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Kielbassa K, Van der Weele L, Voskuyl AE, de Vries N, Eldering E, Kuijpers TW. Differential expression pattern of Bcl-2 family members in B and T cells in systemic lupus erythematosus and rheumatoid arthritis. Arthritis Res Ther 2023; 25:225. [PMID: 37993903 PMCID: PMC10664305 DOI: 10.1186/s13075-023-03203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the expression level of anti-apoptotic Bcl-2 family proteins in B and T cells in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in relation to disease activity and the effect of various Bcl-2 family inhibitors (BH3 mimetics) as potential treatment. METHODS We included 14 SLE patients, 12 RA patients, and 13 healthy controls to study anti-apoptotic Bcl-2, Bcl-XL, and Mcl-1 expression and cell survival in different B and T cell subsets using stimulation assays and intracellular flow cytometry. Effect of various BH3 mimetics was assessed by cell viability analyses. RESULTS In SLE, significant differences in Bcl-2 family members were confined to the B cell compartment with decreased induction of Bcl-XL (p ≤ 0.05) and Mcl-1 (p ≤ 0.001) upon CpG stimulation. In RA, we did not observe any differences in expression levels of Bcl-2 family proteins. Expression patterns did not correlate with disease activity apart from decreased induction of Mcl-1 in B cells in active SLE. After in vitro stimulation with CpG, plasmablasts were more viable after treatment with three different BH3 mimetics compared to naïve or memory B cells in control and patient cells. After activation, Mcl-1 inhibition was most effective in reducing plasmablast and T cell viability, however, less in patients than controls. CONCLUSION Our study provides evidence for the increased differential expression pattern of Bcl-2 family members in B and T cell subsets of patients with SLE compared to controls. Tested BH3 mimetics showed higher efficacy in controls compared to both autoimmune diseases, though nonsignificant due to low patient numbers.
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Affiliation(s)
- K Kielbassa
- Department of Experimental Immunology, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - L Van der Weele
- Department of Experimental Immunology, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - A E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre (ARC), Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - N de Vries
- Department of Experimental Immunology, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E Eldering
- Department of Experimental Immunology, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - T W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Bacour YAA, van Kanten MP, Smit F, Comans EFI, Akarriou M, de Vet HCW, Voskuyl AE, van der Laken CJ, Smulders YM. Development of a simple standardized scoring system for assessing large vessel vasculitis by 18F-FDG PET-CT and differentiation from atherosclerosis. Eur J Nucl Med Mol Imaging 2023; 50:2647-2655. [PMID: 37115211 PMCID: PMC10317865 DOI: 10.1007/s00259-023-06220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE This study is to develop a structured approach to distinguishing large-artery vasculitis from atherosclerosis using 18-fluorodeoxyglucose positron emission tomography combined with low-dose computed tomography (FDG PET/CT). METHODS FDG PET/CT images of 60 patients were evaluated, 30 having biopsy-proven giant cell arteritis (GCA; the most common form of large-artery vasculitis), and 30 with severe atherosclerosis. Images were evaluated by 12 nuclear medicine physicians using 5 criteria: FDG uptake pattern (intensity, distribution, circularity), the degree of calcification, and co-localization of calcifications with FDG-uptake. Criteria that passed agreement, and reliability tests were subsequently analysed for accuracy using receiver operator curve (ROC) analyses. Criteria that showed discriminative ability were then combined in a multi-component scoring system. Both initial and final 'gestalt' conclusion were also reported by observers before and after detailed examination of the images. RESULTS Agreement and reliability analyses disqualified 3 of the 5 criteria, leaving only FDG uptake intensity compared to liver uptake and arterial wall calcification for potential use in a scoring system. ROC analysis showed an area under the curve (AUC) of 0.90 (95%CI 0.87-0.92) for FDG uptake intensity. Degree of calcification showed poor discriminative ability on its own (AUC of 0.62; 95%CI 0.58-0.66). When combining presence of calcification with FDG uptake intensity into a 6-tiered scoring system, the AUC remained similar at 0.91 (95%CI 0.88-0.93). After exclusion of cases with arterial prostheses, the AUC increased to 0.93 (95%CI 0.91-0.95). The accuracy of the 'gestalt' conclusion was initially 89% (95%CI 86-91%) and increased to 93% (95%CI 91-95%) after detailed image examination. CONCLUSION Standardised assessment of arterial wall FDG uptake intensity, preferably combined with assessment of arterial calcifications into a scoring method, enables accurate, but not perfect, distinction between large artery vasculitis and atherosclerosis.
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Affiliation(s)
- Y A A Bacour
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - M P van Kanten
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - F Smit
- Department of Radiology and Nuclear Medicine, Alrijne Hospital, Simon, Smitweg 1, 2353GA, Leiderdorp, The Netherlands
| | - E F I Comans
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, PO Box 7057, Amsterdam 1007MB, Amsterdam, The Netherlands
| | - M Akarriou
- Department of Radiology and Nuclear Medicine, Spaarne Hospital, PO Box 770, Hoofddorp, 2130AT, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VrijeUniversiteit Amsterdam, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - A E Voskuyl
- Amsterdam UMC-Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - C J van der Laken
- Amsterdam UMC-Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands.
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Raadsen R, Agca R, Boers M, van Halm VP, Peters MJL, Smulders Y, Beulens JWJ, Blom MT, Stehouwer CDA, Voskuyl AE, Lems WF, Nurmohamed MT. In RA patients without prevalent CVD, incident CVD is mainly associated with traditional risk factors: A 20-year follow-up in the CARRÉ cohort study. Semin Arthritis Rheum 2023; 58:152132. [PMID: 36434892 DOI: 10.1016/j.semarthrit.2022.152132] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To extend our investigation of cardiovascular diseases (CVD) in rheumatoid arthritis (RA) patients to a follow up of more than 20 years, with a special focus on patients without prevalent CVD. METHODS The CARRÉ study is an ongoing prospective cohort study on CV endpoints in RA patients. Results were compared to those of a reference cohort (n = 2484) enriched for type 2 diabetes mellitus (DM). Hazard ratios (HR) for RA and DM patients compared to non-RA/-DM controls were calculated with cox proportional hazard models, and adjusted for baseline SCORE1 (estimated 10-year CVD mortality risk based on CV risk factors). RESULTS 238 RA patients, 117 DM patients and 1282 controls, without prevalent CVD at baseline were included. Analysis of events in these patients shows that after adjustment, no relevant 'RA-specific' risk remains (HR 1.16; 95%CI 0.88 - 1.53), whereas a 'DM-specific' risk is retained (1.73; 1.24 - 2.42). In contrast, adjusted analyses of all cases confirm the presence of an 'RA-specific' risk (1.50; 1.19 - 1.89). CONCLUSIONS In RA patients without prevalent CVD the increased CVD risk is mainly attributable to increased presence of traditional risk factors. After adjustment for these factors, an increased risk attributable to RA only was thus preferentially seen in the patients with prevalent CVD at baseline. As RA treatment has improved, this data suggests that the 'RA-specific' effect of inflammation is preferentially seen in patients with prevalent CVD. We suggest that with modern (early) treatment of RA, most of the current increased CVD risk is mediated through traditional risk factors.
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Affiliation(s)
- R Raadsen
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands.
