero-Beaumont: None declared, Pascal Zufferey: None declared, Christel Madelaine-Bonjour: None declared, Daryl MacCarter: None declared, Stanley Makman: None declared, Zachary Weber: None declared, Fabiana Figus: None declared, Ingrid Möller: None declared, Marwin Gutierrez: None declared, Carlos Pineda: None declared, Denise Clavijo Cornejo: None declared, Héctor García: None declared, Victor Ilizaliturri: None declared, Jaime Mendoza Torres: None declared, Raul Pichardo: None declared, Luis Carlos Rodriguez Delgado: None declared, Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work., Edoardo Cipolletta: None declared, Teodora Serban: None declared, Catalin Cirstoiu: None declared, Florentin Ananu Vreju: None declared, Dun Grecu: None declared, Gael Mouterde: None declared, Marcello Govoni: None declared, Leonardo Punzi: None declared, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen., Carlo Alberto Scirè: None declared, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi
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Hebeisen M, Micheroli R, Scherer A, Baraliakos X, De Hooge M, Van der Heijde D, Landewé RBM, Buerki K, Nissen M, Moeller B, Zufferey P, Exer P, Ciurea A. OP0075 SPINAL RADIOGRAPHIC PROGRESSION IN AXIAL SPONDYLOARTHRITIS AND THE IMPACT OF CLASSIFICATION AS NONRADIOGRAPHIC VERSUS RADIOGRAPHIC DISEASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Data on spinal radiographic progression is more limited in nonradiographic axial spondyloarthritis (nr-axSpA) than in the radiographic disease state (r-axSpA). It remains unclear, whether radiographic sacroiliitis is by itself associated with progression of spinal structural damage.Objectives:To investigate whether spinal radiographic progression relates to structural damage at the sacroiliac level in axSpA by means of statistical mediation analyses in a large prospective real-life cohort of patients with axSpA.Methods:Patients from the Swiss Clinical Quality Management cohort were included if they fulfilled the ASAS classification criteria and could be classified as nr-axSpA or r-axSpA after central scoring of pelvis radiographs. Spinal radiographs performed every 2 years were scored according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The relationship between classification status and spinal progression over 2 years was investigated using binomial generalized estimating equations models with adjustment for sex, ankylosing spondylitis disease activity score (ASDAS) and tumor necrosis factor inhibitor treatment. Baseline spinal damage was considered an intermediate variable and included in sensitivity analyses, as were additional variables potentially influencing radiographic progression.Results:In total, 88 nr-axSpA and 418 r-axSpA patients contributed to data for 725 radiographic intervals (Table 1). Mean (SD) mSASSS change over 2 years was 0.16 (0.62) units in nr-axSpA and 0.92 (2.78) units in r-axSpA, p=0.01. Nr-axSpA was associated with a significantly lower progression over 2 years (defined as an increase in ≥2 mSASSS units) in adjusted analyses (OR 0.33, 95%CI 0.13; 0.83), confirmed with progression defined as the formation of ≥1 syndesmophyte. Mediation analyses revealed that sacroiliitis exerted its effect on spinal progression indirectly by being associated with the appearance of a first syndesmophyte (OR 0.09, 95%CI 0.02; 0.36 for nr-axSpA vs r-axSpA) (Fig. 1 and 2). Baseline syndesmophytes were predictors of further progression.Table 1.Baseline characteristics at first radiograph.ParameterN506nr-axSpAN = 88r-axSpAN = 418PFemale sex, %50654.533.7<0.001Age, y50639.5±11.140.4±11.00.52Symptom duration, y49810.0±9.914.0±9.8<0.001HLA-B27 positive, %45271.680.70.09BASDAI4274.6±2.04.2±2.30.26ASDAS4082.8±0.92.8±1.10.74Elevated CRP, %42230.640.60.14BASFI4332.8±2.23.1±2.50.71BASMI4351.1±1.42.2±2.0<0.001mSASSS5060.9±1.56.8±12.7<0.001Syndesmophytes, %5069.135.2<0.001On TNFi, %50619.336.40.002Fig. 1.Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) for individual patients plotted as a function of duration since symptom onset.Fig. 2.Two-year mSASSS progression depicted in a cumulative probability plot. Progression was defined as an increase in mSASSS of at least 2 units (dotted line) in 2 years.Conclusion:Spinal structural damage is mainly restricted to patients with r-axSpA, leading to relevant prognostic and therapeutic implications.Disclosure of Interests:Monika Hebeisen: None declared, Raphael Micheroli: None declared, Almut Scherer: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Manouk de Hooge: None declared, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Kristina Buerki: None declared, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Burkhard Moeller: None declared, Pascal Zufferey: None declared, Pascale Exer: None declared, Adrian Ciurea Consultant of: Consulting and/or speaking fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis and Pfizer.
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Zufferey P, Courvoisier DS, Nissen MJ, Möller B, Brulhart L, Ziswiler HR, Tamborrini G, Ciurea A, D'Agostino MA, Finckh A. Discordances between clinical and ultrasound measurements of disease activity among RA patients followed in real life. Joint Bone Spine 2019; 87:57-62. [PMID: 31557525 DOI: 10.1016/j.jbspin.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/31/2019] [Accepted: 09/11/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Measurements of disease activity, such as the clinical disease activity score (DAS28) or ultrasound (US) scores, often yield discordant results. This study's objectives were to determine the proportion of disagreements between the two assessment methods in patients with rheumatoid arthritis (RA) and to describe factors associated with discrepancy in assessment. METHODS All RA patients in the Swiss registry for inflammatory arthritides (SCQM) with at least one concomitant DAS28 and US score, were included. Disease activity was categorized as remission, low-to-moderate, and high, based on previously established cut-offs, for both the DAS28 and the US score. A longitudinal analysis was performed among patients who underwent at least two assessments. RESULTS Of 2369 assessments included (1091 patients), 1196 (50.4%) were discordant. The US score both over- and under-estimated disease activity compared to the DAS28 score (23.5% and 26.8% respectively). Clinical and demographic factors significantly associated with discordant results were the individual components of the DAS28 score when US was used as the reference and age, disease duration, and the swollen joint count when the DAS28 was used as the reference. The main US-related factor associated with discordance was the presence of US tenosynovitis. In the longitudinal analysis of 1081 patients, the proportion of disagreements remained essentially unchanged. CONCLUSION Rates of disagreement between clinical and US assessments of disease activity among RA patients are high and remain high during follow-up, even when the US assessors were aware of the clinical examination findings. Both clinical- and ultrasound- related factors were associated with discordances.
