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Almaani S, Song H, Suthanthira M, Toy C, Fussner LA, Meara A, Nagaraja H, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Warrington KJ, Monach PA, Merkel PA, Rovin B, Birmingham D. Urine and Plasma Complement Ba Levels During Disease Flares in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis. Kidney Int Rep 2023; 8:2421-2427. [PMID: 38025219 PMCID: PMC10658281 DOI: 10.1016/j.ekir.2023.08.017] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Although the alternative complement pathway has been implicated in the pathogenesis of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV), the specific nature of its involvement is unclear. This study measured levels of urine and plasma complement fragment Ba at multiple time points in a group of patients with AAV. Methods The complement fragment Ba was measured by enzyme-linked immunosorbent assay in serial urine and plasma samples from 21 patients with AAV who developed a renal flare, 19 who developed a nonrenal flare, and 20 in long-term remission. Urine Ba levels were corrected for urine creatinine concentration. Changes in Ba levels were modeled using mixed linear-effect models. A logistic regression model was fit to predict a renal flare using Ba levels at the time of flare versus the nonrenal flare and long-term remission groups. Results Data from 60 patients with AAV were used for this analysis; 53% were male, 93% were White, and 74% had antiproteinase3-ANCA. Urine Ba levels increased at renal flare (P < 0.001) but remained stable during a nonrenal flare or long-term remission. Plasma Ba levels were stable over time in all groups. Urine Ba levels predicted a renal flare with an area under the curve of 0.76 (P < 0.001), with a cutoff of 12.53 ng/mg urine creatinine yielding a sensitivity of 76.2% and a specificity of 68.4%. Conclusion Urine Ba levels, but not plasma Ba levels, are increased at the time of a renal flare in AAV, suggesting intrarenal complement activation and highlighting the potential use of this biomarker for surveillance of active renal vasculitis.
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Affiliation(s)
- Salem Almaani
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Huijuan Song
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Meshora Suthanthira
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher Toy
- Department of Soil and Crop Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lynn A. Fussner
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alexa Meara
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Haikady Nagaraja
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, Tampa, Florida, USA
| | - Nader A. Khalidi
- Division of Rheumatology, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | | | | | - Carol A. McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Larry W. Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, Colorado, USA
| | - Christian Pagnoux
- Division of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Ulrich Specks
- Mayo Clinic College of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Antoine G. Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth J. Warrington
- Mayo Clinic College of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Paul A. Monach
- Veteran’s Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Peter A. Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brad Rovin
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel Birmingham
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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2
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Michailidou D, Grayson PC, Hermanson P, Chapa JAG, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Sreih AG, Warrington KJ, Monach PA, Merkel PA, Lood C. Mitochondrial-mediated inflammation and platelet activation in giant cell arteritis. Clin Immunol 2023; 255:109746. [PMID: 37625669 PMCID: PMC10543636 DOI: 10.1016/j.clim.2023.109746] [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: 07/16/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
Markers of extracellular mitochondria are present in giant cell arteritis (GCA) patients. However, their role in promoting inflammation and platelet activation is no known. To investigate this, isolated mitochondria were opsonized with plasma from GCA patients or healthy individuals and incubated with peripheral blood mononuclear cells (PBMCs) or platelets and assessed for inflammatory cytokine production and platelet activation. Plasma from GCA patients promoted increased mitochondrial-mediated cytokine production by PBMCs as compared to healthy controls (p < 0.05). Mitochondria opsonized with plasma factors from patients with GCA induced higher platelet activation as compared to mitochondria opsonized with plasma factors from healthy individuals (p = 0.0015). Platelet levels of P-selectin were associated with disease activity in GCA (r = 0.34, p = 0.01). GCA patients have impaired ability to regulate the clearance of extracellular mitochondria, possibly contributing to excessive inflammation and platelet activation. Targeting key drivers of mitochondrial extrusion and/or their clearance could lead to new therapeutic interventions in GCA.
