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Geraldes R, Santos M, Ponte C, Craven A, Barra L, Robson JC, Hammam N, Springer J, Henes J, Hocevar A, Putaala J, Santos E, Rajasekhar L, Daikeler T, Karadag O, Costa A, Khalidi N, Pagnoux C, Canhão P, Melo TPE, Fonseca AC, Ferro JM, Fonseca JE, Suppiah R, Watts RA, Grayson P, Merkel PA, Luqmani RA. Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: a multicentric observational study. J Neurol 2024:10.1007/s00415-024-12251-1. [PMID: 38472397 DOI: 10.1007/s00415-024-12251-1] [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: 11/03/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV. METHODS Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed. RESULTS The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00-4.06): 102 (2.13% 95% CI 1.73-2.56) with stroke and 81 (1.68% 95% CI 1.33-2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet's disease (9.5%, 95% CI 5.79-14.37), polyarteritis nodosa (6.2%, 95% CI 3.25-10.61), and Takayasu's arteritis (6.0%, 95% CI 4.30-8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09-3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20-3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05-9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01-2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period. CONCLUSION CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet's. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence.
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Affiliation(s)
- Ruth Geraldes
- Neurology Department, Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK.
- Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK.
| | - Monica Santos
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Anthea Craven
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Lillian Barra
- Lawson Health Research Institute, London, ON, Canada
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Jason Springer
- University of Kansas Medical Centre Institute, Lawrence, Kansas, KS, USA
| | - Jöerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-Inflammatory Diseases, Department of Internal Medicine II (Oncology, Haematology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | | | - Jukka Putaala
- Helsinki University Central Hospital, Helsinki, Finland
| | - Ernestina Santos
- Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - Thomas Daikeler
- Department of Rheumatology and Clinical Research, University Hospital, Basel, Switzerland
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andreia Costa
- Centro Hospitalar Universitário de São João, Porto, Portugal
- Neuroscience and Mental Health Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Nader Khalidi
- Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada
| | | | - Patrícia Canhão
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Teresa Pinho E Melo
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - José M Ferro
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | | | | | - Peter Grayson
- National Institutes of Health, NIAMS Vasculitis Translational Research Program, Bethesda, USA
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, USA
- Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK
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Ponte C, Grayson PC, Gribbons KB, Robson JC, Suppiah R, Judge A, Watts RA, Luqmani RA, Merkel PA. Reply. Arthritis Rheumatol 2023; 75:1077-1080. [PMID: 36662483 DOI: 10.1002/art.42448] [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] [Received: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit Instituto de Medicina Molecular, Faculdade de Medicina Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Peter C Grayson
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, Maryland
| | | | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England and Rheumatology Department University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford Oxford, UK, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol and NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
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Ponte C, Grayson PC, Robson JC, Suppiah R, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Watts RA, Merkel PA, Luqmani RA. 2022 American College of Rheumatology/EULAR Classification Criteria for Giant Cell Arteritis. Arthritis Rheumatol 2022; 74:1881-1889. [PMID: 36350123 DOI: 10.1002/art.42325] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To develop and validate updated classification criteria for giant cell arteritis (GCA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate items, 2) prospective collection of candidate items present at the time of diagnosis, 3) expert panel review of cases, 4) data-driven reduction of candidate items, 5) derivation of a points-based risk classification score in a development data set, and 6) validation in an independent data set. RESULTS The development data set consisted of 518 cases of GCA and 536 comparators. The validation data set consisted of 238 cases of GCA and 213 comparators. Age ≥50 years at diagnosis was an absolute requirement for classification. The final criteria items and weights were as follows: positive temporal artery biopsy or temporal artery halo sign on ultrasound (+5); erythrocyte sedimentation rate ≥50 mm/hour or C-reactive protein ≥10 mg/liter (+3); sudden visual loss (+3); morning stiffness in shoulders or neck, jaw or tongue claudication, new temporal headache, scalp tenderness, temporal artery abnormality on vascular examination, bilateral axillary involvement on imaging, and fluorodeoxyglucose-positron emission tomography activity throughout the aorta (+2 each). A patient could be classified as having GCA with a cumulative score of ≥6 points. When these criteria were tested in the validation data set, the model area under the curve was 0.91 (95% confidence interval [95% CI] 0.88-0.94) with a sensitivity of 87.0% (95% CI 82.0-91.0%) and specificity of 94.8% (95% CI 91.0-97.4%). CONCLUSION The 2022 American College of Rheumatology/EULAR GCA classification criteria are now validated for use in clinical research.
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Affiliation(s)
- Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Katherine Bates Gribbons
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Andrew Judge
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anthea Craven
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, UK, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
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Ponte C, Grayson PC, Robson JC, Suppiah R, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Watts RA, Merkel PA, Luqmani RA. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Ann Rheum Dis 2022; 81:1647-1653. [PMID: 36351706 DOI: 10.1136/ard-2022-223480] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and validate updated classification criteria for giant cell arteritis (GCA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in six phases: (1) identification of candidate items, (2) prospective collection of candidate items present at the time of diagnosis, (3) expert panel review of cases, (4) data-driven reduction of candidate items, (5) derivation of a points-based risk classification score in a development data set and (6) validation in an independent data set. RESULTS The development data set consisted of 518 cases of GCA and 536 comparators. The validation data set consisted of 238 cases of GCA and 213 comparators. Age ≥50 years at diagnosis was an absolute requirement for classification. The final criteria items and weights were as follows: positive temporal artery biopsy or temporal artery halo sign on ultrasound (+5); erythrocyte sedimentation rate ≥50 mm/hour or C reactive protein ≥10 mg/L (+3); sudden visual loss (+3); morning stiffness in shoulders or neck, jaw or tongue claudication, new temporal headache, scalp tenderness, temporal artery abnormality on vascular examination, bilateral axillary involvement on imaging and fluorodeoxyglucose-positron emission tomography activity throughout the aorta (+2 each). A patient could be classified as having GCA with a cumulative score of ≥6 points. When these criteria were tested in the validation data set, the model area under the curve was 0.91 (95% CI 0.88 to 0.94) with a sensitivity of 87.0% (95% CI 82.0% to 91.0%) and specificity of 94.8% (95% CI 91.0% to 97.4%). CONCLUSION The 2022 American College of Rheumatology/EULAR GCA classification criteria are now validated for use in clinical research.