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Affiliation(s)
| | | | | | | | - Laure Brulhart
- Hôpital neuchatelois, La chaud de fonds 2300, Switzerland
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Brulhart L, Alpízar-Rodríguez D, Nissen MS, Zufferey P, Ciubotariu I, Fleury G, Lazarou I, Gabay C, Finckh A. Ultrasound is not associated with the presence of systemic autoimmunity or symptoms in individuals at risk for rheumatoid arthritis. RMD Open 2019; 5:e000922. [PMID: 31565240 PMCID: PMC6744083 DOI: 10.1136/rmdopen-2019-000922] [Citation(s) in RCA: 10] [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: 02/06/2019] [Revised: 06/09/2019] [Accepted: 06/29/2019] [Indexed: 12/19/2022] Open
Abstract
Objective To identify whether musculoskeletal ultrasound (MSUS) abnormalities are associated with specific phases of rheumatoid arthritis (RA) development in individuals at risk of RA. Methods This is a prospective cohort study of individuals at risk of developing RA, namely first-degree relatives of patients with RA (RA-FDRs) without evidence of established rheumatic disease at inclusion. The inflammatory activity on MSUS was assessed according to a validated score (SONAR). Active MSUS was defined as a total B-mode score greater than 8, including at least one joint with significant synovitis (grade 2 or 3) or significant synovial hyperaemia (Doppler score greater than 1). We used logistic regression to analyse associations between MSUS findings and recognised preclinical phases of RA development, adjusting for other demographic and biological characteristics. Results A total of 273 RA-FDRs were analysed, of whom 23 (8%) were anticitrullinated protein autoantibodies-positive, 58 (21%) had unclassified arthritis and 96 (35%) had an active MSUS, which was only associated with unclassified arthritis (OR: 1.8, 95% CI 1.0 to 3.3). Conclusion In individuals at risk of RA, active MSUS was associated with the presence of unclassified arthritis, but not with any of the earlier described phases of RA development. These findings do not support an indiscriminate use of ultrasound in a screening strategy for preclinical RA.
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Affiliation(s)
- Laure Brulhart
- Rheumatology, Hopital neuchatelois La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland
| | | | - Michael S Nissen
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Ileana Ciubotariu
- Rheumatology Division, Hôpital du Sacré-Coeur de Montréal (HSCM), Montreal, Quebec, Canada
| | - Gregory Fleury
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Ilias Lazarou
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Cem Gabay
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
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Hajri R, Hajdu SD, Hügle T, Zufferey P, Guiral L, Becce F. Dual‐Energy Computed Tomography for the Noninvasive Diagnosis of Coexisting Gout and Calcium Pyrophosphate Deposition Disease. Arthritis Rheumatol 2019; 71:1392. [DOI: 10.1002/art.40907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Rami Hajri
- Lausanne University Hospital and University of Lausanne
| | | | - Thomas Hügle
- Lausanne University Hospital and University of Lausanne
| | | | | | - Fabio Becce
- Lausanne University Hospital and University of Lausanne Lausanne Switzerland
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Hebeisen M, Scherer A, Micheroli R, Nissen MJ, Tamborrini G, Möller B, Zufferey P, Exer P, Ciurea A. Comparison of drug survival on adalimumab, etanercept, golimumab and infliximab in patients with axial spondyloarthritis. PLoS One 2019; 14:e0216746. [PMID: 31145730 PMCID: PMC6542531 DOI: 10.1371/journal.pone.0216746] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/27/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To compare drug survival in patients with axial spondyloarthritis treated with different TNF inhibitors in standard dosage. Methods Patients fulfilling the Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis in the Swiss Clinical Quality Management cohort were included in this study if a first TNF inhibitor on standard dosage was started after recruitment and if a baseline visit was available. Drug maintenance up to drug discontinuation or dose escalation was compared between TNF inhibitors with multiple adjusted Cox proportional hazards models and multiple imputation for missing baseline covariate data. Results A total of 966 patients were included (adalimumab 344, etanercept 237, golimumab 214, infliximab 171). Patients on certolizumab (n = 18) were excluded. Patients starting golimumab had lower disease activity as well as better physical function and quality of life in comparison to patients starting another drug. A higher proportion of patients starting infliximab had a history of extra-articular manifestations. Drug dosage was more often escalated during follow-up in patients treated with infliximab than with subcutaneously administered agents. However, no significant differences in time up to drug discontinuation or dose escalation were observed in multiple adjusted analyses if treatment was initiated after 2009, when all 4 TNF inhibitors were available: hazard ratio for infliximab versus etanercept 1.16 (95% confidence interval 0.80; 1.67), p = 0.44, for golimumab versus etanercept 0.80 (0.58; 1.10), p = 0.17 and for adalimumab versus etanercept 0.93 (0.69; 1.26), p = 0.66. Conclusion In axial spondyloarthritis, drug survival with standard doses of different TNF inhibitors is comparable.
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Affiliation(s)
- Monika Hebeisen
- Department of Rheumatology, UniversitätsSpital Zürich, Zurich, Switzerland
- Statistics Group, SCQM Foundation, Zurich, Switzerland
| | - Almut Scherer
- Statistics Group, SCQM Foundation, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Michael J. Nissen
- Division of Rheumatology, University Hospital Geneva, Geneva, Switzerland
| | | | - Burkhard Möller
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern, Switzerland
| | - Pascal Zufferey
- Division of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Adrian Ciurea
- Department of Rheumatology, UniversitätsSpital Zürich, Zurich, Switzerland
- * E-mail:
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Zufferey P. [Rheumatoid arthritis : imagery what is new ?]. Rev Med Suisse 2019; 15:533-535. [PMID: 30860323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 2013, EULAR made a number of recommendations regarding the contribution of modern imaging : MRI and ultrasound as an aid to the diagnosis and for the monitoring of rheumatoid arthritis. This article aims to review if these recommendations are still relevant and if some questions have been resolved since then by new studies.