| | - R Agca
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands; Amsterdam UMC Locatie VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, the Netherlands
| | - M Boers
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands; Amsterdam UMC Locatie VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, the Netherlands; Amsterdam UMC Locatie VUmc, Epidemiology & Data Science, Amsterdam, the Netherlands
| | - V P van Halm
- Amsterdam UMC Locatie VUmc, Department of Cardiology, Amsterdam, Noord-Holland, the Netherlands
| | - M J L Peters
- University Medical Centre Utrecht, Department of Internal Medicine, Utrecht, Utrecht, the Netherlands
| | - Y Smulders
- Amsterdam UMC Locatie VUmc, Department of Internal Medicine, Amsterdam, Noord-Holland, the Netherlands
| | - J W J Beulens
- Amsterdam UMC Locatie VUmc, Epidemiology & Data Science, Amsterdam, the Netherlands
| | - M T Blom
- Amsterdam UMC Locatie VUmc, Epidemiology & Data Science, Amsterdam, the Netherlands
| | - C D A Stehouwer
- Maastricht University Medical Centre+, CARIM School for Cardiovascular Diseases, Maastricht, Limburg, the Netherlands; Maastricht University Medical Centre+, Department of Internal Medicine, Maastricht, Limburg, the Netherlands
| | - A E Voskuyl
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands; Amsterdam UMC Locatie VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, the Netherlands
| | - W F Lems
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands; Amsterdam UMC Locatie VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, the Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands; Amsterdam UMC Locatie VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, the Netherlands
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4
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Hartman L, Rasch LA, Turk SA, Ter Wee MM, Kerstens PJSM, van der Laken CJ, Nurmohamed MT, van Schaardenburg D, van Tuyl LHD, Voskuyl AE, Boers M, Lems WF. Favorable effect of a 'second hit' after 13 weeks in early RA non-responders: The Amsterdam COBRA treat-to-target randomized trial. Rheumatology (Oxford) 2022:6751802. [PMID: 36205538 DOI: 10.1093/rheumatology/keac582] [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: 06/09/2022] [Revised: 09/09/2022] [Accepted: 10/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To study the effect of treat-to-target combination therapy with intensification at 13 weeks in early RA. METHODS Early RA patients were classified as high- or low-risk based on disease activity and prognostic factors. High-risk patients received COBRA-light (prednisolone 30 mg/day tapered to 7.5 mg/day, methotrexate (MTX) increasing to 25 mg/week), low-risk patients MTX monotherapy increasing to 25 mg/week. The primary outcome (target) was DAS44 <1.6 or EULAR good response at 26 weeks. At 13 weeks, non-responders were randomized to (open-label) intensification (high-risk: prednisolone 60 mg/day tapered to 7.5 mg/day, addition of sulfasalazine (2 g/day) and hydroxychloroquine (400 mg/day); low-risk: prednisolone 30 mg/day tapered to 7.5 mg/day); or continuation. RESULTS High-risk group (n = 150): 110 patients (73%) reached the target at 13 weeks, 9 dropped out. Non-responders were randomized to intensification (n = 15) or continuation (n = 16). After 26 weeks, 12 (80%) vs 7 (44%) reached the target (difference: 36%, [95%CI 2%;71%]; p = 0.04). Low-risk group (n = 40): 17 (43%) reached the target. Non-responders were randomized to intensification (n = 8) or continuation (n = 7); 4 vs 3 reached the target.Adverse event rates were higher in the high-risk group, and higher in the intensification subgroup. Serious adverse events were rare. Protocol violations were frequent and mostly led to mitigation of actual treatment intensification. CONCLUSION Initial combination therapy was very successful in high-risk RA, and early intensification was beneficial in patients not reaching the strict target. The low-risk group was too small to draw conclusions. In routine practice, adherence to early intensification based on strict targets is difficult. TRIAL REGISTRATION Netherlands Trial Register (NTR): NL4393.
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Affiliation(s)
- L Hartman
- Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - L A Rasch
- Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - S A Turk
- Amsterdam Rheumatology and immunology Center, Reade, Amsterdam, The Netherlands
| | - M M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - P J S M Kerstens
- Department of Rheumatology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - C J van der Laken
- Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Reade, Amsterdam, The Netherlands
| | - D van Schaardenburg
- Amsterdam Rheumatology and immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - L H D van Tuyl
- Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - A E Voskuyl
- Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - M Boers
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - W F Lems
- Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
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5
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Lucassen MJJ, Ter Wee MM, den Uyl D, Konijn NPC, Nurmohamed MT, Voskuyl AE, van Schaardenburg D, Kerstens PJSM, Bultink IEM, Boers M, Lems WF. Long-term effects on bone mineral density after four years of treatment with two intensive combination strategies, including initially high-dose prednisolone, in early rheumatoid arthritis patients: the COBRA-light trial. Osteoporos Int 2021; 32:1441-1449. [PMID: 33464392 PMCID: PMC8192358 DOI: 10.1007/s00198-020-05781-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
UNLABELLED In this study, no difference in bone loss was observed between patients with early RA initially treated with COmbinatietherapie Bij Reumatoide Artritis (COBRA) (including initially 60 mg/day prednisolone) and patients treated with COBRA-light (including initially 30 mg/day prednisolone) during 4-year observation. PURPOSE To assess changes in bone mineral density (BMD) after 4 years in early rheumatoid arthritis (RA) patients initially treated with COBRA-light or COBRA therapy. METHODS In a 1 year, open-label, randomised, non-inferiority trial, patients were assigned to COBRA-light (methotrexate 25 mg/week plus initially prednisolone 30 mg/day) or COBRA (methotrexate 7.5 mg/week, sulfasalazine 2 g/day plus initially prednisolone 60 mg/day) therapy. After 1 year, antirheumatic treatment was at the discretion of treating rheumatologists. BMD was measured at baseline and after 1, 2 and 4 years at hips and lumbar spine with dual-energy X-ray absorptiometry. BMD changes between treatment strategies on average over time were compared with GEE analysis. RESULTS Data from 155 out of 162 patients could be analysed: 68% were female with a mean age of 52 (SD 13) years. Both COBRA-light and COBRA therapy showed declines in BMD at the total hip of -3.3% and -1.7%, respectively (p = 0.12), and the femoral neck, -3.7% and -3.0%, respectively (p = 0.95). At the lumbar spine, both treatment groups showed minor decline in BMD over 4 years: -0.5% and -1.0%, respectively (p = 0.10). CONCLUSION In a treat-to-target design in early RA, over 4 years, no differences between groups were found in change in BMD at total hip, femoral neck and the lumbar spine. At the hip, bone loss was around 3% in both groups, while mild bone loss was observed at lumbar spine, both in patients starting prednisolone 60 and 30 mg/day. These data suggest that the well-known negative effects of prednisolone can be modulated by modern treatment of RA.
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Affiliation(s)
- M J J Lucassen
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - M M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.
| | - D den Uyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - N P C Konijn
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - M T Nurmohamed
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Amsterdam Rheumatology and immunology Center, location Reade Rheumatology and Rehabilitation Center, Amsterdam, Netherlands
| | - A E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - D van Schaardenburg
- Amsterdam Rheumatology and immunology Center, location Reade Rheumatology and Rehabilitation Center, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - P J S M Kerstens
- Department of Rheumatology, Westfriesgasthuis, Hoorn, Netherlands
| | - I E M Bultink
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - M Boers
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
| | - W F Lems
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, VU University Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Amsterdam Rheumatology and immunology Center, location Reade Rheumatology and Rehabilitation Center, Amsterdam, Netherlands
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6
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Knip JJ, Voskuyl AE, Smulders YM. [Systemic autoimmune diseases; diagnostics versus classification]. Ned Tijdschr Geneeskd 2021; 165:D5744. [PMID: 34346619] [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: 06/13/2023]
Abstract
Systemic autoimmune diseases are characterized by their heterogenic clinical presentations and often poorly understood pathogenesis. As such, the diagnosis process may be complex and the final diagnosis is made by an expert, after considering a differential diagnosis. Classification criteria are developed for research purposes to select homogenous populations of already diagnosed patients. In clinical practice, these classification criteria are sometimes misused as diagnostic criteria. We describe three patient histories. Two patients met the classification criteria of several separate diseases, emphasizing the amount of overlap between different sets of criteria and the necessity of making a diagnosis before using classification criteria. A third patient was diagnosed with systemic sclerosis and later developed rheumatoid arthritis; a diagnosis that could have been overlooked if classification criteria were used diagnostically. We describe the correct use of classification criteria in systemic autoimmune diseases and discuss what the diagnostic process is supposed to entail.