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Affiliation(s)
- Despina Michailidou
- Division of Rheumatology, University of Washington, Seattle, WA, USA; Division of Rheumatology, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA; Division of Rheumatology, Oklahoma City VA Health Care System, Oklahoma, OK, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Payton Hermanson
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | | | - David Cuthbertson
- Health Informatics Institute, University of South Florida, South Florida, FL, USA
| | - Nader A Khalidi
- Division of Rheumatology, Mc Master University, Ontario, Canada
| | | | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, CO, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Lood
- Division of Rheumatology, University of Washington, Seattle, WA, USA.
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Junek ML, Zhao L, Garner S, Cuthbertson D, Pagnoux C, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Rhee RL, Seo P, Specks U, Sreih AG, Warrington K, Wechsler ME, Merkel PA, Khalidi NA. Ocular manifestations of ANCA-associated vasculitis. Rheumatology (Oxford) 2023; 62:2517-2524. [PMID: 36440847 PMCID: PMC10321114 DOI: 10.1093/rheumatology/keac663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/25/2022] [Accepted: 11/12/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES ANCA-associated vasculitis (AAV) is a group of multisystem diseases that can have several ocular manifestations. There are published data on ocular manifestations of granulomatosis with polyangiitis (GPA), but few for eosinophilic granulomatosis with polyangiitis (EGPA) or microscopic polyangiitis (MPA). There is little information concerning chronicity, complications, and association with other cranial manifestations of AAV. METHODS This study retrospectively analysed longitudinal multicentre cohorts of individuals with AAV followed between 2006 and 2022. Data included diagnosis, demographics, cranial manifestations of disease, presence of manifestations at onset of disease and/or follow-up, and ocular complications of disease. Univariate and multivariable logistic regression analysis assessed associations across disease manifestations. RESULTS Data from 1441 patients were analysed, including 395 with EGPA, 876 with GPA, and 170 with MPA. Ocular manifestations were seen within 23.1% of patients: 39 (9.9%) with EGPA, 287 (32.7%) with GPA, and 12 (7.1%) with MPA at any time in the disease course. There were more ocular manifestations at onset (n = 224) than during follow-up (n = 120). The most common disease-related manifestations were conjunctivitis/episcleritis and scleritis. In multivariable analysis, dacryocystitis, lacrimal duct obstruction, and retro-orbital disease were associated with sinonasal manifestations of GPA; ocular manifestations were associated with hearing loss in MPA. The most common ocular complications and/or damage seen were cataracts (n = 168) and visual impairment (n = 195). CONCLUSION Ocular manifestations occur in all forms of AAV, especially in GPA. Clinicians should be mindful of the wide spectrum of ocular disease in AAV, caused by active vasculitis, disease-associated damage, and toxicities of therapy.