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Zufferey P, Valcov R, Thomas M, Dumusc A, Forien M, So A, Ottaviani S. Efficacy of anakinra in acute hydroxyapatite calcification-induced joint pain: A retrospective study of 23 cases. Joint Bone Spine 2019; 86:83-88. [DOI: 10.1016/j.jbspin.2018.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
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Filippou G, Scirè CA, Adinolfi A, Damjanov NS, Carrara G, Bruyn GAW, Cazenave T, D'Agostino MA, Delle Sedie A, Di Sabatino V, Diaz Cortes ME, Filippucci E, Gandjbakhch F, Gutierrez M, Maccarter DK, Micu M, Möller Parera I, Mouterde G, Mortada MA, Naredo E, Pineda C, Porta F, Reginato AM, Satulu I, Schmidt WA, Serban T, Terslev L, Vlad V, Vreju FA, Zufferey P, Bozios P, Toscano C, Picerno V, Iagnocco A. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis 2018. [PMID: 29535120 DOI: 10.1136/annrheumdis-2017-212542] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. METHODS A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. RESULTS The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification. CONCLUSIONS Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.
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Affiliation(s)
- Georgios Filippou
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy
| | - Carlo Alberto Scirè
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy
| | | | - Nemanja S Damjanov
- University of Belgrade, Belgrade, Serbia.,SIR Epidemiology Unit, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Mihaela Micu
- Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
| | | | - Gaël Mouterde
- Rheumatology department, Lapeyronie Hospital & EA 2415, Montpellier, France
| | - Mohamed Atia Mortada
- Department of Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Carlos Pineda
- Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - Anthony M Reginato
- Division of Rheumatology, The Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Iulia Satulu
- Department of Rheumatology, Internal Medicine Clinic, Kalmar County Hospital, Kalmar, Sweden
| | | | | | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | | | - Panagiotis Bozios
- Department of Rheumatology, University of Ioannina, Ioannina, Greece
| | | | - Valentina Picerno
- Rheumatology Department of Lucania, "San Carlo" Hospital of Potenza and "Madonna delle Grazie" Hospital of Matera, Potenza, Italy
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Hebeisen M, Neuenschwander R, Scherer A, Exer P, Weber U, Tamborrini G, Micheroli R, Wildi LM, Zufferey P, Nissen MJ, Villiger PM, Bernhard J, Finckh A, van der Horst-Bruinsma IE, Sieper J, Landewé R, van der Heijde D, Ciurea A. Response to Tumor Necrosis Factor Inhibition in Male and Female Patients with Ankylosing Spondylitis: Data from a Swiss Cohort. J Rheumatol 2018; 45:506-512. [PMID: 29449504 DOI: 10.3899/jrheum.170166] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 11/06/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS). METHODS A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response. RESULTS Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37-1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32-1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16-0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03-0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed. CONCLUSION In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.
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Affiliation(s)
- Monika Hebeisen
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Regula Neuenschwander
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Almut Scherer
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Pascale Exer
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Ulrich Weber
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Giorgio Tamborrini
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Raphael Micheroli
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Lukas M Wildi
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Pascal Zufferey
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Michael J Nissen
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Peter M Villiger
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Jürg Bernhard
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Axel Finckh
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Irene E van der Horst-Bruinsma
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Joachim Sieper
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Robert Landewé
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Désirée van der Heijde
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Adrian Ciurea
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. .,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital.
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Zufferey P, Scherer A, Nissen MJ, Ciurea A, Tamborrini G, Brulhart L, Blumhardt S, Toniolo M, Möller B, Ziswiler HR. Can Ultrasound Be Used to Predict Loss of Remission in Patients with RA in a Real-life Setting? A Multicenter Cohort Study. J Rheumatol 2018; 45:887-894. [PMID: 29335344 DOI: 10.3899/jrheum.161193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Several studies have suggested that patients with rheumatoid arthritis (RA) presenting with ultrasound (US) synovitis despite clinical remission have more subsequent flares than those who show both clinical and sonographic remission. The objective of our study was to investigate whether these results could be translated to a real-life setting. METHODS We compared the time from the first US performed in clinical remission to loss of remission (defined by a DAS28 > 2.6 or the need for stepping up treatment with disease-modifying antirheumatic drugs) within the Swiss Clinical Quality Management cohort of patients with RA, and we adjusted for relevant confounders. Analyses were repeated for different definitions of US-detected synovitis (US+) using greyscale, Doppler, and combined modes based on previously validated scores, and they were adjusted for relevant confounders. RESULTS There were 318 RA patients with 378 remission phases included. Loss of clinical remission was observed in 60% of remission phases. Residual US synovitis was associated with a shorter duration of clinical remission (median 2-5 mos) and a moderately increased hazard ratio (HR) for loss of remission (HR 1.2-1.5), with the highest HR for the combined US score. The association between US+ and loss of remission was strongest when the US measurement had taken place early in remission (shorter median duration of 6-20 mos) and when followup time was limited to the first 3 or 6 months (most HR between 2-4). CONCLUSION US-detected synovitis, particularly when US is performed early in clinical remission, has a moderate predictive power for loss of remission in a real-life setting.