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Affiliation(s)
- J J Knip
- Spaarne Gasthuis, afd. Interne Geneeskunde, Haarlem/Hoofddorp
- Contact: J.J. Knip
| | - A E Voskuyl
- Amsterdam UMC, locatie VUmc, afd. Reumatologie en Klinische Immunologie, Amsterdam
| | - Y M Smulders
- Amsterdam UMC, locatie VUmc, afd. Interne Geneeskunde, Amsterdam
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7
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Agca R, Heslinga M, Raterman HG, Simsek S, Voskuyl AE, Nurmohamed MT. Coexistent subclinical hypothyroidism is associated with an increased risk of new cardiovascular events in rheumatoid arthritis: an explorative study. Scand J Rheumatol 2021; 50:441-444. [PMID: 33754936 DOI: 10.1080/03009742.2021.1891279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Autoimmune thyroid disease often coexists with rheumatoid arthritis (RA) and is associated with elevated cardiovascular (CV) risk. However, studies in RA patients are scarce. Our aim was to investigate whether autoimmune thyroid disease increases the risk of new cardiovascular disease (CVD) in RA.Method: Thyroid-stimulating hormone (TSH) and serum free thyroxine (FT4) were assessed in 323 RA patients participating in an ongoing prospective cohort study designed to assess CV risk factors, morbidity, and mortality. Cox proportional hazard models were used to calculate hazard ratios (HRs) for new CVD and adjusted for age, gender, smoking, prevalent CVD, thyroxine replacement therapy, and RA duration.Results: Of the 323 participants, 65.3% were female, and mean ± sd age was 63 ± 7 years. At baseline, 8.1% were hypothyroid (n = 26, 16 clinical, 10 subclinical), 6.8% hyperthyroid (n = 22, 13 clinical, 9 subclinical), and 85.1% (n = 275) euthyroid. A new CV event developed in 94 patients (29.1%) during follow-up. Compared to euthyroid patients, the HR adjusted for age, gender, and prevalent CVD was 2.83 [95% confidence interval (CI) 1.13-7.09; p = 0.026] for subclinical hypothyroidism. Further adjustment for smoking, thyroxine replacement therapy, and RA duration resulted in an HR of 3.0 (95% CI 1.19-7.54; p = 0.02) for CV events in patients with subclinical hypothyroidism.Conclusion: There was no difference in CVD between RA patients with hypothyroidism and hyperthyroidism versus euthyroid patients. Coexistence of subclinical hypothyroidism with RA is associated with a higher occurrence of new CV events. Treatment trials are needed to determine whether thyroxine supplementation can further improve CV outcome in these patients.
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Affiliation(s)
- R Agca
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - M Heslinga
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - H G Raterman
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands.,Department of Rheumatology, Northwest Clinics, Alkmaar, The Netherlands
| | - S Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - A E Voskuyl
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
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8
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Heslinga M, Van Den Oever I, Jonker DL, Griep EN, Griep-Wentink H, Smulders YM, Lems WF, Boers M, Voskuyl AE, Peters M, Van Schaardenburg D, Nurmohamed MT. Suboptimal cardiovascular risk management in rheumatoid arthritis patients despite an explicit cardiovascular risk screening programme. Scand J Rheumatol 2019; 48:345-352. [PMID: 31210083 DOI: 10.1080/03009742.2019.1600718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: In 2011, we started to offer cardiovascular (CV) risk screening to rheumatoid arthritis (RA) patients with a high CV risk. After 1 year, we assessed whether patients labelled as high CV risk had started preventive treatment when indicated, and whether the CV risk score had changed. Methods: CV risk screening was performed in both a large outpatient rheumatology clinic and a general hospital in the Netherlands, and the general practitioner or the internist was informed about the results of the CV screening, including specific advice on the initiation or adjustment of cardiopreventive drugs. National guidelines were used to assess how many patients were eligible for preventive treatment. After 1 year, CV risk, lifestyle, and treatment were re-evaluated. Patients with a history of CV disease at baseline or who experienced a CV event during follow-up were excluded from the analyses. Results: A high 10 year CV risk (> 20%) was present in 58%, and 55% had an indication for anti-hypertensives, statins, or both. At follow-up, cardiopreventive drug treatment had been started or adjusted in only one-third of patients with an indication for treatment. After screening, 42% of patients reported having changed their lifestyle, through more exercise (24%), diet adaption (20%), and weight loss (11%). Conclusion: Despite clear guidelines to improve CV risk, the results of a programme comprising active screening, targeted advice, and referral to the general practitioner or internist prove that primary prevention remains a major challenge in high-risk RA patients.
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Affiliation(s)
- M Heslinga
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands
| | - Iam Van Den Oever
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands
| | - D L Jonker
- Department of Rheumatology, Antonius Hospital , Sneek , The Netherlands
| | - E N Griep
- Department of Rheumatology, Antonius Hospital , Sneek , The Netherlands
| | - Hrm Griep-Wentink
- Department of Rheumatology, Antonius Hospital , Sneek , The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, VU University Medical Center , Amsterdam , The Netherlands
| | - W F Lems
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands.,Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands
| | - M Boers
- Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center , Amsterdam , The Netherlands
| | - A E Voskuyl
- Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands
| | - Mjl Peters
- Department of Internal Medicine, VU University Medical Center , Amsterdam , The Netherlands
| | - D Van Schaardenburg
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center , Amsterdam , The Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands.,Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands.,Amsterdam Rheumatology and Immunology Center/AMC , Amsterdam , The Netherlands
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9
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Blomjous BS, Boers M, Den Uyl D, Twisk JWR, Van Schaardenburg D, Voskuyl AE, Lems WF, Ter Wee MM. Predictors of sick leave and improved worker productivity after 52 weeks of intensive treatment in patients with early rheumatoid arthritis. Scand J Rheumatol 2019; 48:271-278. [DOI: 10.1080/03009742.2019.1570549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- BS Blomjous
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - M Boers
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - D Den Uyl
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - JWR Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - D Van Schaardenburg
- Amsterdam Rheumatology and immunology Center, Reade, Amsterdam, The Netherlands
| | - AE Voskuyl
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - WF Lems
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - MM Ter Wee
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
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10
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Lim J, van Royen-Kerkhof A, Jonkers RE, Starink MV, Voskuyl AE, van der Kooi AJ. [Myositis: more than a muscle disease]. Ned Tijdschr Geneeskd 2018; 162:D2312. [PMID: 29473539] [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: 06/08/2023]
Abstract
Idiopathic inflammatory myopathy (IIM), commonly referred to as "myositis", is a rare but treatable auto-immune disease that is often misdiagnosed or diagnosed after significant delay. Using three clinical case reports as introductory examples, an overview is given - and pitfalls are discussed - of the diagnosis and treatment of myositis. Disease features are often extra-muscular in nature, may vary considerably between patients, and are frequently non-specific. Myositis-related morbidity is high and myositis can be fatal, mainly due to cancer and interstitial lung disease. As such, we stress the importance of early recognition of this severe disease and timely referral of a patient with a (suspected) IIM to a multidisciplinary team for optimal diagnosis and disease management.
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Affiliation(s)
- J Lim
- Academisch Medisch Centrum-Universiteit van Amsterdam, Amsterdam
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11
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Tsang-A-Sjoe MWP, Bultink IEM, Korswagen LA, van der Horst A, Rensink I, de Boer M, Hamann D, Voskuyl AE, Wouters D. Comprehensive approach to study complement C4 in systemic lupus erythematosus: Gene polymorphisms, protein levels and functional activity. Mol Immunol 2017; 92:125-131. [PMID: 29080553 DOI: 10.1016/j.molimm.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022]
Abstract
Genetic variation of the genes encoding complement component C4 is strongly associated with systemic lupus erythematosus (SLE), a chronic multi-organ auto-immune disease. This study examined C4 and its isotypes on a genetic, protein, and functional level in 140 SLE patients and 104 healthy controls. Gene copy number (GCN) variation, silencing CT-insertion, and the retroviral HERV-K(C4) insertion) were analyzed with multiplex ligation-dependent probe amplification. Increased susceptibility to SLE was found for low GCN (≪2) of C4A. Serositis was the only clinical manifestation associated with low C4A GCN. One additional novel silencing mutation in the C4A gene was found by Sanger sequencing. This mutation causes a premature stop codon in exon 11. Protein concentrations of C4 isoforms C4A and C4B were determined with ELISA and were significantly lower in SLE patients compared to healthy controls. To study C4 isotypes on a functional level, a new C4 assay was developed, which distinguishes C4A from C4B by its binding capacity to amino or hydroxyl groups, respectively. This assay showed high correlation with ELISA and detected crossing over of Rodgers and Chido antigens in 3.2% (8/244) of individuals. The binding capacity of available C4 to its substrates was unaffected in SLE. Our study provides, for the first time, a complete overview of C4 in SLE from genetic variation to binding capacity using a novel test. As this test detects crossing over of Rodgers and Chido antigens, it will allow for more accurate measurement of C4 in future studies.