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Affiliation(s)
- Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK.,Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Katherine Bates Gribbons
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Andrew Judge
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anthea Craven
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
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Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, Merkel PA, Hill C, Ranganathan D, Kronbichler A, Blockmans D, Barra L, Carette S, Pagnoux C, Dhindsa N, Fifi‐Mah A, Khalidi N, Liang P, Milman N, Pineau C, Tian X, Wang G, Wang T, Zhao M, Tesar V, Baslund B, Hammam N, Shahin A, Pirila L, Putaala J, Hellmich B, Henes J, Holle J, Lamprecht P, Moosig F, Neumann T, Schmidt W, Sunderkoettey C, Szekanecz Z, Danda D, Das S, Gupta R, Rajasekhar L, Sharma A, Wagh S, Clarkson M, Molloy E, Salvarani C, Schiavon F, Tombetti E, Vaglio A, Amano K, Arimura Y, Dobashi H, Fujimoto S, Harigai M, Hirano F, Hirahashi J, Honma S, Kawakami T, Kobayashi S, Kono H, Makino H, Matsui K, Muso E, Suzuki K, Ikeda K, Takeuchi T, Tsukamoto T, Uchida S, Wada T, Yamada H, Yamagata K, Yumura W, Lai KS, Flores‐Suarez LF, Hinojosa‐Azaola A, Rutgers B, Tak P, Grainger R, Quincey V, Stamp L, Suppiah R, Besada E, Diamantopoulos A, Sznajd J, Azevedo E, Geraldes R, Rodrigues M, Santos E, Song Y, Moiseev S, Hočevar A, Cid MC, Moreno XS, Atukorala I, Berglin E, Mohammed A, Segelmark M, Daikeler T, Direskeneli H, Hatemi G, Kamali S, Karadağ Ö, Pehlevan S, Adler M, Basu N, Bruce I, Chakravarty K, Dasgupta B, Flossmann O, Gendi N, Hassan A, Hoyles R, Jayne D, Jones C, Klocke R, Lanyon P, Laversuch C, Luqmani R, Robson J, Magliano M, Mason J, Maw WW, McInnes I, Mclaren J, Morgan M, Morgan A, Mukhtyar C, O'Riordan E, Patel S, Peall A, Robson J, Venkatachalam S, Vermaak E, Menon A, Watts R, Yee C, Albert D, Calabrese L, Chung S, Forbess L, Gaffo A, Gewurz‐Singer O, Grayson P, Liang K, Matteson E, Merkel PA, Rhee R, Springer J, Sreih A. 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis. Arthritis Rheumatol 2022; 74:1872-1880. [PMID: 36349501 DOI: 10.1002/art.42324] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 07/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for Takayasu arteritis (TAK). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data-driven reduction of candidate items, 5) derivation of a points-based classification score in a development data set, and 6) validation in an independent data set. RESULTS The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large-vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94-0.99) with a sensitivity of 93.8% (95% CI 88.6-97.1%) and specificity of 99.2% (95% CI 96.7-100.0%). CONCLUSION The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
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Affiliation(s)
- Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Acadámico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine Bates Gribbons
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Andrew Judge
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anthea Craven
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
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Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, Merkel PA. 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis 2022; 81:1654-1660. [PMID: 36351705 DOI: 10.1136/ard-2022-223482] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
ObjectiveTo develop and validate new classification criteria for Takayasu arteritis (TAK).MethodsPatients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in six phases: (1) identification of candidate criteria items, (2) collection of candidate items present at diagnosis, (3) expert panel review of cases, (4) data‐driven reduction of candidate items, (5) derivation of a points‐based classification score in a development data set and (6) validation in an independent data set.ResultsThe development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large‐vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1) and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% CI 0.94 to 0.99) with a sensitivity of 93.8% (95% CI 88.6% to 97.1%) and specificity of 99.2% (95% CI 96.7% to 100.0%).ConclusionThe 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
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Affiliation(s)
- Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
- Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine Bates Gribbons
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Andrew Judge
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anthea Craven
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Suppiah R, Noori K, Sharma A, Abidi K. Fuzzy Inference System (FIS) - Long Short-Term Memory (LSTM) Network for Electromyography (EMG) signal analysis. Biomed Phys Eng Express 2022; 8. [DOI: 10.1088/2057-1976/ac9e04] [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] [Received: 06/08/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022]
Abstract
Abstract
A wide range of application domains such as remote robotic control, rehabilitation, and remote surgery require capturing neuromuscular activities. The reliability of the application is highly dependent on an ability to decode intentions accurately based on captured neuromuscular signals. Physiological signals such as Electromyography (EMG) and Electroencephalography (EEG) generated by neuromuscular activities contain intrinsic patterns for users' particular actions. Such actions can generally be classified as motor states, such as Forward, Reverse, Hand-Grip, and Hand Release. In order to classify these motor states truthfully, the signals must be captured and decoded correctly. This paper proposes a novel classification technique using a Fuzzy Inference System (FIS) and Long Short Term Memory (LSTM) networks to classify the motor states based on EMG signals. Existing EMG signal classification techniques generally rely on features derived from data captured at a specific time instance. This typical approach does not consider the temporal correlation of the signal in the entire window. In this paper, the authors propose Long Short Term Memory with Fuzzy Logic method to classify four major hand movements, forward, reverse, raise, and lower. We extract the features associated with the motor state movement by exploring published with the pattern generated data within a given time window. The classification results are promising to achieve 91.3% accuracy for the 4-way action (Forward/Reverse/GripUp/RelDown) and 95.1% (Forward/Reverse Action) and 96.7% (GripUp/RelDown action) for 2-way actions. The proposed mechanism demonstrates high-level, human interpretable results that can be employed in rehabilitation or medical-device industries.
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Grayson PC, Ponte C, Robson JC, Suppiah R, Judge A, Hutchings A, Craven A, Khalid S, Luqmani RA, Watts RA, Merkel PA. Reply. Arthritis Rheumatol 2022; 74:1725-1726. [PMID: 35713987 DOI: 10.1002/art.42267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Cristina Ponte
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Andrew Judge
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | - Anthea Craven
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sara Khalid
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Richard A Watts
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
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9
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Grayson PC, Robson JC, Suppiah R, Ponte C, Watts RA, Luqmani RA, Merkel PA. Response to: Correspondence on '2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis' by Joanna C Robson et al and '2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis' by Ravi Suppiah et al. Ann Rheum Dis 2022:annrheumdis-2022-222362. [PMID: 35318216 DOI: 10.1136/annrheumdis-2022-222362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Peter C Grayson
- National Institutes of Health/NIAMS, Bethesda, Maryland, USA
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, and Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Richard A Watts
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Peter A Merkel
- Divison of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Grayson PC, Ponte C, Suppiah R, Robson JC, Craven A, Judge A, Khalid S, Hutchings A, Luqmani RA, Watts RA, Merkel PA. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis With Polyangiitis. Arthritis Rheumatol 2022; 74:386-392. [PMID: 35106968 DOI: 10.1002/art.41982] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/29/2021] [Accepted: 09/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop and validate revised classification criteria for eosinophilic granulomatosis with polyangiitis (EGPA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate criteria items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data-driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. RESULTS The development set for EGPA consisted of 107 cases of EGPA and 450 comparators. The validation set consisted of an additional 119 cases of EGPA and 437 comparators. From 91 candidate items, regression analysis identified 11 items for EPGA, 7 of which were retained. The final criteria and their weights were as follows: maximum eosinophil count ≥1 × 109 /liter (+5), obstructive airway disease (+3), nasal polyps (+3), cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3 ANCA positivity (-3), extravascular eosinophilic predominant inflammation (+2), mononeuritis multiplex/motor neuropathy not due to radiculopathy (+1), and hematuria (-1). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having EGPA if the cumulative score was ≥6 points. When these criteria were tested in the validation data set, the sensitivity was 85% (95% confidence interval [95% CI] 77-91%) and the specificity was 99% (95% CI 98-100%). CONCLUSION The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for EGPA demonstrate strong performance characteristics and are validated for use in research.
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Affiliation(s)
- Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, and Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Anthea Craven
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Andrew Judge
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK, and Bristol NIHR Biomedical Research Centre and University of Bristol, Bristol, UK
| | - Sara Khalid
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | | | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Richard A Watts
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK, and University of East Anglia, Norwich, UK
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Suppiah R, Robson JC, Grayson PC, Ponte C, Craven A, Khalid S, Judge A, Hutchings A, Merkel PA, Luqmani RA, Watts RA. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Microscopic Polyangiitis. Arthritis Rheumatol 2022; 74:400-406. [PMID: 35106973 DOI: 10.1002/art.41983] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/29/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To develop and validate classification criteria for microscopic polyangiitis (MPA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data-driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. RESULTS The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti-myeloperoxidase-ANCA positivity (+6), pauci-immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino-nasal symptoms or signs (-3), cytoplasmic ANCA or anti-proteinase 3 ANCA positivity (-1), and eosinophil count ≥1 × 109 /liter (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% confidence interval [95% CI] 85-95%) and the specificity was 94% (95% CI 92-96%). CONCLUSION The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research.
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Affiliation(s)
- Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, and Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Anthea Craven
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Sara Khalid
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Andrew Judge
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK, and Bristol NIHR Biomedical Research Centre and University of Bristol, Bristol, UK
| | | | | | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
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Robson JC, Grayson PC, Ponte C, Suppiah R, Craven A, Judge A, Khalid S, Hutchings A, Watts RA, Merkel PA, Luqmani RA. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Granulomatosis With Polyangiitis. Arthritis Rheumatol 2022; 74:393-399. [PMID: 35106964 DOI: 10.1002/art.41986] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/29/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop and validate revised classification criteria for granulomatosis with polyangiitis (GPA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate criteria items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data-driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. RESULTS The development set for GPA consisted of 578 cases of GPA and 652 comparators. The validation set consisted of an additional 146 cases of GPA and 161 comparators. From 91 candidate items, regression analysis identified 26 items for GPA, 10 of which were retained. The final criteria and their weights were as follows: bloody nasal discharge, nasal crusting, or sino-nasal congestion (+3); cartilaginous involvement (+2); conductive or sensorineural hearing loss (+1); cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3 ANCA positivity (+5); pulmonary nodules, mass, or cavitation on chest imaging (+2); granuloma or giant cells on biopsy (+2); inflammation or consolidation of the nasal/paranasal sinuses on imaging (+1); pauci-immune glomerulonephritis (+1); perinuclear ANCA or antimyeloperoxidase ANCA positivity (-1); and eosinophil count ≥1 × 109 /liter (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having GPA if the cumulative score was ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 93% (95% confidence interval [95% CI] 87-96%) and the specificity was 94% (95% CI 89-97%). CONCLUSION The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for GPA demonstrate strong performance characteristics and are validated for use in research.