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Affiliation(s)
- Pascal Zufferey
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland. .,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma.
| | - Almut Scherer
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
| | - Michael J Nissen
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
| | - Adrian Ciurea
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
| | - Giorgio Tamborrini
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
| | - Laure Brulhart
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
| | - Sandra Blumhardt
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
| | - Martin Toniolo
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
| | - Burkhard Möller
- From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.,P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma
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Safran A, Perreau M, So A, Zufferey P. High titers of ADAbs in rheumatic disease patients undergoing anti-TNF therapy is not associated with lupus-like autoimmunity. Lupus 2017. [DOI: 10.1177/0961203317713145] [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: 11/16/2022]
Affiliation(s)
- A Safran
- Service of Rheumatology (RHU/DAL), Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - M Perreau
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - A So
- Service of Rheumatology (RHU/DAL), Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - P Zufferey
- Service of Rheumatology (RHU/DAL), Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Molnar C, Scherer A, Baraliakos X, de Hooge M, Micheroli R, Exer P, Kissling RO, Tamborrini G, Wildi LM, Nissen MJ, Zufferey P, Bernhard J, Weber U, Landewé RBM, van der Heijde D, Ciurea A. TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis 2017; 77:63-69. [PMID: 28939631 PMCID: PMC5754737 DOI: 10.1136/annrheumdis-2017-211544] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [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: 03/28/2017] [Revised: 07/16/2017] [Accepted: 09/08/2017] [Indexed: 01/02/2023]
Abstract
Objectives To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS). Methods Patients with AS in the Swiss Clinical Quality Management cohort with up to 10 years of follow-up and radiographic assessments every 2 years were included. Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. The relationship between TNFi use before a 2-year radiographic interval and progression within the interval was investigated using binomial generalised estimating equation models with adjustment for potential confounding and multiple imputation of missing values. Ankylosing Spondylitis Disease Activity Score (ASDAS) was regarded as mediating the effect of TNFi on progression and added to the model in a sensitivity analysis. Results A total of 432 patients with AS contributed to data for 616 radiographic intervals. Radiographic progression was defined as an increase in ≥2 mSASSS units in 2 years. Mean (SD) mSASSS increase was 0.9 (2.6) units in 2 years. Prior use of TNFi reduced the odds of progression by 50% (OR 0.50, 95% CI 0.28 to 0.88) in the multivariable analysis. While no direct effect of TNFi on progression was present in an analysis including time-varying ASDAS (OR 0.61, 95% CI 0.34 to 1.08), the indirect effect, via a reduction in ASDAS, was statistically significant (OR 0.75, 95% CI 0.59 to 0.97). Conclusion TNFis are associated with a reduction of spinal radiographic progression in patients with AS. This effect seems mediated through the inhibiting effect of TNFi on disease activity.
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Affiliation(s)
- Christoph Molnar
- Stastistics Group, Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Almut Scherer
- Stastistics Group, Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | | | - Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Pascale Exer
- Private Practice, Praxis Rheuma-Basel, Basel, Switzerland
| | - Rudolf O Kissling
- Department of Rheumatology, Balgrist University Hospital, Zurich, Switzerland
| | | | - Lukas M Wildi
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Michael J Nissen
- Department of Rheumatology, University Hospital, Geneva, Switzerland
| | | | - Jürg Bernhard
- Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland
| | - Ulrich Weber
- King Christian 10th Hospital for Rheumatic Diseases, Grasten, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Robert B M Landewé
- Department of Clinical Immunology & Rheumatology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology, Zuyderland Hospital, Heerlen, The Netherlands
| | | | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Laporte S, Chapelle C, Bertoletti L, Ollier E, Zufferey P, Lega JC, Merah A, Décousus H, Schulman S, Meyer G, Cucherat M, Mismetti P. Assessment of clinically relevant bleeding as a surrogate outcome for major bleeding: validation by meta-analysis of randomized controlled trials. J Thromb Haemost 2017; 15:1547-1558. [PMID: 28544422 DOI: 10.1111/jth.13740] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Indexed: 01/27/2023]
Abstract
Essentials Surrogacy of clinically relevant bleeding (CRB) for major bleeding has never been validated. Our meta-analysis evaluated CRB surrogacy in trials of new versus traditional anticoagulants. Surrogacy was not validated in orthopedic surgery, venous thromboembolism or atrial fibrillation The difficulty in demonstrating the surrogacy may reflect a lack of homogeneity in its definition SUMMARY: Background Clinically relevant bleeding (CRB), comprising major bleeding and clinically relevant non-major bleeding, has been used as a surrogate for major bleeding in most anticoagulant trials. The validity of this surrogate to estimate trade-off between thrombotic and bleeding events in clinical trials was never assessed. Methods We systematically reviewed randomized phase III trials comparing new anticoagulants with the standard of care for venous thromboembolism prevention following major orthopedic surgery, venous thromboembolism (VTE) treatment, or stroke and systemic embolism prevention in atrial fibrillation (AF), and reporting both major bleeding and CRB rates. The validity of CRB as a surrogate for major bleeding was assessed according to the strength of the association between the relative risks of major bleeding and CRB, measured by the use of R2trial and its 95% confidence interval (CI). Results In the postoperative prophylactic setting (13 studies), major bleeding and CRB rates were 1.12% and 3.56%, respectively, and R2trial was 0.69 (95% CI 0.34-0.93). For acute VTE studies (n = 12), major bleeding and CRB rates were 1.87% and 9.07%; the corresponding R2trial values were 0.28 (95% CI 0.01-0.80) and 0.68 (95% CI 0.09-1.00) when only double-blind studies were considered (n = 7). For AF studies (n = 7; 22 strata), major bleeding and CRB rates were 4.82% and 15.3%, and R2trial was 0.59 (95% CI 0.15-0.82). Conclusion Despite an apparent correlation between CRB and major bleeding in major orthopedic surgery, AF, and double-blind acute VTE studies, the wide CIs suggest that CRB might not be an acceptable surrogate outcome in any of these settings.