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Affiliation(s)
- Mats L Junek
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Lily Zhao
- Division of Ophthalmology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Stephanie Garner
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - Paul A Monach
- Rheumatology Section, Veteran’s Affairs Boston Healthcare System, Boston, MA, USA
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Nader A Khalidi
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
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Smith RM, Jones RB, Specks U, Bond S, Nodale M, Al-Jayyousi R, Andrews J, Bruchfeld A, Camilleri B, Carette S, Cheung CK, Derebail V, Doulton T, Ferraro A, Forbess L, Fujimoto S, Furuta S, Gewurz-Singer O, Harper L, Ito-Ihara T, Khalidi N, Klocke R, Koening C, Komagata Y, Langford C, Lanyon P, Luqmani R, McAlear C, Moreland LW, Mynard K, Nachman P, Pagnoux C, Peh CA, Pusey C, Ranganathan D, Rhee RL, Spiera R, Sreih AG, Tesar V, Walters G, Wroe C, Jayne D, Merkel PA. Rituximab versus azathioprine for maintenance of remission for patients with ANCA-associated vasculitis and relapsing disease: an international randomised controlled trial. Ann Rheum Dis 2023; 82:937-944. [PMID: 36958796 PMCID: PMC10313987 DOI: 10.1136/ard-2022-223559] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 01/22/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Following induction of remission with rituximab in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) relapse rates are high, especially in patients with history of relapse. Relapses are associated with increased exposure to immunosuppressive medications, the accrual of damage and increased morbidity and mortality. The RITAZAREM trial compared the efficacy of repeat-dose rituximab to daily oral azathioprine for prevention of relapse in patients with relapsing AAV in whom remission was reinduced with rituximab. METHODS RITAZAREM was an international randomised controlled, open-label, superiority trial that recruited 188 patients at the time of an AAV relapse from 29 centres in seven countries between April 2013 and November 2016. All patients received rituximab and glucocorticoids to reinduce remission. Patients achieving remission by 4 months were randomised to receive rituximab intravenously (1000 mg every 4 months, through month 20) (85 patients) or azathioprine (2 mg/kg/day, tapered after month 24) (85 patients) and followed for a minimum of 36 months. The primary outcome was time to disease relapse (either major or minor relapse). RESULTS Rituximab was superior to azathioprine in preventing relapse: HR 0.41; 95% CI 0.27 to 0.61, p<0.001. 19/85 (22%) patients in the rituximab group and 31/85 (36%) in the azathioprine group experienced at least one serious adverse event during the treatment period. There were no differences in rates of hypogammaglobulinaemia or infection between groups. CONCLUSIONS Following induction of remission with rituximab, fixed-interval, repeat-dose rituximab was superior to azathioprine for preventing disease relapse in patients with AAV with a prior history of relapse. TRIAL REGISTRATION NUMBER NCT01697267; ClinicalTrials.gov identifier.
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Affiliation(s)
- Rona M Smith
- Medicine, University of Cambridge, Cambridge, UK
| | | | - Ulrich Specks
- Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Marianna Nodale
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Reem Al-Jayyousi
- Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jacqueline Andrews
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Annette Bruchfeld
- Nephrology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | | | - Simon Carette
- Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | | | - Vimal Derebail
- Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tim Doulton
- Nephrology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Alastair Ferraro
- Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lindsy Forbess
- Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shouichi Fujimoto
- Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shunsuke Furuta
- Allergy and Clinical Immunology, Chiba University, Chiba, Japan
| | | | | | - Toshiko Ito-Ihara
- The Clinical and Translational Research Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nader Khalidi
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rainer Klocke
- Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Curry Koening
- Rheumatology, The University of Utah, Salt Lake City, Utah, USA
| | - Yoshinori Komagata
- First Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Carol Langford
- Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Peter Lanyon
- Rheumatology, Nottingham University Hospital, Nottingham, UK
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | - Carol McAlear
- Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Larry W Moreland
- Medicine/Rheumatology, University of Pittsburg, Pittsburg, Pennsylvania, USA
| | - Kim Mynard
- Vasculitis and lupus clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patrick Nachman
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christian Pagnoux
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chen Au Peh
- Nephrology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | - Rennie L Rhee
- Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Spiera
- Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Antoine G Sreih
- Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Giles Walters
- Nephrology, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Caroline Wroe
- Nephrology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - David Jayne
- Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Peter A Merkel
- Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Michailidou D, Kuley R, Wang T, Hermanson P, Grayson PC, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Warrington KJ, Monach PA, Merkel PA, Lood C. Neutrophil extracellular trap formation in anti-neutrophil cytoplasmic antibody-associated and large-vessel vasculitis. Clin Immunol 2023; 249:109274. [PMID: 36878421 PMCID: PMC10066833 DOI: 10.1016/j.clim.2023.109274] [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: 01/31/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
Levels of neutrophil extracellular traps (NETs) were measured in plasma of healthy controls (HC, n = 30) and patients with granulomatosis with polyangiitis (GPA, n = 123), microscopic polyangiitis (MPA, n = 61), Takayasu's arteritis (TAK, n = 58), and giant cell arteritis (GCA, n = 68), at times of remission or activity and correlated with levels of the platelet-derived thrombospondin-1 (TSP-1). Levels of NETs were elevated during active disease in patients with GPA (p < 0.0001), MPA (p = 0.0038), TAK (p < 0.0001), and GCA (p < 0.0001), and in remission for GPA, p < 0.0001, MPA, p = 0.005, TAK, p = 0.03, and GCA, p = 0.0009. All cohorts demonstrated impaired NET degradation. Patients with GPA (p = 0.0045) and MPA (p = 0.005) had anti-NET IgG antibodies. Patients with TAK had anti-histone antibodies (p < 0.01), correlating with presence of NETs. Levels of TSP-1 were increased in all patients with vasculitis, and associated with NET formation. NET formation is a common process in vasculitides. Targeting NET formation or degradation could be potential therapeutic approaches for vasculitides.