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Affiliation(s)
- Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, and Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | - Anthea Craven
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Andrew Judge
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK, and Bristol NIHR Biomedical Research Centre and University of Bristol, Bristol, UK
| | - Sara Khalid
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | | | - Richard A Watts
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK, and University of East Anglia, Norwich, UK
| | | | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
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Grayson PC, Ponte C, Suppiah R, Robson JC, Craven A, Judge A, Khalid S, Hutchings A, Luqmani RA, Watts RA, Merkel PA. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis. Ann Rheum Dis 2022; 81:309-314. [PMID: 35110334 DOI: 10.1136/annrheumdis-2021-221794] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [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: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop and validate revised classification criteria for eosinophilic granulomatosis with polyangiitis (EGPA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate criteria items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. RESULTS The development set for EGPA consisted of 107 cases of EGPA and 450 comparators. The validation set consisted of an additional 119 cases of EGPA and 437 comparators. From 91 candidate items, regression analysis identified 11 items for EPGA, 7 of which were retained. The final criteria and their weights were as follows: maximum eosinophil count ≥1×109/L (+5), obstructive airway disease (+3), nasal polyps (+3), cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3-ANCA positivity (-3), extravascular eosinophilic predominant inflammation (+2), mononeuritis multiplex/motor neuropathy not due to radiculopathy (+1) and haematuria (-1). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having EGPA if the cumulative score was ≥6 points. When these criteria were tested in the validation data set, the sensitivity was 85% (95% CI 77% to 91%) and the specificity was 99% (95% CI 98% to 100%). CONCLUSION The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis demonstrate strong performance characteristics and are validated for use in research.
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Affiliation(s)
- Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Universidade de Lisboa, Lisboa, Portugal.,Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Anthea Craven
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Andrew Judge
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK.,Bristol NIHR Biomedical Research Centre and University of Bristol, Bristol, UK
| | - Sara Khalid
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | | | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Richard A Watts
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK.,University of East Anglia, Norwich, UK
| | - Peter A Merkel
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Suppiah R, Robson JC, Grayson PC, Ponte C, Craven A, Khalid S, Judge A, Hutchings A, Merkel PA, Luqmani RA, Watts RA. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis. Ann Rheum Dis 2022; 81:321-326. [PMID: 35110332 DOI: 10.1136/annrheumdis-2021-221796] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [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: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and validate classification criteria for microscopic polyangiitis (MPA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. RESULTS The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti-myeloperoxidase-ANCA positivity (+6), pauci-immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino-nasal symptoms or signs (-3), cytoplasmic ANCA or anti-proteinase 3 ANCA positivity (-1) and eosinophil count ≥1×109/L (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% CI 85% to 95%) and the specificity was 94% (95% CI 92% to 96%). CONCLUSION The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research.
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Affiliation(s)
- Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Universidade de Lisboa, and Centro Académico deMedicina de Lisboa, Lisbon, Portugal
| | - Anthea Craven
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Sara Khalid
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Andrew Judge
- Bristol NIHR Biomedical Research Centre and University of Bristol, Bristol, UK.,Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Peter A Merkel
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Richard A Watts
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK.,University of East Anglia, Norwich, UK
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Robson JC, Grayson PC, Ponte C, Suppiah R, Craven A, Judge A, Khalid S, Hutchings A, Watts RA, Merkel PA, Luqmani RA. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis. Ann Rheum Dis 2022; 81:315-320. [PMID: 35110333 DOI: 10.1136/annrheumdis-2021-221795] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [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: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To develop and validate revised classification criteria for granulomatosis with polyangiitis (GPA). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate criteria items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. RESULTS The development set for GPA consisted of 578 cases of GPA and 652 comparators. The validation set consisted of an additional 146 cases of GPA and 161 comparators. From 91 candidate items, regression analysis identified 26 items for GPA, 10 of which were retained. The final criteria and their weights were as follows: bloody nasal discharge, nasal crusting or sino-nasal congestion (+3); cartilaginous involvement (+2); conductive or sensorineural hearing loss (+1); cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3 ANCA positivity (+5); pulmonary nodules, mass or cavitation on chest imaging (+2); granuloma or giant cells on biopsy (+2); inflammation or consolidation of the nasal/paranasal sinuses on imaging (+1); pauci-immune glomerulonephritis (+1); perinuclear ANCA or antimyeloperoxidase ANCA positivity (-1); and eosinophil count ≥1×109 /L (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having GPA if the cumulative score was ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 93% (95% CI 87% to 96%) and the specificity was 94% (95% CI 89% to 97%). CONCLUSION The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for GPA demonstrate strong performance characteristics and are validated for use in research.
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Affiliation(s)
- Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Cristina Ponte
- Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Universidade de Lisboa, and Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | - Anthea Craven
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Andrew Judge
- Bristol NIHR Biomedical Research Centre and University of Bristol, Bristol, UK.,Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Sara Khalid
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
| | - Andrew Hutchings
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Richard A Watts
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK.,University of East Anglia, Norwich, UK
| | - Peter A Merkel
- University of Pennsylvania, Philadelphia, Pensylvania, USA
| | - Raashid A Luqmani
- Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, UK
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Makhzoum JP, Grayson PC, Ponte C, Robson J, Suppiah R, Watts RA, Luqmani R, Merkel PA, Pagnoux C. Pulmonary Involvement in Primary Systemic Vasculitides. Rheumatology (Oxford) 2021; 61:319-330. [PMID: 33788906 DOI: 10.1093/rheumatology/keab325] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study describes the spectrum and initial impact of pulmonary manifestations in the primary systemic vasculitides. METHODS Description and comparison of pulmonary manifestations in adults with Takayasu's arteritis (TAK), giant cell arteritis (GCA), granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), polyarteritis nodosa (PAN), and IgA vasculitis (IgAV), using data collected within the Diagnostic and Classification Criteria in Vasculitis (DCVAS) study. RESULTS Data from 1952 patients with primary vasculitides were included: 170 TAK, 657 GCA, 555 GPA, 223 MPA, 146 EGPA, 153 IgAV, and 48 PAN. Pulmonary manifestations were observed in patients with TAK (21.8%), GCA (15.8%), GPA (64.5%), MPA (65.9%), EGPA (89.0%), PAN (27.1%) and IgAV (5.9%). Dyspnea occurred in patients with TAK (14.7%), GCA (7.8%), GPA (41.8%), MPA (43.5%), EGPA (65.8%), PAN (18.8%) and IgAV (2.6%). Cough was reported in TAK (7.6%), GCA (9.3%), GPA (34.8%), MPA (37.7%), EGPA (55.5%), PAN (16.7%) and IgAV (3.3%). Hemoptysis occurred mainly in patients with ANCA-associated vasculitis (AAV). Fibrosis on imaging at diagnosis was documented in GPA (1.9%), MPA (24.9%), and EGPA (6.3%). Only patients with AAV (GPA 2.7%, MPA 2.7% and EGPA 3.4%) required mechanical ventilation. At 6 months, the presence of at least one pulmonary item in the Vasculitis Damage Index (VDI) was observed in TAK (4.1%), GCA (3.3%), GPA (15.4%), MPA (28.7%), EGPA (52.7%), PAN (6.2%), and IgAV (1.3%). CONCLUSIONS Pulmonary manifestations can occur in all primary systemic vasculitides, but are more frequent and more often associated with permanent damage in AAV.
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Affiliation(s)
- Jean-Paul Makhzoum
- Vasculitis Clinic, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, CAN
| | - Peter C Grayson
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
| | - Cristina Ponte
- Hospital de Santa Maria, Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; and Rheumatology Research Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Lisboa, PT
| | - Joanna Robson
- Academic Rheumatology Unit, Bristol Royal Infirmary, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; andHon Senior Lecturer, School of Clinical Sciences, University of Bristol & Hon Consultant in Rheumatology, Department of Rheumatology, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Ravi Suppiah
- Department of Rheumatology, Auckland District Health Board, Auckland, NZ
| | - Richard A Watts
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Raashid Luqmani
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Pagnoux
- Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Putman MS, Gribbons KB, Ponte C, Robson J, Suppiah R, Craven A, Watts R, Luqmani R, Merkel PA, Archer AM, Grayson PC. Clinicopathologic Associations in a Large International Cohort of Patients with Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2020; 74:1013-1018. [PMID: 33338326 DOI: 10.1002/acr.24540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In addition to aiding in diagnosis, histopathologic findings from temporal artery biopsy (TAB) specimens in giant cell arteritis (GCA) may be valuable for their associations with clinical features of the disease. This study compared histopathologic findings on TAB with biopsy interpretation and demographic, clinical, and imaging features at time of diagnosis. METHODS Patients with a clinical diagnosis of GCA who had a TAB were selected from an international, multicenter observational cohort of vasculitis. Associations between demographic, clinical, radiographic, and histopathologic features were identified using bivariate testing and multivariate regression modeling. RESULTS Out of 705 patients with GCA who underwent TAB, 69% had histopathological evidence of definite vasculitis. Specific histopathological findings included the presence of giant cells (51%), fragmentation of the internal elastic lamina (41%), intimal thickening (33%), and predominantly mononuclear leukocyte infiltration (32%). Histopathologic interpretation of definite vasculitis was independently associated with giant cells (odds ratios (OR) 151.8, 95% confidence interval (CI): 60.2-551.6), predominantly mononuclear leukocyte infiltration (OR 11.8, CI 5.9-24.9), and fragmentation of the internal elastic lamina (OR 3.7, CI 1.9-7.4). A halo sign on temporal artery ultrasound and luminal damage of large arteries on angiography were significantly associated with presence of giant cells (OR 2.6, CI 1.1-6.5 and OR 2.4, CI 1.1-5.2, respectively). Specific histopathologic findings were associated with older age but no associations were identified with vision loss or other clinical features. CONCLUSION Histopathologic findings in GCA are strongly associated with the clinical diagnosis of GCA but have a limited role in identifying patterns of disease.