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Affiliation(s)
- S Laporte
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - C Chapelle
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - L Bertoletti
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - E Ollier
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Laboratoire de Pharmacologie, Toxicologie et Gaz du sang, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - P Zufferey
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Unité de Recherche Clinique Innovation, Pharmacologie, and Service d'Anesthésie Réanimation, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - J-C Lega
- Département de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, CHU Lyon, Pierre-Bénite, France
- UMR CNRS 5558 Evaluation et Modelisation des Effets Therapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - A Merah
- Inserm CIE1408, F-CRIN INNOVTE Network, Paris, France
| | - H Décousus
- Inserm CIE1408, F-CRIN INNOVTE Network, Paris, France
| | - S Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - G Meyer
- Hopital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRs 970, CIE1418, F-CRIN INNOVTE Network, Paris, France
| | - M Cucherat
- UMR CNRS 5558 Evaluation et Modelisation des Effets Therapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - P Mismetti
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
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Micheroli R, Hebeisen M, Wildi LM, Exer P, Tamborrini G, Bernhard J, Möller B, Zufferey P, Nissen MJ, Scherer A, Ciurea A. Impact of obesity on the response to tumor necrosis factor inhibitors in axial spondyloarthritis. Arthritis Res Ther 2017; 19:164. [PMID: 28724442 PMCID: PMC5518107 DOI: 10.1186/s13075-017-1372-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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: 03/27/2017] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the impact of obesity on the response to tumor necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA). The aim of our study was to investigate the impact of different body mass index (BMI) categories on TNFi response in a large cohort of patients with axSpA. METHODS Patients with axSpA within the Swiss Clinical Quality Management (SCQM) program were included in the current study if they fulfilled the Assessment in Spondyloarthritis International Society (ASAS) criteria for axSpA, started a first TNFi after recruitment, and had available BMI data as well as a baseline and follow-up visit at 1 year (±6 months). Patients were categorized according to BMI: normal (BMI 18.5 to <25), overweight (BMI 25-30), and obese (BMI >30). We evaluated the proportion of patients achieving the 40% improvement in ASAS criteria (ASAS40), as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued the TNFi were considered nonresponders. We controlled for age, sex, HLA-B27, axSpA type, BASDAI, BASMI, elevated C-reactive protein (CRP), current smoking, enthesitis, physical exercise, and co-medication with disease-modifying antirheumatic drugs, as well as with nonsteroidal anti-inflammatory drugs in multiple adjusted logistic regression analyses. RESULTS A total of 624 axSpA patients starting a first TNFi were considered in the current study (332 patients of normal weight, 204 patients with overweight, and 88 obese patients). Obese individuals were older, had higher BASDAI levels, and had a more important impairment of physical function in comparison to patients of normal weight, while ASDAS and CRP levels were comparable between the three BMI groups. An ASAS40 response was reached by 44%, 34%, and 29% of patients of normal weight, overweight, and obesity, respectively (overall p = 0.02). Significantly lower odds ratios (ORs) for achieving ASAS40 response were found in adjusted analyses in obese patients versus patients with normal BMI (OR 0.27, 95% confidence interval (CI) 0.09-0.70). The respective adjusted ASAS40 OR in overweight versus normal weight patients was 0.62 (95% CI 0.24-1.14). Comparable results were found for the other outcomes assessed. CONCLUSIONS Obesity is associated with significantly lower response rates to TNFi in patients with axSpA.
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Affiliation(s)
- Raphael Micheroli
- Department of Rheumatology, Zurich University Hospital, Gloriastrasse 25, CH-8091, Zurich, Switzerland
| | - Monika Hebeisen
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Lukas M Wildi
- Department of Rheumatology, Zurich University Hospital, Gloriastrasse 25, CH-8091, Zurich, Switzerland
| | | | | | - Jürg Bernhard
- Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland
| | - Burkhard Möller
- Department of Rheumatology, Allergology and Clinical Immunology, Inselspital, Bern, Switzerland
| | | | - Michael J Nissen
- Department of Rheumatology, University Hospital, Geneva, Switzerland
| | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, Gloriastrasse 25, CH-8091, Zurich, Switzerland.
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Alpizar-Rodriguez D, Mueller RB, Möller B, Dudler J, Ciurea A, Zufferey P, Kyburz D, Walker UA, von Mühlenen I, Roux-Lombard P, Mahler M, Lamacchia C, Courvoisier DS, Gabay C, Finckh A. Female hormonal factors and the development of anti-citrullinated protein antibodies in women at risk of rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:1579-1585. [DOI: 10.1093/rheumatology/kex239] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 12/13/2022] Open
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Zufferey P, Rebell C, Benaim C, Ziswiler HR, Dumusc A, So A. Ultrasound can be useful to predict an evolution towards rheumatoid arthritis in patients with inflammatory polyarthralgia without anticitrullinated antibodies. Joint Bone Spine 2017; 84:299-303. [DOI: 10.1016/j.jbspin.2016.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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Zufferey P. [Drug-induced iatrogenic arthropathies]. Rev Med Suisse 2017; 13:559-564. [PMID: 28718589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Arthropathies induced by drugs, especially arthralgias, are very frequently reported in pharmacology. The major difficulty often consists in confirming the accountability of the drug in the occurrence of the symptoms. Stopping the drug when it really responsible of the arthralgia is then likely to lead to the disappearance of the symptoms. The aim of this article is to review some of classical known induced arthropathies and some innovations by describing the clinical characteristics as well as the mechanisms linking the drug to the arthropathies when these have been clarified.
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Affiliation(s)
- Pascal Zufferey
- Service de rhumatologie et centre des maladies osseuses, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
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32
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Filippou G, Scirè CA, Damjanov N, Adinolfi A, Carrara G, Picerno V, Toscano C, Bruyn GA, D'Agostino MA, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Möller I, Naredo E, Pineda C, Porta F, Schmidt WA, Terslev L, Vlad V, Zufferey P, Iagnocco A. Definition and Reliability Assessment of Elementary Ultrasonographic Findings in Calcium Pyrophosphate Deposition Disease: A Study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. J Rheumatol 2017; 44:1744-1749. [PMID: 28250136 DOI: 10.3899/jrheum.161057] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To define the ultrasonographic characteristics of calcium pyrophosphate crystal (CPP) deposits in joints and periarticular tissues and to evaluate the intra- and interobserver reliability of expert ultrasonographers in the assessment of CPP deposition disease (CPPD) according to the new definitions. METHODS After a systematic literature review, a Delphi survey was circulated among a group of expert ultrasonographers, who were members of the CPPD Ultrasound (US) Outcome Measures in Rheumatology (OMERACT) subtask force, to obtain definitions of the US characteristics of CPPD at the level of fibrocartilage (FC), hyaline cartilage (HC), tendon, and synovial fluid (SF). Subsequently, the reliability of US in assessing CPPD at knee and wrist levels according to the agreed definitions was tested in static images and in patients with CPPD. Cohen's κ was used for statistical analysis. RESULTS HC and FC of the knee yielded the highest interobserver κ values among all the structures examined, in both the Web-based (0.73 for HC and 0.58 for FC) and patient-based exercises (0.55 for the HC and 0.64 for the FC). Kappa values for the other structures were lower, ranging from 0.28 in tendons to 0.50 in SF in the static exercise and from 0.09 (proximal patellar tendon) to 0.27 (triangular FC of the wrist) in the patient-based exercise. CONCLUSION The new OMERACT definitions for the US identification of CPPD proved to be reliable at the level of the HC and FC of the knee. Further studies are needed to better define the US characteristics of CPPD and optimize the scanning technique in other anatomical sites.