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Affiliation(s)
- M W P Tsang-A-Sjoe
- Amsterdam Rheumatology and immunology Center, VU University Medical Center, Department of Rheumatology, Amsterdam, The Netherlands.
| | - I E M Bultink
- Amsterdam Rheumatology and immunology Center, VU University Medical Center, Department of Rheumatology, Amsterdam, The Netherlands
| | - L A Korswagen
- Amsterdam Rheumatology and immunology Center, VU University Medical Center, Department of Rheumatology, Amsterdam, The Netherlands
| | - A van der Horst
- Sanquin Diagnostic Services, Department of Immunopathology and Blood Coagulation, Amsterdam, The Netherlands
| | - I Rensink
- Sanquin Diagnostic Services, Department of Immunopathology and Blood Coagulation, Amsterdam, The Netherlands
| | - M de Boer
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands; Sanquin Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - D Hamann
- Sanquin Research, Department of Blood Cell Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A E Voskuyl
- Amsterdam Rheumatology and immunology Center, VU University Medical Center, Department of Rheumatology, Amsterdam, The Netherlands
| | - D Wouters
- Sanquin Research, Department of Blood Cell Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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12
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van Vilsteren M, Boot CRL, Twisk JWR, Steenbeek R, Voskuyl AE, van Schaardenburg D, Anema JR. One Year Effects of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis: Results of a Randomized Controlled Trial. J Occup Rehabil 2017; 27:128-136. [PMID: 27056549 PMCID: PMC5306224 DOI: 10.1007/s10926-016-9639-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose To evaluate the effectiveness of a workplace integrated care intervention on at-work productivity loss in workers with rheumatoid arthritis (RA) compared to usual care. Methods In this randomized controlled trial, 150 workers with RA were randomized into either the intervention or control group. The intervention group received an integrated care and participatory workplace intervention. Outcome measures were the Work Limitations Questionnaire, Work Instability Scale for RA, pain, fatigue and quality of life (RAND 36). Participants filled out a questionnaire at baseline, and after 6 and 12 months. We performed linear mixed models to analyse the outcomes. Results Participants were on average 50 years of age, and mostly female. After 12 months, no significant intervention effect was found on at-work productivity loss. We also found no significant intervention effects on any of the secondary outcomes. Conclusions We did not find evidence for the effectiveness of our workplace integrated care intervention after 12 months of follow up. Future studies should focus on investigating the intervention in groups of workers with severe limitations in work functioning, and an unstable work situation.
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Affiliation(s)
- M van Vilsteren
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Room BS7-C573, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
| | - C R L Boot
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Room BS7-C573, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands.
| | - J W R Twisk
- Department of Health Sciences Section Methodology and Applied Biostatistics, VU University, Amsterdam, The Netherlands
| | - R Steenbeek
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- TNO Work, Health and Care, Leiden, The Netherlands
| | - A E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - J R Anema
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Room BS7-C573, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VU University Medical Center, Amsterdam, The Netherlands
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13
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Ekholm L, Vosslamber S, Tjärnlund A, de Jong TD, Betteridge Z, McHugh N, Plestilova L, Klein M, Padyukov L, Voskuyl AE, Bultink IEM, Michiel Pegtel D, Mavragani CP, Crow MK, Vencovsky J, Lundberg IE, Verweij CL. Autoantibody Specificities and Type I Interferon Pathway Activation in Idiopathic Inflammatory Myopathies. Scand J Immunol 2017; 84:100-9. [PMID: 27173897 DOI: 10.1111/sji.12449] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/08/2016] [Indexed: 11/29/2022]
Abstract
Myositis is a heterogeneous group of autoimmune diseases, with different pathogenic mechanisms contributing to the different subsets of disease. The aim of this study was to test whether the autoantibody profile in patients with myositis is associated with a type I interferon (IFN) signature, as in patients with systemic lupus erythematous (SLE). Patients with myositis were prospectively enrolled in the study and compared to healthy controls and to patients with SLE. Autoantibody status was analysed using an immunoassay system and immunoprecipitation. Type I IFN activity in whole blood was determined using direct gene expression analysis. Serum IFN-inducing activity was tested using peripheral blood cells from healthy donors. Blocking experiments were performed by neutralizing anti-IFNAR or anti-IFN-α antibodies. Patients were categorized into IFN high and IFN low based on an IFN score. Patients with autoantibodies against RNA-binding proteins had a higher IFN score compared to patients without these antibodies, and the IFN score was related to autoantibody multispecificity. Patients with dermatomyositis (DM) and inclusion body myositis (IBM) had a higher IFN score compared to the other subgroups. Serum type I IFN bioactivity was blocked by neutralizing anti-IFNAR or anti-IFN-α antibodies. To conclude, a high IFN score was not only associated with DM, as previously reported, and IBM, but also with autoantibody monospecificity against several RNA-binding proteins and with autoantibody multispecificity. These studies identify IFN-α in sera as a trigger for activation of the type I IFN pathway in peripheral blood and support IFN-α as a possible target for therapy in these patients.
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Affiliation(s)
- L Ekholm
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - S Vosslamber
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - A Tjärnlund
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - T D de Jong
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Z Betteridge
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - N McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - L Plestilova
- Institute of Rheumatology, Prague, Czech Republic
| | - M Klein
- Institute of Rheumatology, Prague, Czech Republic
| | - L Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - A E Voskuyl
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - I E M Bultink
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - D Michiel Pegtel
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - C P Mavragani
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.,Department of Experimental Physiology, University of Athens, Athens, Greece
| | - M K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - J Vencovsky
- Institute of Rheumatology, Prague, Czech Republic
| | - I E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - C L Verweij
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, the Netherlands
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14
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Houben E, van der Heijden JW, van Dam B, Bax WA, Voskuyl AE, Penne EL. Screening for renal involvement in ANCA-associated vasculitis: room for improvement? Neth J Med 2017; 75:21-26. [PMID: 28124664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Renal involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) requires prompt and aggressive immunosuppressive therapy. The aim of this study was to evaluate screening practice for renal involvement in AAV and its potential effect on renal outcomes. METHODS Between 2005 and 2015, ANCA-positive AAV patients in a teaching hospital in the Netherlands were retrospectively included. Complete screening for renal involvement was defined as: assessment of erythrocyturia, proteinuria and serum creatinine within two weeks of the diagnosis of AAV. Characteristics at presentation and at 12 months were compared between patients with and without complete screening. RESULTS A total of 109 AAV patients (63% male) were identified with a mean age of 62 ±; 14 years. Complete screening for renal involvement was performed in 90 of the 109 patients (83%). Patients with incomplete screening had a lower serum creatinine (86 ±; 53 vs. 190 ±; 185 μmol/l, p < 0.001) and were more often diagnosed outside the renal department (100% vs. 78%, p = 0.02). Three patients with incomplete screening had a rise in serum creatinine of ≥ 30% at 12 months. Incomplete screening was not associated with the development of end-stage renal disease. Urine analysis of patients with renal biopsy-proven AAV (n = 31) showed erythrocyturia in 58% after one sample and in 94% after three samples. CONCLUSION Screening for renal involvement in AAV was suboptimal, primarily in patients who presented outside the renal department. A higher sensitivity for erythrocyturia is achieved if urine analysis is repeated. Incomplete screening may lead to renal impairment if renal involvement is not treated appropriately.
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Affiliation(s)
- E Houben
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
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15
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van Vilsteren M, Boot CRL, Voskuyl AE, Steenbeek R, van Schaardenburg D, Anema JR. Process Evaluation of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis. J Occup Rehabil 2016; 26:382-391. [PMID: 26811171 PMCID: PMC4967423 DOI: 10.1007/s10926-015-9624-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose To perform a process evaluation of the implementation of a workplace integrated care intervention for workers with rheumatoid arthritis to maintain and improve work productivity. The intervention consisted of integrated care and a participatory workplace intervention with the aim to make adaptations at the workplace. Methods The implementation of the workplace integrated care intervention was evaluated with the framework of Linnan and Steckler. We used the concepts recruitment, reach, dose delivered, dose received, fidelity and satisfaction with the intervention. Data collection occurred through patient questionnaires and medical records. Results Participants were recruited by sending a letter including a reply card from their own rheumatologist. In total, we invited 1973 patients to participate. We received 1184 reply cards, and of these, 150 patients eventually participated in the study. Integrated care was delivered according to protocol for 46.7 %, while the participatory workplace intervention was delivered for 80.6 %. Dose received was nearly 70 %, which means that participants implemented 70 % of the workplace adaptations proposed during the participatory workplace intervention. The fidelity score for both integrated care and the participatory workplace intervention was sufficient, although communication between members of the multidisciplinary team was limited. Participants were generally satisfied with the intervention. Conclusions This process evaluation shows that our intervention was not entirely implemented as intended. The integrated care was not delivered to enough participants, but for the intervention components that were delivered, the fidelity was good. Communication between members of the multidisciplinary team was limited. However, the participatory workplace intervention was implemented successfully, and participants indicated that they were satisfied with the intervention.