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Affiliation(s)
- Michael S Putman
- Department of Rheumatology, Northwestern University, Chicago, IL, USA
| | - K Bates Gribbons
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
| | - Cristina Ponte
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Joanna Robson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, GB, United Kingdom of Great Britain and Northern Ireland
| | - Ravi Suppiah
- Department of Rheumatology, Auckland District Health Board, Auckland, NZ
| | - Anthea Craven
- Department of Rheumatology, University of Oxford, Oxford, GB, United Kingdom of Great Britain and Northern Ireland
| | - Richard Watts
- Norwich Medical School, University of East Anglia, Norwich, GB, United Kingdom of Great Britain and Northern Ireland
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, GB, United Kingdom of Great Britain and Northern Ireland
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy M Archer
- Department of Rheumatology, Northwestern University, Chicago, IL, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
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Gribbons KB, Ponte C, Carette S, Craven A, Cuthbertson D, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Quinn KA, Robson JC, Seo P, Sreih AG, Suppiah R, Warrington KJ, Ytterberg SR, Luqmani R, Watts R, Merkel PA, Grayson PC. Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2020; 72:1615-1624. [PMID: 31444857 DOI: 10.1002/acr.24055] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). METHODS Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort. RESULTS A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage. CONCLUSION Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis.
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Affiliation(s)
- K Bates Gribbons
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
| | | | - Simon Carette
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Paul A Monach
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | | | - Christian Pagnoux
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin A Quinn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland, and Georgetown University, Washington, DC
| | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | - Richard Watts
- Norwich Medical School, University of East Anglia, Norwich, and University of Oxford, Oxford, UK
| | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
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Gribbons KB, Ponte C, Craven A, Robson JC, Suppiah R, Luqmani R, Watts R, Merkel PA, Grayson PC. Diagnostic Assessment Strategies and Disease Subsets in Giant Cell Arteritis: Data From an International Observational Cohort. Arthritis Rheumatol 2020; 72:667-676. [PMID: 31729185 DOI: 10.1002/art.41165] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Diagnostic assessment in giant cell arteritis (GCA) is rapidly changing as vascular imaging becomes more available. This study was undertaken to determine if clinical GCA subsets have distinct profiles or reflect differential diagnostic assessments. METHODS Patients were recruited from an international cohort and divided into 4 subsets based on a temporal artery (TA) abnormality (positive TA biopsy [TAB] or halo sign on TA ultrasound [TA-US]) and/or evidence of large vessel (LV) involvement on imaging: 1) both TA abnormality and LV involvement (TA+/LV+ GCA); 2) TA abnormality without LV involvement (TA+/LV- GCA); 3) LV involvement without TA abnormality (TA-/LV+ GCA); and 4) clinically diagnosed GCA without LV involvement or TA abnormality (TA-/LV- GCA). RESULTS Nine hundred forty-one patients with GCA were recruited from 72 international study sites. Most patients received multiple forms of diagnostic assessment, including TAB (n = 705 [75%]), TA-US (n = 328 [35%]), and LV imaging (n = 534 [57%]). Assessment using TAB, TA-US, and LV imaging confirmed the diagnosis of GCA in 66%, 79%, and 40% of cases, respectively. GCA subsets had distinct profiles independent of diagnostic assessment strategies. TA+/LV- were the most common subset (51%), with a high burden of cranial ischemia. Those in the TA-/LV- subset (26%) had a high prevalence of cranial ischemia and musculoskeletal symptoms. Patients in the TA-/LV+ subset (12%) had prevalent upper extremity vascular abnormalities and a low prevalence of vision loss, and those in the TA+/LV+ subset (11%) were older and had a high prevalence of cranial ischemia, constitutional symptoms, and elevated acute-phase reactant levels. CONCLUSION Vascular imaging is increasingly incorporated into the diagnostic assessment of GCA and identifies clinical subsets of patients based on involvement of temporal and extracranial arteries.
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Affiliation(s)
- K Bates Gribbons
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Hospital de Santa Maria and Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | | | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | | | - Richard Watts
- University of East Anglia Norwich Medical School, Norwich, UK, and University of Oxford, Oxford, UK
| | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Gearry RB, Frampton C, Inns S, Poppelwell D, Rademaker M, Suppiah R. VITALITY: impact of adalimumab on health and disability outcomes in patients with Crohn's disease, rheumatoid arthritis, or psoriasis treated in clinical practice in New Zealand. Curr Med Res Opin 2019; 35:1837-1846. [PMID: 31233347 DOI: 10.1080/03007995.2019.1634952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: VITALITY, a 6-month, multicenter, prospective, observational study, assessed the effects of originator adalimumab (HUMIRA) on health and disability outcomes in patients with Crohn's disease (CD), rheumatoid arthritis (RA), or psoriasis treated in routine clinical practice in New Zealand (NZ). Methods: Biologic-naïve adults initiating adalimumab in accordance with NZ funding requirements were recruited. The primary endpoint was 6-month change from baseline in World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score in all participants completing the study (full analysis set). Secondary endpoints included 6-month change in other patient-reported outcomes (PROs) of work activity and wellbeing (Work Productivity and Activity Impairment Questionnaire: General Health, Kessler Psychological Distress Scale, Flourishing Scale, and Subject Vitality Scale) and in disease-specific PRO measures. Results: In total, 164 participants with severe disease initiating adalimumab completed the WHODAS 2.0 at baseline, of whom 114 (69.5%) completed the study at 6 months. Mean WHODAS 2.0 score halved from 15.2 points (SD = ±9.1) at baseline to 7.3 points (SD = ±7.2) after 6 months' adalimumab treatment (mean difference = 7.9 points; 95% CI = 6.4-9.4; p < .001), with statistically significant improvements seen as early as 2 months after adalimumab initiation (p < .001). The proportion of participants with a WHODAS 2.0 score ≥ 10 more than halved, from 68.3% to 28.9%, between baseline and 6 months. Other PROs also improved significantly at 6 months, as did disease-specific measures. No new adalimumab safety signals were observed. Conclusions: Health and disability outcomes improved significantly after 6 months of adalimumab use in NZ patients with severe CD, RA, or psoriasis. Clinicaltrials.gov: NCT02451839.
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Affiliation(s)
- Richard B Gearry
- Department of Gastroenterology, Christchurch Hospital , Christchurch , New Zealand
- Department of Medicine, University of Otago , Christchurch , New Zealand
| | | | - Stephen Inns
- Department of Medicine, University of Otago , Christchurch , New Zealand
- Hutt Valley District Health Board IBD Service , Lower Hutt , New Zealand
| | | | - Marius Rademaker
- Waikato Clinical School, University of Auckland , Hamilton , New Zealand
| | - Ravi Suppiah
- Department of Rheumatology, Auckland District Health Board , Auckland , New Zealand
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Bischof A, Jaeger VK, Hadden RDM, Luqmani RA, Pröbstel AK, Merkel PA, Suppiah R, Craven A, Collins MP, Daikeler T. Peripheral neuropathy in antineutrophil cytoplasmic antibody-associated vasculitides: Insights from the DCVAS study. Neurol Neuroimmunol Neuroinflamm 2019; 6:6/6/e615. [PMID: 31540965 PMCID: PMC6807658 DOI: 10.1212/nxi.0000000000000615] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022]
Abstract
Objective Reported prevalence of vasculitic neuropathy (VN) in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is highly variable, and associations with other organ manifestations have not been studied systematically while accounting for diagnostic certainty of VN. Methods Data of all patients with AAV within the Diagnostic and Classification criteria for primary systemic VASculitis study were analyzed cross-sectionally. VN was categorized as definite (histology proven), probable (multiple mononeuropathy or nerve biopsy consistent with vasculitis), or possible (all others). Associations with other organ manifestations were compared in patients with and without VN. Results Nine hundred fifty-five patients (mean age 57 years, range 18–91 years, 51% female) were identified. Of these, 572 had granulomatosis with polyangiitis (GPA), 218 microscopic polyangiitis (MPA), and 165 eosinophilic granulomatosis with polyangiitis (EGPA). The prevalence of VN was 65% in EGPA, 23% in MPA, and 19% in GPA. Nerve biopsy was performed in 32/269 (12%) patients, demonstrating definite vasculitis in 17/32 (53%) of patients. VN was associated with myeloperoxidase-ANCA positivity (p = 0.004) and skin (p < 0.001), musculoskeletal, (p < 0.001) and cardiovascular (p = 0.005) involvement. Patients with VN were less likely to have renal (p < 0.001), eye (p < 0.001), and gastrointestinal (p = 0.023) involvement. Conclusions Our study provides comprehensive insights into the prevalence and organ associations of VN in a large, systematically collected AAV cohort. VN is most commonly associated with skin, musculoskeletal, and cardiovascular manifestations. In routine clinical practice, diagnosis of VN is infrequently confirmed by the gold standard of nerve biopsy but rather supported by the clinical setting of active systemic AAV.