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Affiliation(s)
- Georgios Filippou
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland. .,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino.
| | - Carlo A Scirè
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Nemanja Damjanov
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Antonella Adinolfi
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Greta Carrara
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Valentina Picerno
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Carmela Toscano
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - George A Bruyn
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Maria Antonietta D'Agostino
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Andrea Delle Sedie
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Emilio Filippucci
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Marwin Gutierrez
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Mihaela Micu
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Ingrid Möller
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Esperanza Naredo
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Carlos Pineda
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Francesco Porta
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Wolfgang A Schmidt
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Lene Terslev
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Violeta Vlad
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Pascal Zufferey
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
| | - Annamaria Iagnocco
- From the University of Siena, Siena; Italian Society for Rheumatology (SIR) Epidemiology Unit, Milan; University of Pisa, Pisa; Università Politecnica delle Marche, Jesi; Internal Medicine Division, San Jacopo Hospital, Pistoia; Università degli Studi di Torino, Turin, Italy; University of Belgrade, Belgrade, Serbia; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Rehabilitation Clinical Hospital, Cluj-Napoca; Sf. Maria Hospital, Bucharest, Romania; Instituto Poal, University of Barcelona, Barcelona; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University, Madrid, Spain; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch Berlin, Berlin, Germany; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Lausanne University Hospital, Lausanne, Switzerland.,G. Filippou, MD, PhD, University of Siena; C.A. Scirè, MD, Professor of Rheumatology, SIR Epidemiology Unit; N. Damjanov, MD, PhD, Professor of Rheumatology, University of Belgrade; A. Adinolfi, MD, University of Siena; G. Carrara, MSc, SIR Epidemiology Unit; V. Picerno, MD, University of Siena; C. Toscano, MD, University of Siena; G.A. Bruyn, MD, Professor of Rheumatology, Department of Rheumatology, MC Groep; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; A. Delle Sedie, MD, University of Pisa; E. Filippucci, MD, PhD, Senior Lecturer in Rheumatology, Università Politecnica delle Marche; M. Gutierrez, MD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; M. Micu, MD, Rehabilitation Clinical Hospital; I. Möller, MD, PhD, Instituto Poal, University of Barcelona; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jimenez Deaz and Autónoma University; C. Pineda, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra; F. Porta, MD, Internal Medicine Division, San Jacopo Hospital; W.A. Schmidt, MD, Professor of Charité University Medicine, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; V. Vlad, MD, PhD, Sf. Maria Hospital; P. Zufferey, MD, Lausanne University Hospital; A. Iagnocco, MD, Professor of Rheumatology, Università degli Studi di Torino
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Hardy S, Hashemi K, Catanese M, Candil M, Zufferey P, Gabison E, Guex-Crosier Y. Necrotising Scleritis and Peripheral Ulcerative Keratitis Associated with Rheumatoid Arthritis Treated with Rituximab. Klin Monbl Augenheilkd 2017; 234:567-570. [DOI: 10.1055/s-0042-121315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Hardy
- Jules Gonin Eye Hospital, Ophthalmology Department, Lausanne University Hospital, Jules Gonin Eye Hospital chairman ad interim: Prof. Dr. med Thomas Wolfensberger, FAA, Lausanne Switzerland
| | - K. Hashemi
- Jules Gonin Eye Hospital, Ophthalmology Department, Lausanne University Hospital, Jules Gonin Eye Hospital chairman ad interim: Prof. Dr. med Thomas Wolfensberger, FAA, Lausanne Switzerland
| | - M. Catanese
- Jules Gonin Eye Hospital, Ophthalmology Department, Lausanne University Hospital, Jules Gonin Eye Hospital chairman ad interim: Prof. Dr. med Thomas Wolfensberger, FAA, Lausanne Switzerland
| | - M. Candil
- CHUV Centre Hospitalier Universitaire Vaudois (CHUV), Department of Rheumatology, Département de lʼappareil locomoteur, CHUV chairman: Prof. Dr. med Alexander So, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - P. Zufferey
- CHUV Centre Hospitalier Universitaire Vaudois (CHUV), Department of Rheumatology, Département de lʼappareil locomoteur, CHUV chairman: Prof. Dr. med Alexander So, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - E. Gabison
- Jules Gonin Eye Hospital, Ophthalmology Department, Lausanne University Hospital, Jules Gonin Eye Hospital chairman ad interim: Prof. Dr. med Thomas Wolfensberger, FAA, Lausanne Switzerland
| | - Y. Guex-Crosier
- Jules Gonin Eye Hospital, Ophthalmology Department, Lausanne University Hospital, Jules Gonin Eye Hospital chairman ad interim: Prof. Dr. med Thomas Wolfensberger, FAA, Lausanne Switzerland
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Alpizar-Rodriguez D, Brulhart L, Mueller RB, Möller B, Dudler J, Ciurea A, Walker UA, Von Mühlenen I, Kyburz D, Zufferey P, Mahler M, Bas S, Gascon D, Lamacchia C, Roux-Lombard P, Lauper K, Nissen MJ, Courvoisier DS, Gabay C, Finckh A. The prevalence of anticitrullinated protein antibodies increases with age in healthy individuals at risk for rheumatoid arthritis. Clin Rheumatol 2017; 36:677-682. [DOI: 10.1007/s10067-017-3547-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/21/2016] [Accepted: 01/14/2017] [Indexed: 12/20/2022]
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Candil M, Zufferey P. [Anti-IL-6 : new therapeutic trends]. Rev Med Suisse 2017; 13:105-109. [PMID: 28703549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The anti-IL-6 tocilizumab is a recognized treatment in rheumatoid arthritis and in systemic juvenile idiopathic arthritis. Almost ten years after its first use, there is more information about its security profile and its indication should be extended to other systemic inflammatory diseases, such as the giant cell arteritis. New molecules targetting the IL-6 pathway are under validation : sarilumab, sirukumab and olokizumab. Here is a brief state of the future outlook and trends of this therapeutic class.