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Affiliation(s)
- M van Vilsteren
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Room BS7-C573, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
| | - C R L Boot
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Room BS7-C573, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands.
| | - A E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - R Steenbeek
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- TNO Work, Health and Care, Leiden, The Netherlands
| | | | - J R Anema
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Room BS7-C573, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Body@Work, Research Center on Physical Activity, Work, and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VU University Medical Center, Amsterdam, The Netherlands
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16
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Lensen KDF, Voskuyl AE, Comans EFI, van der Laken CJ, Smulders YM. Extracranial giant cell arteritis: A narrative review. Neth J Med 2016; 74:182-192. [PMID: 27323671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A systematic literature search was performed to summarise current knowledge on extracranial giant cell arteritis (GCA), i.e. large-artery involvement in patients with or without clinically apparent temporal arteritis (cranial GCA). Extracranial GCA is increasingly recognised, both in patients with cranial GCA and with solitary extracranial GCA, due to increased awareness among physicians and development of modern imaging modalities. The literature on the pathogenesis and histopathology of extracranial GCA is scarce. It is considered to be similar to cranial GCA. Patients with solitary extracranial GCA often present with non-specific signs and symptoms, although vascular manifestations, mostly secondary to stenosis, may occur. Due to the non-specific clinical presentation and low sensitivity of temporal artery biopsies, extracranial GCA is usually diagnosed by imaging. 18F-FDG-PET, MRI, CT angiography and ultrasound are used for this purpose. At present, the optimal diagnostic strategy is undetermined. The choice for a particular modality can be guided by the clinical scenario that raises suspicion of extracranial GCA, in addition to local availability and expertise. Extracranial complications in GCA consist of aortic aneurysm or dissection (mainly the ascending aorta), aortic arch syndrome, arm claudication and posterior stroke (although this is technically a cranial complication, it often results from stenosis of the vertebrobasilar arteries). Mortality is generally not increased in patients with GCA. Treatment of patients with solitary extracranial and those with extracranial and cranial GCA has been debated in the recent literature. In general, the same strategy is applied as in patients with temporal arteritis, although criteria regarding who to treat are unclear. Surgical procedures may be indicated, in which case optimal medical treatment prior to surgery is important.
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Affiliation(s)
- K D F Lensen
- Departments of Internal Medicine and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
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17
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van Dongen HM, Masoumi N, Tsang-A-Sjoe M, Middeldorp JM, Voskuyl AE, Pegtel DM. A2.09 Longitudinal EBV antibody profiling in sle patients reveals patients with lupus nephritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.44] [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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18
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de Jong TD, Vosslamber S, Mantel E, de Ridder S, Wesseling JG, Kraan TCTMDP, Leurs C, Hegen H, Deisenhammer F, Killestein J, Lundberg IE, Vencovsky J, Nurmohamed MT, van Schaardenburg D, Bultink IEM, Voskuyl AE, Pegtel DM, van der Laken CJ, Bijlsma JW, Verweij CL. A6.12 Physiological evidence for diversification of IFNα- and IFNβ-mediated response programs in different autoimmune diseases. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.124] [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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19
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de Jong TD, Vosslamber S, Blits M, Wolbink G, Nurmohamed MT, van der Laken CJ, Jansen G, Mantel E, Lübbers J, de Ridder S, Voskuyl AE, Verweij CL. A7.14 Effect of prednisone on type I interferon signature in rheumatoid arthritis: consequences for response prediction to rituximab. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.184] [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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20
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Tsang-A-Sjoe MWP, de Groot KA, Niewerth D, Cloos J, Blank JL, Zweegman S, Jansen G, Voskuyl AE, van der Heijden JW. A8.17 Effective use of bortezomib and plasma filtration in a critically ill patient with lupus nephritis and myocarditis: a case report and dynamics of (immuno) proteasome inhibition. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.202] [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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21
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Arends S, Berden JHM, Grootscholten C, Derksen RHWM, Berger SP, de Sévaux RGL, Voskuyl AE, Bijl M. Induction therapy with short-term high-dose intravenous cyclophosphamide followed by mycophenolate mofetil in proliferative lupus nephritis. Neth J Med 2014; 72:481-490. [PMID: 25431394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND For decades, high-dose intravenous cyclophosphamide (ivCY) given for 24-30 months was regarded as the standard therapy for proliferative lupus nephritis, despite serious side effects. Our aim was to evaluate the effect of induction therapy with short-term high-dose ivCY followed by mycophenolate mofetil (MMF) on disease parameters, mortality and health-related quality of life (HRQoL) in patients with proliferative lupus nephritis. METHODS Between January 2003 and November 2006, 71 patients with biopsy-proven proliferative lupus nephritis were included in the second Dutch Lupus Nephritis Study. All patients were treated with ivCY (750 mg÷m2, six monthly pulses) plus oral prednisone, followed by MMF (2000 mg÷day) plus oral prednisone for 18 months, and then azathioprine (2 mg÷kg÷day) plus oral prednisone. Study endpoints included the occurrence of renal relapse, end-stage renal disease (ESRD) and mortality. RESULTS After a median follow-up of 3.8 years (range 0.1-4.5), four (5.6%) of the 71 patients had a renal relapse, one (1.4%) failed treatment, one (1.4%) reached ESRD, and two (2.8%) died. Systemic lupus erythematosus (SLE) Disease Activity Index, serum creatinine, proteinuria and antibodies against anti-dsDNA decreased significantly during treatment and serum levels of complement factor 3 and 4 increased significantly. Furthermore, six of eight domains of the Short Form-36 as well as the number of symptoms and total distress level according to the SLE Symptom Checklist improved significantly over time. CONCLUSIONS This open-label study shows that induction therapy with short-term (six monthly pulses) high-dose ivCY followed by MMF is effective in preventing renal relapses, ESRD and mortality and improving HRQoL in patients with proliferative lupus nephritis.
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Affiliation(s)
- S Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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22
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Jacobs J, Sjoe MWPTA, Voskuyl AE, Lems WF, Bultink IEM. Unexpected severe incident vertebral fractures in patients with systemic lupus erythematosus: comment on the article by Zhu et al. Lupus 2014; 24:222-3. [PMID: 25335489 DOI: 10.1177/0961203314556294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Jacobs
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - M W P Tsang A Sjoe
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - A E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - W F Lems
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - I E M Bultink
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
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Meijs J, Voskuyl AE, Bloemsaat-Minekus JPJ, Vonk MC. Blood flow in the hands of a predefined homogeneous systemic sclerosis population: the presence of digital ulcers and the improvement with bosentan. Rheumatology (Oxford) 2014; 54:262-9. [DOI: 10.1093/rheumatology/keu300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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de Jong TD, Vosslamber S, de Jager W, Raterman H, Voskuyl AE, Gelderman KA, Verweij CL. A1.7 Serum cytokine changes in rituximab-treated rheumatoid arthritis patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vosslamber S, van Sijl A, Bos CL, Lubbers J, de Ridder S, Voskuyl AE, Nurmohamed MT, Verweij CL. A1.77 Interferon regulatory factor 5 (IRF5) gene variant RS2004640 is associated with carotid intima media thickness in rheumatoid arthritis patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.76] [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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Bruijnen STG, Gent YYJ, Voskuyl AE, Hoekstra OS, van der Laken CJ. Present Role of Positron Emission Tomography in the Diagnosis and Monitoring of Peripheral Inflammatory Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2013; 66:120-30. [DOI: 10.1002/acr.22184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 09/17/2013] [Indexed: 01/28/2023]
Affiliation(s)
| | - Y. Y. J. Gent
- VU University Medical Center; Amsterdam The Netherlands
| | - A. E. Voskuyl
- VU University Medical Center; Amsterdam The Netherlands
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Raterman HG, Voskuyl AE, Simsek S, Schreurs MWJ, van Hoogstraten IMW, Peters MJL, van Halm VP, Dijkmans BAC, Lips P, Lems WF, Nurmohamed MT. Increased progression of carotid intima media thickness in thyroid peroxidase antibodies-positive rheumatoid arthritis patients. Eur J Endocrinol 2013; 169:751-7. [PMID: 24005313 DOI: 10.1530/eje-13-0394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Autoimmune diseases such as rheumatoid arthritis (RA) and hypothyroidism tend to cluster, and this coexistence amplifies the elevated cardiovascular risk in RA. Whether thyroid peroxidase antibodies (TPOabs) are associated with increased cardiovascular disease (CVD) risk has not been studied extensively. Therefore, this study determined firstly the prevalence of TPOabs in RA and secondly whether TPOabs were associated with CVD. Moreover, this study explored whether TPOabs were related to RA characteristics. DESIGN AND METHODS Data from the CARRÉ Study, an ongoing study investigating CVDs and its risk factors in RA (n=322), was used to ascertain the prevalence of TPOabs in RA patients. In addition, cardiovascular and RA disease characteristics were compared between TPOabs-positive and -negative patients at baseline and at a second visit after 3 years. RESULTS TPOabs were present in 47/322 (15%) RA patients and TSH levels were higher in TPOabs-positive patients (1.40 mU/l) compared with TPOabs-negative patients (1.26 mU/l, P=0.048). At baseline and after 3 years no association was observed between TPOabs and (risk factors for) CVD. Regression analyses revealed a significantly larger progression of carotid intima media thickness (cIMT; β=0.13 mm) in TPOabs-positive compared with TPOabs-negative patients independent of risk factors for cIMT progression. RA disease activity scores (DAS28) were higher in TPOabs-positive compared with TPOabs-negative patients (4.4 vs 3.8 P=0.018). CONCLUSIONS TPOabs were associated with increased cIMT progression. Moreover, an association between TPOabs and DAS28 was observed. Hence, TPOabs seems to have a role in the amplified cardiovascular risk in RA patients.