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Affiliation(s)
- Antje Bischof
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI.
| | - Veronika K Jaeger
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Robert D M Hadden
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Raashid A Luqmani
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Anne-Katrin Pröbstel
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Peter A Merkel
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Ravi Suppiah
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Anthea Craven
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Michael P Collins
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
| | - Thomas Daikeler
- From the Immunology Clinic and Department of Neurology (A.B.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel; Department of Rheumatology (V.K.J., T.D.), University Hospital Basel, Switzerland; Department of Neurology (R.D.M.H.), King's College Hospital, London; Nuffield Department of Orthopedics (R.A.L., A.C.), Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, United Kingdom; Department of Neurology (A.-K.P.), University Hospital Basel & Clinical Neuroimmunology; Department of Biomedicine (A.-K.P.), University of Basel, Switzerland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics (P.A.M.), University of Pennsylvania, Philadelphia; Department of Rheumatology (R.S.), Auckland District Health Board, New Zealand; and Department of Neurology (M.P.C.), Medical College of Wisconsin, Milwaukee, WI
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Robson J, Grayson P, Ponte C, Suppiah R, Craven A, Khalid S, Judge A, Hutchings A, Watts R, Merkel P, Luqmani R. 110. CLASSIFICATION CRITERIA FOR THE ANCA-ASSOCIATED VASCULITIDES. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joanna Robson
- UWE Bristol, Bristol Royal Infirmary Bristol, United Kingdom
| | | | | | - Ravi Suppiah
- Auckland District Health Board Auckland, New Zealand
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Gribbons K, Ponte C, Craven A, Cuthbertson D, Carette S, Hoffman G, Khalidi N, Koening C, Langford C, Maksimowicz-McKinnon K, McAlear C, Monach P, Moreland L, Pagnoux C, Quinn K, Robson J, Seo P, Sreih A, Suppiah R, Warrington K, Ytterberg S, Luqmani R, Watts R, Merkel P, Grayson P. 083. COMPARISON OF ARTERIAL PATTERNS OF DISEASE IN TAKAYASU’S ARTERITIS AND GIANT CELL ARTERITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.023] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Paul Monach
- Boston University Medical Center Boston, MA USA
| | | | | | | | - Joanna Robson
- Bristol Royal Infirmary UHBristol NHS Trust Bristol, United Kingdom
| | - Philip Seo
- Johns Hopkins University Baltimore, MD USA
| | | | - Ravi Suppiah
- Auckland District Health Board Auckland, New Zealand
| | | | | | | | | | | | - Peter Grayson
- NIAMS/ National Institutes of Health Bethesda, MD USA
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Ponte C, Grayson P, Suppiah R, Robson J, Gribbons K, Craven A, Khalid S, Judge A, Hutchings A, Watts R, Merkel P, Luqmani R. 077. CLASSIFICATION CRITERIA FOR LARGE-VESSEL VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.017] [Citation(s) in RCA: 8] [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: 11/12/2022] Open
Affiliation(s)
| | | | - Ravi Suppiah
- Auckland District Health Board Auckland, New Zealand
| | - Joanna Robson
- Bristol Royal Infirmary UHBristol NHS Trust Bristol, United Kingdom
| | | | | | | | | | | | | | - Peter Merkel
- University of Pennsylvania Philadelphia, PA, USA
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Gribbons K, Ponte C, Craven A, Robson J, Suppiah R, Watts R, Luqmani R, Merkel P, Grayson P. 082. CLINICAL SUBSETS IN GIANT CELL ARTERITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.022] [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: 11/12/2022] Open
Affiliation(s)
| | | | | | - Joanna Robson
- Bristol Royal Infirmary UHBristol NHS Trust United Kingdom
| | - Ravi Suppiah
- Auckland District Health Board Auckland, New Zealand
| | - Richard Watts
- Auckland District Health Board Auckland, New Zealand
| | | | | | - Peter Grayson
- NIAMS/ National Institutes of Health Bethesda, MD USA
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Affiliation(s)
- Ravi Suppiah
- School of Computer Science and EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Achutavarrier Prasad Vinod
- School of Computer Science and EngineeringNanyang Technological UniversitySingaporeSingapore
- Indian Institute of TechnologyPalakkadIndia
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Baraliakos X, Heldmann F, Callhoff J, Suppiah R, McQueen FM, Krause D, Klink C, Schmitz-Bortz E, Igelmann M, Kalthoff L, Kiltz U, Schmuedderich A, Braun J. Quantification of Bone Marrow Edema by Magnetic Resonance Imaging Only Marginally Reflects Clinical Neck Pain Evaluation in Rheumatoid Arthritis and Ankylosing Spondylitis. J Rheumatol 2016; 43:2131-2135. [PMID: 27744396 DOI: 10.3899/jrheum.150553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Neck pain is common in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). We investigated the correlation of bone marrow edema (BME) on magnetic resonance imaging (MRI) in RA and AS and its association with clinical complaints of neck pain. METHODS Cervical spine short-tau inversion recovery-MRI and T1w-MRI of 34 patients with RA and 6 patients with AS complaining about neck pain were obtained. Clinical and laboratory data were available. BME was scored by 2 blinded readers using a modification of a published score, including various cervical sites. Degenerative changes were also quantified. RESULTS Patients were predominantly women (82.5%), and mean ± SD age was 57.5 ± 11.8 years, C-reactive protein (CRP) was 0.8 ± 1.3 mg/dl, and pain score was 46.0 ± 17.5. BME was detected in 24/40 patients (60%) involving the atlantoaxial region (21%), vertebral bodies (75%), facet joints (29%), and spinous processes (46%). Degenerative changes were identified in 21/40 patients (52.5%), 13 (62%) of whom also had BME in vertebral bodies. No differences were found between patients with versus without cervical BME for clinical assessments: numeric rating scale pain (median ± interquartile range) 5.5 ± 3.0 vs 6.0 ± 4.0 (p = 0.69), Funktionsfragebogen Hannover 68.2 ± 41.0 vs 42.0 ± 55.5 (p = 0.19), Northwick pain score 44.4 ± 21.8 vs 47.2 ± 27.0 (p = 0.83), or CRP 0.40 ± 0.80 vs 0.60 ± 0.66 (p = 0.94). For patients with degenerative changes, symptom duration was longer than for patients without (10 ± 12.5 vs 5.0 ± 18.0 yrs, p = 0.73). CONCLUSION In this small study of patients with RA and AS complaining about neck pain, BME was found in many different cervical sites, including the facet joints and the spinous processes. However, the occurrence and severity of BME did not correlate with the severity of neck pain.
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Affiliation(s)
- Xenofon Baraliakos
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand. .,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet.