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Affiliation(s)
- Margarita Candil
- Service de rhumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Pascal Zufferey
- Service de rhumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
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Abstract
In this article, the authors consider the manifestations of intraarticular and periarticular crystal deposits. Most cases of crystal deposits are asymptomatic and represent incidental findings at imaging. In symptomatic arthropathies, imaging can play an important role in the diagnosis and assessment of disease progression and the extent of crystal deposits. Conventional radiography is the most common imaging modality. But ultrasound, conventional computerized tomography (CT), dual-energy CT, and MRI play an increasing role. The authors review typical radiographic features of crystal-induced arthropathies and findings that help to differentiate them. The authors also emphasize the increasing role of complementary imaging techniques.
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Affiliation(s)
- Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland.
| | - Pascal Zufferey
- Department of Rheumatology, Lausanne University Hospital, Av Pierre Decker 5, Lausanne 1011, Switzerland
| | - Jacques Malghem
- Department of Radiology, Saint Luc University Hospital, UC Louvain, Av Hippocrate 10, Brussels 1200, Belgium
| | - Alexander So
- Department of Rheumatology, Lausanne University Hospital, Av Pierre Decker 5, Lausanne 1011, Switzerland
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Adinolfi A, Filippou G, Scirè C, Damjanov N, Carrara G, Picerno V, Toscano C, Bruyn G, D'Agostino M, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Moller I, Naredo E, Pascal Z, Pineda C, Porta F, Schmidt W, Terslev L, Vlad V, Zufferey P, Frediani B, Iagnocco A. FRI0517 The Omeract Ultrasonographic Criteria for Elementary Lesions in Calcium Pyrophosphate Deposition Disease: Results of A Delphi Process by Ultrasound Working Group. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5406] [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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Alpizar-Rodriguez D, Brulhart L, Müller R, Möller B, Dudler J, Ciurea A, Walker U, Von Mühlenen I, Kyburz D, Zufferey P, Mahler M, Bas S, Gascon D, Lamacchia C, Roux-Lombard P, Lauper K, Nissen M, Courvoisier D, Gabay C, Finckh A. FRI0071 Predictors for The Development of anti-Citrullinated Protein Antibodies in Individuals Genetically at Risk for Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2652] [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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Galeazzi M, Voll R, Sebastiani G, Bazzichi L, Viapiana O, Dudler J, Sarzi-Puttini P, Selvi E, Iuliano A, Pedretti M, Giovannoni L, Bindi I, Bettini C, Ravenni N, Wilton J, Zufferey P, Ferraccioli G, Caporali R, Specker C, Wollenhaupt J, Neri D. AB0364 A Novel Approach for Rheumatoid Arthritis: Results of The Ongoing Clinical Trials with The Fully Human Immunocytokine Dekavil (F8-IL10). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4077] [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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Brulhart L, Alpizar-Rodriguez D, Zufferey P, Bas S, Gascon D, Lamacchia C, Roux-Lombard P, Ciubotariu E, Nissen M, Gabay C, Finckh A. SAT0072 Ultrasound Is Associated with Late Phases Preceding The Clinical Onset of Rheumatoid Arthritis in Individuals Genetically at Risk. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6084] [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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Alpizar-Rodriguez D, Müller R, Möller B, Dudler J, Ciurea A, Von Mühlenen I, Kyburz D, Zufferey P, Bas S, Gascon D, Lamacchia C, Roux-Lombard P, Lauper K, Courvoisier D, Gabay C, Finckh A. AB0178 Menopause Is A Predictor for The Development of Anti-Citrullinated Protein Antibodies in Women at Risk for Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2679] [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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Möller B, Zufferey P, Brulhart L, Tamborrini G, Nydegger A, Dan D, Grobety V, Nissen M, Staerkle A, Finckh A, Aubry-Rozier B, Ziswiler HR, Andor M, Atkinson A, Scherer A. FRI0522 Ultrasound-Detected Synovitis May Predict Radiographic Damage Progression in Rheumatoid Arthritis over The Next Five Years – A Prospective Cohort Study Nested in The Swiss Quality Management Program (SCQM). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2245] [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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Filippou G, Scirè C, Damjanov N, Adinolfi A, Carrara G, Picerno V, Toscano C, Bruyn G, D'Agostino M, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Moller I, Naredo E, Pineda C, Porta F, Schmidt W, Terslev L, Vlad V, Zufferey P, Frediani B, Iagnocco A. OP0122 Inter-Reader and Intra-Reader Reliability of The New Omeract Ultrasonographic Criteria for The Diagnosis of CPPD. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5183] [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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Nissen M, Lamacchia C, Bas S, Roux-Lombard P, Courvoisier D, Kyburz D, Moeller B, Ciurea A, Mueller R, Zufferey P, Bentow C, Finckh A, Mahler M, Gabay C. FRI0088 Comparison of Rheumatoid Factor, Anti-Citrullinated Protein Antibodies, Anti-Carbamylated Protein Antibody, Anti-Peptidyl Arginine Deiminase Type-3 Antibodies and Calprotectin in Patients with Rheumatoid Arthritis and Spondyloarthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3893] [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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Omoumi P, Larbi A, Zufferey P, So A, Becce F, Vande Berg B, Malghem J. [MRI of axial spondyloarthritis: diagnostic role and pitfalls]. Rev Med Suisse 2016; 12:495-502. [PMID: 27089638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
MRI has become a major tool for the diagnosis of axial spondyloarthritis and provides objective signs based on which therapy can be initiated. In clinical practice, ASAS classification criteria are often applied for the diagnosis of spondyloarthritis at a pre-radiographic stage. However, MRI signs of spondyloarthritis as stated in ASAS criteria lack specificity, and can be encountered in a wide array of diagnoses, in particular degenerative and mechanical conditions. In this article, we will review the role of MRI in the diagnosis and classification of spondyloarthritis, general technical considerations, the elementary MRI signs of axial spondyloarthritis, as well as diagnostic pitfalls. We also provide a practical approach on how to avoid overdiagnosis of spondyloarthritis and to improve the diagnostic value of MRI.
