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Troldborg A, Thiel S, Trendelenburg M, Friebus-Kardash J, Nehring J, Steffensen R, Hansen SWK, Laska MJ, Deleuran B, Jensenius JC, Voss A, Stengaard-Pedersen K. The Lectin Pathway of Complement Activation in Patients with Systemic Lupus Erythematosus. J Rheumatol 2018; 45:1136-1144. [PMID: 29907670 DOI: 10.3899/jrheum.171033] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The pathogenesis of systemic lupus erythematosus (SLE) involves complement activation. Activation of complement through the classical pathway (CP) is well established. However, complement activation through pattern recognition not only happens through the CP, but also through the lectin pathway (LP). We investigated the hypothesis that the LP is activated in SLE and involved in the pathogenesis of the disease. METHODS Using immunoassays developed in-house, we measured concentrations of LP proteins in a cohort of 372 patients with SLE and 170 controls. We estimated complement activation measuring total C3, and investigated whether LP protein concentrations were associated with complement activation and disease activity. Protein changes and disease activity over time were assessed in a cohort of 52 patients with SLE followed with repeated samples over a 5-year period. RESULTS Concentrations of LP proteins in SLE were altered compared with controls. The differences observed in LP proteins associated with complement activation were reflected by a decrease in total C3. The pattern recognition molecules (M-ficolin, CL-L1, and CL-K1), the serine protease (MASP-3), and the associated protein (MAp19) displayed a negative correlation with disease activity. Changes in MASP-2 concentrations over time correlated significantly with increased disease activity. Association between active proteinuria and serum concentration was observed for MASP-3 and MAp19. CONCLUSION In patients with SLE, we measured specific changes in LP proteins that are associated with complement activation and disease activity, indicating that the LP is activated in patients with SLE. These novel findings substantiate the involvement of the LP in SLE.
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Affiliation(s)
- Anne Troldborg
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland. .,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University.
| | - Steffen Thiel
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Marten Trendelenburg
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Justa Friebus-Kardash
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Josephine Nehring
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Rudi Steffensen
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Søren Werner Karlskov Hansen
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Magdalena Janina Laska
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Bent Deleuran
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Jens Christian Jensenius
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Anne Voss
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
| | - Kristian Stengaard-Pedersen
- From the Department of Rheumatology, Aarhus University Hospital; Institute of Clinical Medicine, and Department of Biomedicine, Aarhus University, Aarhus; Department of Clinical Immunology, Aalborg University Hospital, Aalborg; Department of Cancer and Inflammation Research, University of Southern Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University; S. Thiel, PhD, Professor, Department of Biomedicine, Aarhus University; M. Trendelenburg, PhD, Professor, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Friebus-Kardash, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; J. Nehring, MD, Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; R. Steffensen, PhD, Department of Clinical Immunology, Aalborg University Hospital; S.W. Hansen, PhD, Associate Professor, Department of Cancer and Inflammation Research, University of Southern Denmark; M.J. Laska, PhD, Associate Professor, Institute of Clinical Medicine, Aarhus University, and Division of Internal Medicine and Department of Biomedicine, University Hospital Basel, University of Basel; B. Deleuran, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University; J.C. Jensenius, PhD, Professor, Department of Biomedicine, Aarhus University; A. Voss, MD, PhD, Department of Rheumatology, Odense University Hospital; K. Stengaard-Pedersen, PhD, Professor, Department of Rheumatology, Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University
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