| | - Frank Heldmann
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Johanna Callhoff
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Ravi Suppiah
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Fiona Marion McQueen
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Dietmar Krause
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Claudia Klink
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Elmar Schmitz-Bortz
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Manfred Igelmann
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Ludwig Kalthoff
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Uta Kiltz
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Anna Schmuedderich
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
| | - Juergen Braun
- From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.,X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet
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Driessen EMC, de Lorenzo P, Campbell M, Felice M, Ferster A, Hann I, Vora A, Hovi L, Escherich G, Li CK, Mann G, Leblanc T, Locatelli F, Biondi A, Rubnitz J, Schrappe M, Silverman L, Stary J, Suppiah R, Szczepanski T, Valsecchi M, Pieters R. Outcome of relapsed infant acute lymphoblastic leukemia treated on the interfant-99 protocol. Leukemia 2016; 30:1184-7. [PMID: 26369984 DOI: 10.1038/leu.2015.246] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- E M C Driessen
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - P de Lorenzo
- Interfant-99 Trial Data Center, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy
| | - M Campbell
- Chilean National Pediatric Oncology Group, PINDA, Roberto del Rio Hospital, Universidad de Chile, Santiago, Chile
| | - M Felice
- Department of Pediatric Hematology/Oncology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - A Ferster
- Department of Hemato-Oncology, Hôpital Unviversitaire des Enfants Reine Fabiola (ULB), Brussels, Belgium
| | - I Hann
- UK Children's Cancer Study Group, Great Ormond Street Hospital for Children, London, UK
| | - A Vora
- Department of Paediatric Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - L Hovi
- Nordic Society of Paediatric Haematology and Oncology, University of Helsinki, Helsinki, Finland
| | - G Escherich
- University Medical Center Hamburg-Eppendorf, Clinic of Pediatric Hematology and Oncology, Hamburg, Germany
| | - C K Li
- Hong Kong Paediatric Haematology and Oncology Study Group, Prince of Wales Hospital, Hong Kong, China
| | - G Mann
- St. Anna Children's Cancer Research Institute and St. Anna Children's Hospital, Department of Pediatrics, Medical University School, Vienna, Austria
| | - T Leblanc
- Departement of Pediatric Hematology, Hôpital Robert-Debré, Paris, fort he FRALLE group, Paris, France
| | - F Locatelli
- Associazione Italiana Ematologia Oncologia Pediatrica, Italy Bambino Gesù Children's Hospital, Rome, Italy
| | - A Biondi
- Associazione Italiana Ematologia Oncologia Pediatrica, Italy Bambino Gesù Children's Hospital, Rome, Italy
| | - J Rubnitz
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - M Schrappe
- Berlin-Frankfurt-Münster Study Group, Hannover, Germany
| | - L Silverman
- Dana-Farber Cancer Institute ALL Consortium, Boston, MA, USA
| | - J Stary
- Czech Pediatric Haematology, Prague, Czech Republic
| | - R Suppiah
- Australian and New Zealand Children's Haematology and Oncology Study Group, North Adelaide, Australia
| | - T Szczepanski
- Polish Pediatric Leukemia and Lymphoma Study Group, and Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - M Valsecchi
- Interfant-99 Trial Data Center, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy
| | - R Pieters
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group, The Hague, the Netherlands
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Ponte C, Rodrigues A, Prieto-González S, Alba M, Geraldes R, Craven A, Judge A, Grayson P, Suppiah R, Robson J, Watts R, Merkel P, Cid M, Luqmani R. OP0237 The Use of Positron Emission Tomography (PET) in Patients with Giant Cell Arteritis (GCA): Analysis of Data from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3638] [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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Teoh L, Suppiah R, Gow P. Late-onset rheumatoid arthritis in the Counties Manukau District Health Board region of New Zealand: an observational study of treatment. N Z Med J 2014; 127:40-48. [PMID: 25530330] [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: 06/04/2023]
Abstract
AIM The aim of this retrospective study was to investigate whether there are differences in the early treatment of Rheumatoid Arthritis (RA) depending on the age of the patient at diagnosis. METHODS The electronic records of 127 newly diagnosed RA patients presenting to the Counties Manukau District Health Board Rheumatology outpatient clinic between January 2008 and December 2010 were reviewed. Demographics, disease severity, relevant investigations, and medication use were analysed using Pearson's Chi squared test, Fisher's exact test and t-test. RESULTS The cohort included 32 aged greater than or equal to 60 years with Late Onset RA (LORA) and 95 aged <60 years with Young Onset RA (YORA). No significant differences in baseline disease severity, disease modifying anti-rheumatic drug or prednisone use rates were observed between the LORA and YORA groups, with methotrexate use rates of 26/32 (81.25%) and 74/95 (77.89%) respectively. Nonsteroidal anti-inflammatory (NSAID) rate was significantly lower (p=0.013) in the LORA group 14/32 (43.75%) compared to the YORA group 65/95 (68.42%), reflecting an awareness of the adverse effects of these drugs in an older population. CONCLUSION Patients with new onset rheumatoid arthritis at our institution received similar disease modifying anti-rheumatic drug treatment irrespective of their age.
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Affiliation(s)
- Laurence Teoh
- Rheumatology Department, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.
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Robson J, Doll H, Suppiah R, Flossmann O, Harper L, Höglund P, Jayne D, Mahr A, Westman K, Luqmani R. Glucocorticoid treatment and damage in the anti-neutrophil cytoplasm antibody-associated vasculitides: long-term data from the European Vasculitis Study Group trials. Rheumatology (Oxford) 2014; 54:471-81. [PMID: 25205825 DOI: 10.1093/rheumatology/keu366] [Citation(s) in RCA: 84] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Granulomatosis with polyangiitis and microscopic polyangiitis are ANCA-associated vasculitides (AAVs). The Vasculitis Damage Index (VDI) quantifies damage. This study aims to determine the factors associated with long-term damage in the AAVs. METHODS Data from 535 patients from four European Vasculitis Study Group trials were studied. A long-term follow-up (LTFU) questionnaire at 7 years post-diagnosis was completed. The associations between baseline (age, creatinine and BVAS score) and cumulative (number of relapses and duration of glucocorticoid use) factors and damage accrued (total VDI scores and individual treatment-related damage items) during follow-up were explored. Multiple regressions identified independent associations between baseline measures, cumulative factors and VDI scores at LTFU. RESULTS Two hundred and ninety-six patients had glucocorticoid use and VDI data available at LTFU, with the mean length of glucocorticoid use being 40.4 months (S.D. 16.7). High levels of damage were independently associated with older age at baseline (P = 0.051), lower glomerular filtration rate (P = 0.041), higher BVAS scores (P = 0.046), increased cumulative glucocorticoid use (P = 0.016) and increasing number of relapses. Patients with longer duration of glucocorticoid treatment were more likely to have a total VDI score ≥5 [odds ratio 1.26 per 12 months of glucocorticoid use (95% CI 1.03, 1.53), P = 0.022]. The main limitation is that approximately half of the patients enrolled had no LTFU data available; these patients were older with more severe initial disease. CONCLUSION Long-term damage in the AAVs may be associated with severity of initial disease, age, number of relapses and duration of glucocorticoid use.
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Affiliation(s)
- Joanna Robson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
| | - Helen Doll
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Ravi Suppiah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Oliver Flossmann
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Lorraine Harper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Peter Höglund
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - David Jayne
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Alfred Mahr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Kerstin Westman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
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Ponte C, Craven A, Robson J, Grayson PC, Suppiah R, Watts RA, Merkel PA, Luqmani RA. P10. Review of the expert panel methodology in the diagnostic and classification criteria for vasculitis study: a pilot study. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu210.010] [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: 11/12/2022] Open
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Ponte C, Grayson P, Suppiah R, Robson J, Anthea C, Judge A, Merkel P, Watts R, Luqmani R. FRI0464 Development of the Classification Criteria for GIANT Cell Arteritis in the Diagnostic and Classification Criteria for Vasculitis Study: A Pilot Study Using A Panel Review Methodology:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Robson J, Doll H, Suppiah R, Flossmann O, Harper L, Höglund P, Jayne D, Mahr A, Westman K, Luqmani R. Damage in the anca-associated vasculitides: long-term data from the European vasculitis study group (EUVAS) therapeutic trials. Ann Rheum Dis 2013; 74:177-84. [PMID: 24243925 DOI: 10.1136/annrheumdis-2013-203927] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe short-term (up to 12 months) and long-term (up to 7 years) damage in patients with newly diagnosed antineutrophil-cytoplasm antibody-associated vasculitis (AAV). METHODS Data were combined from six European Vasculitis Study group trials (n=735). Long-term follow-up (LTFU) data available for patients from four trials (n=535). Damage accrued was quantified by the Vasculitis Damage Index (VDI). Sixteen damage items were defined a priori as being potentially treatment-related. RESULTS VDI data were available for 629 of 735 patients (85.6%) at baseline, at which time 217/629 (34.5%) had ≥1 item of damage and 32 (5.1%) ≥5 items, reflecting disease manifestations prior to diagnosis and trial enrolment. LTFU data were available for 467/535 (87.3%) at a mean of 7.3 years postdiagnosis. 302/535 patients (56.4%) had VDI data at LTFU, with 104/302 (34.4%) having ≥5 items and only 24 (7.9%) no items of damage. At 6 months and LTFU, the most frequent items were proteinuria, impaired glomerular filtration rate, hypertension, nasal crusting, hearing loss and peripheral neuropathy. The frequency of damage, including potentially treatment-related damage, rose over time (p<0.01). At LTFU, the most commonly reported items of treatment-related damage were hypertension (41.5%; 95% CI 35.6 to 47.4%), osteoporosis (14.1%; 9.9 to 18.2%), malignancy (12.6%; 8.6 to 16.6%), and diabetes (10.4%; 6.7 to 14.0%). CONCLUSIONS In AAV, renal, otolaryngological and treatment-related (cardiovascular, disease, diabetes, osteoporosis and malignancy) damage increases over time, with around one-third of patients having ≥5 items of damage at a mean of 7 years postdiagnosis.