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Zufferey P. [New synthetic and biologic treatments for spondylarthritis]. Rev Med Suisse 2016; 12:512-516. [PMID: 27089641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The only biological treatments recognized and reimbursed for spondylarthritis in Switzerland are anti TNF. Other effective agents in rheumatoid arthritis were found to be of little use in this indication. Fortunately, in recent years appeared biological molecules blocking cytokines involved in new pathways of inflammation in particular that of IL7. They have been very effective against psoriasis and have a high potential in psoriatic arthritis and spondylarthritis. In parallel, synthetic small molecules capable of modulating the production of intracellular cytokines begin to be marketed. They also are potentially active in the same rheumatic diseases. The purpose of this article is to review these new drugs, in particular to review the progress of their development and commercialization status.
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Chevalier-Ruggeri P, Zufferey P. [Intra-articular infiltrations in rheumatology: update]. Rev Med Suisse 2016; 12:90-94. [PMID: 26946713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intra-articular treatments are very useful in the daily practice of rheumatology, although their survival in the joint cavity is short and their mode of action still widely misunderstood. Corticosteroids were first used in fifty's, and are still the most widely used, despite potential local and systemic side effects. In recentyears, other molecules have been developed, especially in the treatment of osteoarthritis, but their effectiveness is controversial. Therapeutic trials were conducted with biological treatments in inflammatory arthritis, without success so far In the area of biotechnology, molecules to increase the survival of drugs into the joint are in preparation.
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Cunningham S, Maulucci F, Zufferey P, Ribi C, Maillard MH. [Whipple's disease, when to think about it?]. Rev Med Suisse 2015; 11:1582-1586. [PMID: 26502617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Whipple's disease is a chronic, systemic, bacterial infection caused by Tropheryma whipplei. Its cardinal symptoms include intermittent and recurrent arthralgia or arthritis together with chronic diarrhoea, abdominal pain and weight loss. It may mimick many chronic inflammatory diseases, and the diagnosis remains a challenge. Salivary and faecal quantitative PCR for T. whipplei should be ensued, if positive, by an upper endoscopy for duodenal biopsies. The treatment consists of a combination of oral doxycycline and hydroxychloroquine for 12 months followed by life-long doxycycline. Whipple's disease, although rare, is an entity that should be considered regularly, as its progression may be fatal if left untreated.
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Affiliation(s)
- Pascal Zufferey
- Service de rhumatologie, département de l'appareil locomoteur and
| | - Mathieu Perreau
- Service d'immunologie, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - Alexander So
- Service de rhumatologie, département de l'appareil locomoteur and
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Zufferey P, Pascal Z, Valcov R, Fabreguet I, Dumusc A, Omoumi P, So A. A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis. Arthritis Res Ther 2015; 17:188. [PMID: 26198435 PMCID: PMC4511437 DOI: 10.1186/s13075-015-0701-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/29/2015] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The performance of ultrasound (US) in the diagnosis of acute gouty (MSU) arthritis and calcium pyrophosphate (CPP) arthritis is not yet well defined. Most studies evaluated US as the basis for diagnosing crystal arthritis in already diagnosed cases of gout and few prospective studies have been performed. METHODS One hundred nine consecutive patients who presented an acute arthritis of suspected microcrystalline arthritis were prospectively included. All underwent an US of the symptomatic joints(s) and of knees, ankles and 1(st) metatarsopalangeal (MTP) joints by a rheumatologist "blinded" to the clinical history. 92 also had standard X-rays. Crystal identification was the gold standard. RESULTS Fifty-one patients had MSU, 28 CPP and 9 had both crystals by microscopic analysis. No crystals were detected in 21. One had septic arthritis. Based on US signs in the symptomatic joint, the sensitivity of US for both gout and CPP was low (60% for both). In gout, the presence of US signs in the symptomatic joint was highly predictive of the diagnosis (PPV = 92%). When US diagnosis was based on an examination of multiple joints, the sensitivity for both gout and CPP rose significantly but the specificity and the PPV decreased. In the absence of US signs in all the joints studied, CPP arthritis was unlikely (NPV = 87%) particularly in patients with no previous crisis (NPV = 94%). X-ray of the symptomatic joints was confirmed to be not useful in diagnosing gout and was equally sensitive or specific as US in CPP arthritis. CONCLUSIONS Arthrocenthesis remains the key investigation for the diagnosis of microcrystalline acute arthritis. Although US can help in the diagnostic process, its diagnostic performance is only moderate. US should not be limited to the symptomatic joint. Examination of multiple joints gives a better diagnostic sensitivity but lower specificity.
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Affiliation(s)
| | - Zufferey Pascal
- Department of Rheumatology, Département de l'appareil locomoteur, Lausanne University Hospital (CHUV), Av Pierre Decker 5, 1011, Lausanne, Switzerland.
| | - Roxana Valcov
- Department of Rheumatology, Département de l'appareil locomoteur, Lausanne University Hospital (CHUV), Av Pierre Decker 5, 1011, Lausanne, Switzerland.
| | - Isabelle Fabreguet
- Department of Rheumatology, Département de l'appareil locomoteur, Lausanne University Hospital (CHUV), Av Pierre Decker 5, 1011, Lausanne, Switzerland.
| | - Alexandre Dumusc
- Department of Rheumatology, Département de l'appareil locomoteur, Lausanne University Hospital (CHUV), Av Pierre Decker 5, 1011, Lausanne, Switzerland.
| | - Patrick Omoumi
- Departement de l'appareil locomoteur, Lausanne University Hospital (CHUV), Av Pierre Decker 5, 1011, Lausanne, Switzerland.
| | - Alexander So
- Department of Rheumatology, Département de l'appareil locomoteur, Lausanne University Hospital (CHUV), Av Pierre Decker 5, 1011, Lausanne, Switzerland.
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