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van Exel E, Jacobs J, Korswagen LA, Voskuyl AE, Stek M, Dekker J, Bultink IEM. Depression in systemic lupus erythematosus, dependent on or independent of severity of disease. Lupus 2013; 22:1462-9. [PMID: 24135079 DOI: 10.1177/0961203313508443] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [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: 11/15/2022]
Abstract
OBJECTIVES To estimate the prevalence of depression in subjects with systemic lupus erythematosus (SLE) in relation to the general population and to unravel the relation between depression and SLE disease characteristics. METHODS One hundred and two subjects with SLE (mean age 44.4 years) were studied using the Beck Depression Inventory (BDI) score to estimate the prevalence of depression. The BDI scores in subjects with SLE were compared with BDI scores from a pan-European population based study (Outcome in Depression International Network (ODIN) study, n = 7934), i.e. the general population. RESULTS The mean BDI score was higher in SLE subjects (10.1 points) compared with the BDI scores derived from the general population (10.1 versus 5.6 points, respectively, p < 0.001). This corresponds to a prevalence of depression of 16.6% and 6.7%, respectively. There was no association between disease activity or organ damage and BDI scores in subjects with SLE (p > 0.1). Only 7% of SLE subjects with high BDI scores used antidepressants. CONCLUSION The mean BDI score and prevalence of depression are significantly higher in SLE subjects compared with the general population. No association was found between SLE disease characteristics and BDI scores. The number of depressed SLE subjects treated with antidepressants is low, suggesting inadequate recognition and treatment of depression in SLE.
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Affiliation(s)
- E van Exel
- 1Department of Psychiatry, VU University Medical Center, the Netherlands
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Hofstee HMA, de Waal TT, Zweegman S, Voskuyl AE, Smulders YM, Schoordijk MCE, Janssen JJWM, Serné EH. Nailfold capillary abnormalities in sclerodermatous chronic GVHD. Bone Marrow Transplant 2013; 48:1574-7. [PMID: 23892332 DOI: 10.1038/bmt.2013.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 11/09/2022]
Abstract
Chronic GVHD (cGVHD) complicating allo-SCT commonly presents as sclerotic skin changes resembling systemic sclerosis (SSc), suggesting a common pathophysiological pathway. Damage to capillaries is considered an early event in the pathogenesis of SSc, and is associated with characteristic nailfold capillary abnormalities. Whether such nailfold capillary abnormalities occur in sclerodermatous cGVHD is unknown. Nailfold videocapillaroscopy (NVC) was used to evaluate capillary morphology, density and loop dimensions in 14 patients with sclerodermatous cGVHD, 14 sex- and age-matched SSc patients, and 14 healthy controls. It was shown that none of the cGVHD patients and controls, whereas all SSc patients showed severe capillary abnormalities. cGVHD patients and controls showed no differences in capillary density (9.05 vs 9.16 loops/mm, respectively, P=0.84), and capillary loop dimensions (total loop width 44.36 vs 45.56 μm, respectively, P=0.84). Compared with cGVHD patients, SSc patients had a reduced capillary density (9.05 vs 5.25 loops/mm, respectively, P<0.001), and an increase in capillary loop dimensions (total loop width 44.36 vs 99.97 μm, respectively, P=<0.001). In conclusion sclerodermatous cGVHD patients do not show the characteristic microvascular abnormalities seen in SSc, suggesting that capillary damage does not contribute to the pathophysiology of sclerodermatous cGVHD, and making NVC unsuitable for early identification.
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Affiliation(s)
- H M A Hofstee
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Van Sijl AM, van den Oever IA, Peters MJ, van Halm VV, Voskuyl AE, Smulders YM, Nurmohamed MT. OP0166 Sustained Development of Cardiovascular Disease in Rheumatoid Arthritis Despite Cardioprotective Treatment: The 10-Year Prospective Carre-Study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.371] [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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Jacobs J, Korswagen LA, Schilder AM, van Tuyl LH, Dijkmans BAC, Lems WF, Voskuyl AE, Bultink IEM. Six-year follow-up study of bone mineral density in patients with systemic lupus erythematosus. Osteoporos Int 2013; 24:1827-33. [PMID: 23052940 DOI: 10.1007/s00198-012-2157-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/20/2012] [Indexed: 01/16/2023]
Abstract
UNLABELLED Long-term bone mineral density (BMD) changes and the associated factors in systemic lupus erythematosus (SLE) patients were assessed. Despite the remarkably low overall bone loss, significant spine bone loss was associated with the use of glucocorticoids, use of antimalarials, and lower 25-hydroxyvitamin D levels, stressing the importance of prevention of osteoporosis and vitamin D deficiency in SLE patients. INTRODUCTION The aim of this study is to assess the BMD changes in patients with SLE and to identify the associated factors. METHODS Demographic and clinical data of 126 SLE patients were collected, and BMD measurements of the lumbar spine and the total hip were performed by dual-energy X-ray absorptiometry at baseline and follow-up. Statistical analyses were performed using independent Mann-Whitney U tests and linear regression analyses. RESULTS At baseline, 39.7 % of the patients (90 % female, mean age 39 ± 12.2 years) had osteopenia, and 6.3 % had osteoporosis. The median follow-up duration was 6.7 years (range 1.9-9.3 years). Mean changes in BMD at the lumbar spine (-0.08 %/year) and the hip (-0.20 %/year) were not significant. During follow-up, 70 % of the patients used glucocorticoids. The mean ± SD daily glucocorticoid dose was 5.0 ± 5.0 mg. In multiple regression analysis, BMD loss at the spine was significantly associated with higher daily glucocorticoid dose and lower baseline 25-hydroxyvitamin D levels. BMD loss at the hip was associated with lower 25-hydroxyvitamin D levels at baseline, reduction of body mass index, and baseline use of antimalarials. CONCLUSIONS In this 6-year follow-up study, bone loss was remarkably low. A dose-dependent relationship between glucocorticoid use and spinal bone loss was found. In addition, the use of antimalarials and lower 25-hydroxyvitamin D levels at baseline were associated with BMD loss. These findings underline the importance of prevention and treatment of vitamin D deficiency and osteoporosis in SLE, especially in patients using glucocorticoids or antimalarials.