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Affiliation(s)
- Joanna Robson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, USA Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, UK
| | - Helen Doll
- Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Ravi Suppiah
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Oliver Flossmann
- Renal Department, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Lorraine Harper
- School of Immunity and Infection, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Peter Höglund
- Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden
| | - David Jayne
- Renal Department, Addenbrooke's Hospital, Cambridge, UK
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, Paris, France
| | - Kerstin Westman
- Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, USA
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Craven A, Robson J, Ponte C, Grayson PC, Suppiah R, Judge A, Watts R, Merkel PA, Luqmani RA. ACR/EULAR-endorsed study to develop Diagnostic and Classification Criteria for Vasculitis (DCVAS). Clin Exp Nephrol 2013; 17:619-621. [PMID: 23996327 DOI: 10.1007/s10157-013-0854-0] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 08/02/2013] [Indexed: 12/16/2022]
Abstract
The systemic vasculitides are a group of uncommon diseases characterized by blood vessel inflammation. There are currently no diagnostic criteria for the primary systemic vasculitides and physicians must rely on experience and disease definitions. The absence of validated criteria can result in delays in making the correct diagnosis and starting appropriate therapy. With the increased understanding of the pathophysiology of vasculitis and newer diagnostic tests in widespread clinical use, it is an appropriate time for classification criteria for primary vasculitis to be revised. The Diagnostic and Classification Criteria for Vasculitis (DCVAS) study is a multinational observational study designed to develop and validate diagnostic criteria and to improve and validate classification criteria for primary systemic vasculitis. The analytic approach will be based on the traditional approach of vessel size for classification of vasculitis but will also incorporate detailed clinical data, evaluation of anti-neutrophil cytoplasm antibody diagnostic testing, biopsy and imaging data. The study is following the guidelines for the development of classification criteria established by the American College of Rheumatology and the European League against Rheumatism. The study will incorporate the use of pre-defined cases of each condition to reduce the inherent circularity when developing new classification criteria and will explore alternative approaches to deriving reference standards by creating data-driven classification algorithms. We anticipate recruiting >2,000 patients with primary systemic vasculitis and 1,500 patients with autoimmune diseases and other conditions that mimic vasculitis. As of June 2013, >100 medical centers across 31 countries in Asia, Australasia, Europe, North America, and South America were contributing data to the study. The DCVAS study provides a unique opportunity to increase generalizability and collate a large dataset on the occurrence, presentation, and outcome of vasculitis in different populations.
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Affiliation(s)
- Anthea Craven
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
| | - Joanna Robson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Cristina Ponte
- Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, CHLN, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Peter C Grayson
- Section of Rheumatology and the Clinical Epidemiology Unit, Vasculitis Center, Boston University School of Medicine, Boston, USA
| | - Ravi Suppiah
- Auckland District Health Board, Greenlane, New Zealand
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Richard Watts
- Rheumatology Department, Ipswich Hospital and University of East Anglia, Suffolk, UK
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, USA
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
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Baraliakos X, Heldmann F, Suppiah R, McQueen F, Braun J. SAT0093 Quantification of Bone Marrow Edema by Using Magnetic Resonance Imaging for the Assessment of Neck Pain Only Marginally Reflects Clinical Evaluation in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1819] [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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Robson J, Watts R, Grayson P, Suppiah R, Merkel P, Craven A, Luqmani R. AB0757 EULAR/ACR diagnostic and classification criteria of systemic vasculitis (DCVAS) study update. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.757] [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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Gayed M, Leone F, Toescu V, Bruce I, Giles I, Teh LS, McHugh N, Edwards C, Akil M, Khamashta M, Gordon C, Parker B, Urowitz M, Gladman D, Lunt M, Bruce I, Redmond A, Alcacer-Pitarch B, Gray J, Denton C, Herrick A, Navarro-Coy N, Collier H, Loughrey L, Pavitt S, Siddle H, Wright J, Helliwell P, Emery P, Buch M, Abrol E, Pulido CG, Isenberg DA, Kia S, Patil P, Williams M, Adizie T, Christidis D, Gordon T, Borg FA, Jain S, Dasgupta B, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Al-Mossawi MH, Ridley A, Wong I, Kollnberger S, Shaw J, Bowness P, Di Cicco M, Humby F, Kelly S, Ng N, Hands R, Dadoun S, Buckley C, McInnes IB, Taylor P, Bombardieri M, Pitzalis C, Mansour S, Tocheva A, Goulston L, Platten H, Edwards C, Cooper C, Gadola SD, Lugli E, Lundberg K, Bracke K, Brusselle G, Venables PJ, Sanchez-Blanco C, Cornish G, Burn G, Saini M, Brownlie R, Klavinskis L, Williams R, Thompson S, Svensson L, Zamoyska R, Cope A, Hong CF, Khan K, Alade R, Nihtyanova SI, Ong VH, Denton CP, Scott DL, Ibrahim F, Kelly C, Birrell F, Chakravarty K, Walker D, Maddison P, Kingsley G, Cohen C, Karaderi T, Appleton L, Keidel S, Pointon J, Ridley A, Bowness P, Wordsworth P, Williams MA, Heine PJ, McConkey C, Lord J, Dosanjh S, Williamson E, Adams J, Underwood M, Lamb SE. Oral Abstracts 1: Connective Tissue Disease * O1. Long-Term Outcomes of Children Born to Mothers with SLE. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Marshall GM, Dalla Pozza L, Sutton R, Ng A, de Groot-Kruseman HA, van der Velden VH, Venn NC, van den Berg H, de Bont ESJM, Maarten Egeler R, Hoogerbrugge PM, Kaspers GJL, Bierings MB, van der Schoot E, van Dongen J, Law T, Cross S, Mueller H, de Haas V, Haber M, Révész T, Alvaro F, Suppiah R, Norris MD, Pieters R. High-risk childhood acute lymphoblastic leukemia in first remission treated with novel intensive chemotherapy and allogeneic transplantation. Leukemia 2013; 27:1497-503. [PMID: 23407458 DOI: 10.1038/leu.2013.44] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 12/20/2022]
Abstract
Children with acute lymphoblastic leukemia (ALL) and high minimal residual disease (MRD) levels after initial chemotherapy have a poor clinical outcome. In this prospective, single arm, Phase 2 trial, 111 Dutch and Australian children aged 1-18 years with newly diagnosed, t(9;22)-negative ALL, were identified among 1041 consecutively enrolled patients as high risk (HR) based on clinical features or high MRD. The HR cohort received the AIEOP-BFM (Associazione Italiana di Ematologia ed Oncologia Pediatrica (Italy)-Berlin-Frankfurt-Münster ALL Study Group) 2000 ALL Protocol I, then three novel HR chemotherapy blocks, followed by allogeneic transplant or chemotherapy. Of the 111 HR patients, 91 began HR treatment blocks, while 79 completed the protocol. There were 3 remission failures, 12 relapses, 7 toxic deaths in remission and 10 patients who changed protocol due to toxicity or clinician/parent preference. For the 111 HR patients, 5-year event-free survival (EFS) was 66.8% (±5.5) and overall survival (OS) was 75.6% (±4.3). The 30 patients treated as HR solely on the basis of high MRD levels had a 5-year EFS of 63% (±9.4%). All patients experienced grade 3 or 4 toxicities during HR block therapy. Although cure rates were improved compared with previous studies, high treatment toxicity suggested that novel agents are needed to achieve further improvement.
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Affiliation(s)
- G M Marshall
- Children's Cancer Institute Australia for Medical Research, Lowy Cancer Research Centre, UNSW, Sydney, New South Wales, Australia.
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Kumar S, Gupta R, Suppiah R. Gout in women: differences in risk factors in young and older women. N Z Med J 2012; 125:39-45. [PMID: 23159900] [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: 06/01/2023]
Abstract
AIM To describe the clinical characteristics of female patients with gout, assess risk factors in this group and to identify any differences between pre- and postmenopausal women with this diagnosis. METHODS We retrospectively reviewed the case records of all women who were seen with gout in a secondary care setting (inpatient and outpatient) at Counties Manukau District Health Board between July 2007 and July 2008. Demographic data, risk factors for gout and information on urate-lowering therapy was collected. A cut-off of less than and equal to 50 years was used to estimate pre-menopausal status. RESULTS 122/509 (24%) of patients seen with gout were female. Fourteen female patients were less than or equal to 50 years of age; all of these patients were either Maori (43%) or of Pacific Island ethnicity (57%). Comorbidities in those =50 years old were renal impairment (78.6%), hypertension (64.3%), congestive heart failure (43%) and diabetes mellitus (42.9%). Comorbidities in women >50 years old were similar: hypertension (77%), renal impairment (70%), dyslipidemia (53%) and diabetes mellitus (50%). Ischemic heart disease was more common in older women (43% vs 7%), P<0.01. Mean body mass index (BMI) was significantly higher in the younger women (43.5 vs 33.1), P<0.01. Half of all the female patients were on diuretics, and medication used to lower uric acid level was prescribed in 35.7% of women less than and equal to 50 years of age, and 42.59% of women >50 years of age. CONCLUSION Women who develop gout are more likely to be over the age of 50, have other comorbidities and be on diuretics. In comparison, younger women who develop gout have similar risk factors but tended to have a higher body mass index and are more likely to be of Maori or Pacific Island ethnicity.
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Affiliation(s)
- Sunil Kumar
- Department of Rheumatology, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.