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Affiliation(s)
- J Jacobs
- Department of Rheumatology, VU University Medical Center, PO Box 7057, 1007MB Amsterdam, The Netherlands
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Tsang-A-Sjoe MWP, Bultink IEM, Voskuyl AE. THU0332 Use and Reasons for Non-Use of Antimalarial Drugs in a Dutch Cohort of Patients with Systemic Lupus Erythematosus. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.860] [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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Lensen KDF, Voskuyl AE, van der Laken CJ, Comans EFI, van Schaardenburg D, Arntzenius AB, Zwijnenburg T, Stam F, Gompelman M, van der Zant F, van Paassen AQ, Voerman B, Smit F, Anten S, Siegert CE, Binnerts A, Smulders YM. FRI0485 18f-fluorodeoxyglucose positron emission tomography in elderly patients with an elevated erythrocyte sedimentation rate of unknown origin. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1612] [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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Gent YY, Voskuyl AE, Ahmadi N, Britsemmer K, Hoetjes N, van Kuijk C, Hoekstra OS, Boers M, van der Laken CJ. SAT0531 Association between Presence of Subclinical Synovitis on (R)-11C-PK11195 Positron Emission Tomography and Clinical Outcome in Rheumatoid Arthritis Patients without Clinical Synovitis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2255] [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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Raterman H, Voskuyl AE, Simsek S, Schreurs M, Hoogstraten IV, Peters M, Halm VV, Dijkmans B, Lips P, Lems W, Nurmohamed M. FRI0134 Increased progression of carotid intima media thickness in thyroid peroxidase antibody positive rheumatoid arthritis patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1261] [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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Jong TDD, Vosslamber S, Eloranta ML, Rönnblom L, Mantel E, Gelderman KA, von Blomberg ME, Bultink IE, Voskuyl AE, Verweij CL. A10.20 On the Origin of the Type I Interferon Activity in Rheumatoid Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203224.20] [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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Hofstee HMA, Serne EH, Roberts C, Hesselstrand R, Scheja A, Moore TL, Wildt M, Manning JB, Vonk Noordegraaf A, Voskuyl AE, Herrick AL. Comment on: A multicentre study on the reliability of qualitative and quantitative nailfold videocapillaroscopy assessment: reply. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes197] [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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van Tellingen A, Voskuyl AE, Vervloet MG, Bijl M, de Sévaux RGL, Berger SP, Derksen RHWM, Berden JHM. Dutch guidelines for diagnosis and therapy of proliferative lupus nephritis. Neth J Med 2012; 70:199-207. [PMID: 22641632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Proliferative lupus nephritis is a strong predictor of morbidity and mortality in patients with systemic lupus erythematosus. Despite improvements in the management of lupus nephritis, a significant number of the patients do not respond to immunosuppressive therapy and progress to end-stage renal failure. In order to optimise the diagnostic strategy and treatment of patients with proliferative lupus nephritis, guidelines are needed. In this review, the Dutch Working Party on Systemic Lupus Erythematosus provides recommendations regarding four important areas in patients with proliferative lupus nephritis: I) indications for a first renal biopsy, II ) definitions of treatment response, III ) selection of treatment options, and IV) indications for a repeat biopsy.
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Affiliation(s)
- A van Tellingen
- Department of Nephrology, VU University Medical Centre, Amsterdam, the Netherlands.
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Martens HA, Nienhuis HLA, Gross S, van der Steege G, Brouwer E, Berden JHM, de Sévaux RGL, Derksen RHWM, Voskuyl AE, Berger SP, Navis GJ, Nolte IM, Kallenberg CGM, Bijl M. Receptor for advanced glycation end products (RAGE) polymorphisms are associated with systemic lupus erythematosus and disease severity in lupus nephritis. Lupus 2012; 21:959-68. [PMID: 22513366 DOI: 10.1177/0961203312444495] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Interaction of advanced glycation end products (AGEs) with their receptors (RAGE) plays an important role in inflammation in auto-immune diseases. Several functional polymorphisms of RAGE have been described. In this study we analysed the role of RAGE polymorphisms in disease susceptibility for systemic lupus erythematosus (SLE). In addition, we investigated whether these polymorphisms in SLE are associated with serum levels of soluble RAGE (sRAGE), renal involvement (lupus nephritis (LN)) and its outcome. METHODS For this cross-sectional study DNA samples of 97 SLE patients, 114 LN patients and 429 healthy controls (HC) were genotyped for four RAGE polymorphisms: -429 T/C, -374 T/A, 2184 A/G and Gly82Ser. Differences in genotype frequencies and allele frequencies were tested between patients and HCs. In SLE patients, sRAGE was measured by enzyme-linked immunosorbent assay (ELISA). In addition, association of genotypes with sRAGE and disease severity in LN was analysed. RESULTS The C allele of -429 T/C, the T allele of -374 T/A and the G allele of 2184 A/G were significantly more prevalent in SLE and LN compared with HC. In LN, the C allele of RAGE -429 T/C, the A allele of -374 T/A and the G allele of RAGE 2184 A/G polymorphism were significantly associated with more proteinuria and worse renal function during the first two years of treatment. No association of genotype with sRAGE was found. CONCLUSION RAGE polymorphisms are associated with susceptibility to SLE and LN. In addition, some of these polymorphisms are likely to be associated with disease severity and initial response to treatment in LN.
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Affiliation(s)
- H A Martens
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
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Hofstee HMA, Serne EH, Roberts C, Hesselstrand R, Scheja A, Moore TL, Wildt M, Manning JB, Vonk Noordegraaf A, Voskuyl AE, Herrick AL. A multicentre study on the reliability of qualitative and quantitative nail-fold videocapillaroscopy assessment. Rheumatology (Oxford) 2011; 51:749-55. [DOI: 10.1093/rheumatology/ker403] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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van Sijl AM, van den Oever IAM, Peters MJL, Boers M, Dijkmans BAC, van Halm VP, Smulders YM, Voskuyl AE, Nurmohamed MT. Subclinical renal dysfunction is independently associated with cardiovascular events in rheumatoid arthritis: the CARRÉ Study. Ann Rheum Dis 2011; 71:341-4. [PMID: 21953344 DOI: 10.1136/annrheumdis-2011-200051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have double the risk of cardiovascular (CV) disease, largely independently of traditional CV risk factors. Renal dysfunction is associated with CV morbidity and mortality in the general population, but data on this association in RA are lacking. OBJECTIVE To investigate the association between renal function and CV events in RA. METHODS The CARRÉ Study is an ongoing prospective cohort study of Dutch patients with RA, which records CV events. Glomerular filtration rate (GFR) was estimated with the abbreviated Modification of Diet in Renal Disease formula. Logistic regression determined the association between estimated GFR and the occurrence of CV events. RESULTS 353 patients were followed for 3 years, and 23 (7%) had a CV event. Patients who had an event had a significantly lower baseline GFR than those who did not (59 vs 79 ml/min, p=0.001). This association remained significant after adjustment for traditional risk factors: in this analysis, a decrease in GFR of 5 ml/min was associated with a 30% (95% CI 7% to 59%) increase in the occurrence of CV events. During follow-up, an unfavourable change in GFR was noted in patients who later had a CV event compared with those who did not. CONCLUSION These data confirm that, in RA, renal dysfunction is associated with a higher risk of CV disease independently of traditional CV risk factors.
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Affiliation(s)
- A M van Sijl
- Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands
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Jamnitski A, Krieckaert CL, Nurmohamed MT, Hart MH, Dijkmans BA, Aarden L, Voskuyl AE, Wolbink GJ. Patients non-responding to etanercept obtain lower etanercept concentrations compared with responding patients. Ann Rheum Dis 2011; 71:88-91. [PMID: 21914626 DOI: 10.1136/annrheumdis-2011-200184] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectiveTo investigate the relationship between serum etanercept levels and clinical response.MethodsIn 292 etanercept-treated patients with rheumatoid arthritis clinical and pharmacological data were determined at baseline and after 1, 4 and 6 months of etanercept treatment. Differences in etanercept levels between good, moderate and European League Against Rheumatism (EULAR) non-responders were assessed after 6 months of therapy.ResultsAfter 6 months of therapy etanercept levels were significantly higher in good responders (median (IQR) 3.78 (2.53–5.17)) compared with both moderate 3.10 (2.12–4.47) and EULAR non-responders 2.80 (1.27–3.93) (all p<0.05). There was a significant association between clinical response and serum etanercept levels (regression coefficient 0.54, 95% CI 0.21 to 0.86, p=0.001). When patients were categorised into quartiles according to the height of etanercept levels, the lowest quartile (etanercept level <2.1 mg/l) comprised 40% of all non-responders. The highest quartile (etanercept level >4.7 mg/l) comprised 35% of all good EULAR responders. Anti-etanercept antibodies were detected in none of the sera.ConclusionThe authors demonstrated that lower etanercept levels were associated with non-response. Therapeutic drug monitoring and the possibility of the adjusted dosing regimes in the selected groups of patients should be investigated further as a possible tool to optimise treatment with etanercept.
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Affiliation(s)
- A Jamnitski
- Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands
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Schouffoer AA, Ninaber MK, Beaart-van de Voorde LJJ, van der Giesen FJ, de Jong Z, Stolk J, Voskuyl AE, Scherptong RWC, van Laar JM, Schuerwegh AJM, Huizinga TWJ, Vlieland TPMV. Randomized comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis. Arthritis Care Res (Hoboken) 2011; 63:909-17. [DOI: 10.1002/acr.20448] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Carmona FD, Simeon CP, Beretta L, Carreira P, Vonk MC, Rios-Fernandez R, Espinosa G, Navarrete N, Vicente-Rabaneda E, Rodriguez-Rodriguez L, Tolosa C, Garcia-Hernandez FJ, Castellvi I, Egurbide MV, Fonollosa V, Gonzalez-Gay MA, Rodriguez-Carballeira M, Diaz-Gonzalez F, Saez-Comet L, Hesselstrand R, Riemekasten G, Witte T, Voskuyl AE, Schuerwegh AJ, Madhok R, Shiels P, Fonseca C, Denton C, Nordin A, Palm O, Hoffmann-Vold AM, Airo P, Scorza R, Lunardi C, van Laar JM, Hunzelmann N, Kreuter A, Herrick A, Worthington J, Koeleman BPC, Radstake TRDJ, Martin J. Association of a non-synonymous functional variant of the ITGAM gene with systemic sclerosis. Ann Rheum Dis 2011; 70:2050-2. [DOI: 10.1136/ard.2010.148874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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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Vosslamber S, Raterman HG, van der Pouw Kraan TCTM, Schreurs MWJ, von Blomberg BME, Nurmohamed MT, Lems WF, Dijkmans BAC, Voskuyl AE, Verweij CL. Induction of IFN type I biology following therapy determines clinical response to rituximab in rheumatoid arthritis. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149005.20] [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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Bossini-Castillo L, Broen JCA, Simeon CP, Beretta L, Vonk MC, Ortego-Centeno N, Espinosa G, Carreira P, Camps MT, Navarrete N, González-Escribano MF, Vicente-Rabaneda E, Rodríguez L, Tolosa C, Román-Ivorra JA, Gómez-Gracia I, García-Hernández FJ, Castellví I, Gallego M, Fernández-Nebro A, Egurbide MV, Follonosa V, García de la Peña P, Pros A, González-Gay MA, Hesselstrand R, Riemekasten G, Witte T, Coenen MJH, Koeleman BP, Houssiau F, Smith V, De Keyser F, Westhovens R, De Langhe E, Voskuyl AE, Schuerwegh AJ, Chee MM, Madhok R, Shiels P, Fonseca C, Denton C, Claes K, Padykov L, Nordin A, Palm Ø, Lie BA, Airó P, Scorza R, van Laar JM, Hunzelmann N, Kreuter A, Herrick A, Worthington J, Radstake TRDJ, Martín J, Rueda B. A replication study confirms the association of TNFSF4 (OX40L) polymorphisms with Systemic Sclerosis in a large European cohort. J Transl Med 2010. [PMCID: PMC3007795 DOI: 10.1186/1479-5876-8-s1-p5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Gorlova O, Martin JM, Rueda B, Koeleman BPC, Ying J, Teruel M, Diaz-Gallo LM, Broen JC, Vonk MC, Simeon CP, Alizadeh BZ, Coenen MJH, Voskuyl AE, Schuerwegh AJ, van Riel PLCM, Vanthuyne M, van ‘t Slot R, Italiaander A, Ophoff RA, Hunzelmann N, Fonollosa V, Ortego-Centeno N, González-Gay MA, García-Hernández FJ, González-Escribano MF, Airo P, van Laar J, Worthington J, Hesselstrand R, Smith V, De Keyser F, Houssiau F, Chee MM, Madhok R, Shiels P, Westhovens R, Kreuter A, de Baere E, Witte T, Padyukov L, Nordin A, Scorza R, Lunardi C, Lie BA, Hoffmann-Vold AM, García de la Peña P, Carreira P, Varga J, Hinchcliff M, Lee AT, Gourh P, Amos CI, Riemekasten G, Herrick A, Beretta L, Fonseca C, Denton CP, Gregersen PK, Agarwal S, Assassi S, Tan FK, Arnett FC, Radstake TRDJ, Mayes MD, Martin J. Identification of novel genetic markers associated with the clinical phenotypes of systemic sclerosis through a genome wide association strategy. Lab Invest 2010. [PMCID: PMC3007743 DOI: 10.1186/1479-5876-8-s1-o1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Peters MJL, Voskuyl AE, Sattar N, Dijkmans BAC, Smulders YM, Nurmohamed MT. The interplay between inflammation, lipids and cardiovascular risk in rheumatoid arthritis: why ratios may be better. Int J Clin Pract 2010; 64:1440-3. [PMID: 20716150 DOI: 10.1111/j.1742-1241.2009.02220.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is abundant evidence that patients with rheumatoid arthritis (RA) are at elevated cardiovascular (CV) risk. The contribution of lipids in general is well recognised, but is as yet unclear in inflammatory diseases such as RA in part because inflammation appears inversely associated with lipid levels in RA. METHODS The CARRE study is a cohort study of 353 randomly selected RA outpatients followed since their enrollment in 2001-2002. We used data from this cohort to (i) evaluate the relationship at baseline between lipid levels [total cholesterol (TC), high-density lipoprotein (HDL)-cholesterol and the TC:HDLc ratio] and inflammation [by means of C-reactive protein (CRP)]; and (ii) determine the association of baseline TC and TC:HDLc ratio with incident (fatal and non-fatal) CV events. RESULTS C-reactive protein correlated negatively with TC (r = -0.184, p = 0.002), more so with HDLc (r = -0.327, p = 0.001) and therefore positively with TC:HDLc ratio (r = 0.204, p = 0.001). These associations were most evident when CRP exceeded 10 mg/l. Furthermore, the TC:HDLc ratio, but not TC, was positively related to event risk, again most marked in those with elevated CRP. CONCLUSION Our observations support use of TC:HDLc ratio rather than TC alone in assessing cardiovascular risk in RA patients, especially in those with high inflammatory activity.
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Affiliation(s)
- M J L Peters
- Clinical Research Bureau of the JBI , The Netherlands
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Jamnitski A, Visman IM, Peters MJL, Dijkmans BAC, Voskuyl AE, Nurmohamed MT. Beneficial effect of 1-year etanercept treatment on the lipid profile in responding patients with rheumatoid arthritis: the ETRA study. Ann Rheum Dis 2010; 69:1929-33. [PMID: 20498216 DOI: 10.1136/ard.2009.127597] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Effective anti-inflammatory treatment with tumour necrosis factor α (TNFα) inhibitors may have favourable effects on the lipid profile. Available evidence is derived from short-term studies, and it is not clear whether TNFα inhibitors have a similar effect on the lipid profile in responders and non-responders to the treatment. OBJECTIVES To investigate the effect of long-term etanercept treatment on the lipid profile in a large sample of patients with rheumatoid arthritis (RA), stratified for European League Against Rheumatism (EULAR) response. METHODS Between 2004 and 2008, 292 consecutive patients with active RA (DAS28 >3.2) and a new etanercept prescription were included in an observational cohort. Clinical response variables and lipid samples were collected at baseline and after 4 months and 1 year of etanercept treatment. Generalised estimating equation analyses were used to investigate the longitudinal course of lipid levels in relation to clinical response variables. RESULTS According to the EULAR response criteria, 76% of the patients were good or moderate responders at 4 months, and 85% of the remainder at 1 year. Significant changes in apoA-I (increased by 3.5% (p=0.002) at 4 months and 3.1% (p=0.005) at 1 year) and apoB/apoA-I ratio (decreased by 6.2% (p<0.001) at 4 months and 3.6% (p=0.025) at 1 year) were observed in EULAR responders. No significant differences were observed in EULAR non-responders at all time points. CONCLUSIONS Treatment with etanercept resulted in a significant and sustained decrease in the apoB/apoA-I ratio in patients with good or moderate EULAR response. This may have a beneficial effect on the cardiovascular risk in patients with RA.
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Affiliation(s)
- A Jamnitski
- Jan van Breemen Institute, Amsterdam, The Netherlands
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Raterman HG, Hoving JL, Nurmohamed MT, Herenius MMJ, Sluiter JK, Lems WF, Tak PP, Dijkmans BAC, Twisk J, Frings-Dresen MHW, Voskuyl AE. Work ability: a new outcome measure in rheumatoid arthritis? Scand J Rheumatol 2010; 39:127-31. [DOI: 10.3109/03009740903447044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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