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Merkel PA, Aydin SZ, Boers M, Direskeneli H, Herlyn K, Seo P, Suppiah R, Tomasson G, Luqmani RA. The OMERACT core set of outcome measures for use in clinical trials of ANCA-associated vasculitis. J Rheumatol 2012; 38:1480-6. [PMID: 21724720 DOI: 10.3899/jrheum.110276] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There has been a marked increase in the past 15 years in the number and quality of clinical trials in the idiopathic inflammatory vasculitides, especially the small-vessel vasculitides known as antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis [AAV; granulomatosis, with polyangiitis (Wegener's)]. These trials have been conducted by multicenter, international groups in Europe and the United States with financial support provided by government agencies and biopharmaceutical companies. This increased clinical trial activity in vasculitis has been accompanied by the development and validation of new outcome measures--a challenging process for these complex, multiorgan system diseases. The international OMERACT Vasculitis Working Group has developed and implemented an iterative research agenda that has utilized accumulated experience and datasets from several multicenter clinical trials and large cohort studies. This work has led to the development, evaluation, validation, and endorsement, through the OMERACT consensus and validation processes, of a "core set" of outcome measurements for use in clinical trials of AAV. The core set includes domains of disease activity, damage assessment, patient-reported outcomes, and mortality; there is at least one validated outcome measurement instrument available for each domain. This report reviews the domains of illness in AAV included in the OMERACT core set, describes the instruments validated to measure these domains, and presents the approved core set.
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Affiliation(s)
- Peter A Merkel
- Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA.
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Suppiah R, Hadden RDM, Batra R, Arden NK, Collins MP, Guillevin L, Jayne DRW, Luqmani RA. Peripheral neuropathy in ANCA-associated vasculitis: outcomes from the European Vasculitis Study Group trials. Rheumatology (Oxford) 2011; 50:2214-22. [DOI: 10.1093/rheumatology/ker266] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Direskeneli H, Aydin SZ, Kermani TA, Matteson EL, Boers M, Herlyn K, Luqmani RA, Neogi T, Seo P, Suppiah R, Tomasson G, Merkel PA. Development of outcome measures for large-vessel vasculitis for use in clinical trials: opportunities, challenges, and research agenda. J Rheumatol 2011; 38:1471-9. [PMID: 21724719 PMCID: PMC3653638 DOI: 10.3899/jrheum.110275] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [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] [Indexed: 11/22/2022]
Abstract
Giant cell (GCA) and Takayasu's arteritis (TAK) are 2 forms of large-vessel vasculitis (LVV) that involve the aorta and its major branches. GCA has a predilection for the cranial branches, while TAK tends to affect the extracranial branches. Both disorders may also cause nonspecific constitutional symptoms. Although some clinical features are more common in one or the other disorder and the ages of initial presentation differ substantially, there is enough clinical and histopathologic overlap between these disorders that some investigators suggest GCA and TAK may be 2 processes within the spectrum of a single disease. There have been few randomized therapeutic trials completed in GCA, and none in TAK. The lack of therapeutic trials in LVV is only partially explained by the rarity of these diseases. It is likely that the lack of well validated outcome measures for LVV and uncertainties regarding trial design contribute to the paucity of trials for these diseases. An initiative to develop a core set of outcome measures for use in clinical trials of LVV was launched by the international OMERACT Vasculitis Working Group in 2009 and subsequently endorsed by the OMERACT community at the OMERACT 10 meeting. Aims of this initiative include: (1) to review the literature and existing data related to outcome assessments in LVV; (2) to obtain the opinion of experts and patients on disease content; and (3) to formulate a research agenda to facilitate a more data-based approach to outcomes development.
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Williams VK, Suppiah R, Coppin B, Nicholls CM, Simsek A, McGregor LK. Investigation of inflicted injury in a young girl reveals mild haemophilia A and Turner's syndrome. Int J Lab Hematol 2011; 34:98-101. [PMID: 21707934 DOI: 10.1111/j.1751-553x.2011.01347.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 2-year-old girl presented to casualty with a right knee effusion after apparently minor trauma. Inflicted injury was suspected and full forensic coagulation studies were performed which revealed a mild deficiency of factor VIII. Screening of the exons and intron/exon boundaries of F8 gene indicated that the child appeared to be homozygous for the missense mutation c.5123G>A (p.Arg1708His) in exon 14 of the F8 gene. This mutation has been reported to be associated with mild haemophilia A. The possibility of hemizygosity had been masked by the test kit employed but referral to the genetics service and subsequent array CGH resulted in a diagnosis of Turner syndrome.
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Affiliation(s)
- V K Williams
- Department of Haematology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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Suppiah R, Judge A, Batra R, Flossmann O, Harper L, Höglund P, Javaid MK, Jayne D, Mukhtyar C, Westman K, Davis JC, Hoffman GS, McCune WJ, Merkel PA, St Clair EW, Seo P, Spiera R, Stone JH, Luqmani R. A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis. Arthritis Care Res (Hoboken) 2011; 63:588-96. [PMID: 21452269 DOI: 10.1002/acr.20433] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To create a prognostic tool to quantify the 5-year cardiovascular (CV) risk in patients with newly diagnosed Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) without premorbid CV disease. METHODS We reviewed CV outcomes during the long-term followup of patients in the first 4 European Vasculitis Study Group (EUVAS) trials of WG and MPA. CV events were defined as CV death, stroke, myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention. Logistic regression was performed to create a model to predict the absolute risk of a CV event. The model was tested using the Wegener's Granulomatosis Etanercept Trial (WGET) cohort. RESULTS Seventy-four (13.8%) of 535 patients with 5 years of followup from the EUVAS trials had at least 1 CV event: 33 (11.7%) of 281 WG versus 41 (16.1%) of 254 MPA. The independent determinants of CV outcomes were older age (odds ratio [OR] 1.45, 95% confidence interval [95% CI] 1.11-1.90), diastolic hypertension (OR 1.97, 95% CI 0.98-3.95), and positive proteinase 3 (PR3) antineutrophil cytoplasmic antibody (ANCA) status (OR 0.39, 95% CI 0.20-0.74). The model was validated using the WGET cohort (area under the receiver operating characteristic curve of 0.80). CONCLUSION Within 5 years of diagnosis of WG or MPA, 14% of patients will have a CV event. We have constructed and validated a tool to quantify the risk of a CV event based on age, diastolic hypertension, and PR3 ANCA status in patients without prior CV disease. In patients with vasculitis, PR3 ANCA is associated with a reduced CV risk compared to myeloperoxidase ANCA or negative ANCA status.
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Luqmani RA, Suppiah R, Grayson PC, Merkel PA, Watts R. Nomenclature and classification of vasculitis - update on the ACR/EULAR diagnosis and classification of vasculitis study (DCVAS). Clin Exp Immunol 2011; 164 Suppl 1:11-3. [PMID: 21447123 DOI: 10.1111/j.1365-2249.2011.04358.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Classification of vasculitis remains unsatisfactory. This is largely because the pathogenetic mechanisms of this family of related disorders have not been fully understood. Existing classification criteria are useful but limited. This has become more apparent with the advent of more effective and more specific therapies. A rational basis for classification could significantly improve our approach to treatment. The development of diagnostic criteria in vasculitis is an even greater challenge but may ultimately provide more useful for the non-specialist clinician. International efforts are underway to provide more effective classification and diagnostic criteria.
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Affiliation(s)
- R A Luqmani
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.
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Ionescu RA, Daha IC, Sisiroi M, Tanasescu C, Dasgupta B, Crowson C, Maradit-Kremers H, Matteson E, Youngstein T, Mehta P, Mason J, Suppiah R, Hadden RD, Batra R, Arden N, Collins MP, Guillevin L, Jayne D, Luqmani R, Mukherjee J, Youngstein T, Pyne D, Hughes E, Nash J, Andrews J, Mason JC, Atzeni F, Boiardi L, Casali B, Farnetti E, Nicoli D, Sarzi-Puttini P, Pipitone N, Olivieri I, Cantini F, Salvi F, La Corte R, Triolo G, Filippini D, Paolazzi G, Salvarani C, Suppiah R, Batra R, Robson J, Arden N, Flossmann O, Harper L, Hoglund P, Jayne D, Judge A, Mukhtyar C, Westman K, Luqmani R, Suppiah R, Judge A, Batra R, Flossmann O, Harper L, Hoglund P, Kassim Javaid M, Jayne D, Mukhtyar C, Westman K, Davis JC, Hoffman GS, Joseph McCune W, Merkel PA, William St. Clair E, Seo P, Specks U, Spiera R, Stone JH, Luqmani R. Vasculitis: 265. Cryoglobulinemic Vasculitis Secondary to Hepatitis C Infection: Is Prediction of Disease Severity Feasible? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker036] [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: 11/13/2022] Open
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Teh J, Suppiah R, Sharp R, Newton J. Imaging in the Assessment and Management of Overuse Injuries in the Foot and Ankle. Semin Musculoskelet Radiol 2011; 15:101-14. [DOI: 10.1055/s-0031-1271962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Suppiah R, Mukhtyar C, Flossmann O, Alberici F, Baslund B, Batra R, Brown D, Holle J, Hruskova Z, Jayne DRW, Judge A, Little MA, Palmisano A, Stegeman C, Tesar V, Vaglio A, Westman K, Luqmani R. A cross-sectional study of the Birmingham Vasculitis Activity Score version 3 in systemic vasculitis. Rheumatology (Oxford) 2010; 50:899-905. [DOI: 10.1093/rheumatology/keq400] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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