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Affiliation(s)
| | - Runa Kuley
- Division of Rheumatology, University of Washington, Seattle, USA; Center for Life Sciences, Mahindra University, Hyderabad, India
| | - Ting Wang
- Division of Rheumatology, University of Washington, Seattle, USA
| | - Payton Hermanson
- Division of Rheumatology, University of Washington, Seattle, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, South Florida, FL, USA
| | - Nader A Khalidi
- Division of Rheumatology, Mc Master University, Ontario, Canada
| | | | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, CO, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Lood
- Division of Rheumatology, University of Washington, Seattle, USA.
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Michailidou D, Duvvuri B, Kuley R, Cuthbertson D, Grayson PC, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Warrington KJ, Mustelin T, Monach PA, Merkel PA, Lood C. Neutrophil activation in patients with anti-neutrophil cytoplasmic autoantibody-associated vasculitis and large-vessel vasculitis. Arthritis Res Ther 2022; 24:160. [PMID: 35768848 PMCID: PMC9241246 DOI: 10.1186/s13075-022-02849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To assess markers of neutrophil activation such as calprotectin and N-formyl methionine (fMET) in anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) and large-vessel vasculitis (LVV). Methods Levels of fMET, and calprotectin, were measured in the plasma of healthy controls (n=30) and patients with AAV (granulomatosis with polyangiitis (GPA, n=123), microscopic polyangiitis (MPA, n=61)), and LVV (Takayasu’s arteritis (TAK, n=58), giant cell arteritis (GCA, n=68)), at times of remission or flare. Disease activity was assessed by physician global assessment. In vitro neutrophil activation assays were performed in the presence or absence of formyl peptide receptor 1 (FPR1) inhibitor cyclosporine H. Results Levels of calprotectin, and fMET were elevated in patients with vasculitis as compared to healthy individuals. Levels of fMET correlated with markers of systemic inflammation: C-reactive protein (r=0.82, p<0.0001), and erythrocyte sedimentation rate (r=0.235, p<0.0001). The neutrophil activation marker, calprotectin was not associated with disease activity. Circulating levels of fMET were associated with neutrophil activation (p<0.01) and were able to induce de novo neutrophil activation via FPR1-mediated signaling. Conclusion Circulating fMET appears to propagate neutrophil activation in AAV and LVV. Inhibition of fMET-mediated FPR1 signaling could be a novel therapeutic intervention for systemic vasculitides.
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Affiliation(s)
- Despina Michailidou
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - Bhargavi Duvvuri
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - Runa Kuley
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, South Florida, Tampa, FL, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Nader A Khalidi
- Division of Rheumatology, Mc Master University, Hamilton, Ontario, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Colorado, Denver, CO, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Tomas Mustelin
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA
| | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Lood
- Division of Rheumatology, Department of Medicine, University of Washington, 750 Republican Street, Seattle, WA, 98109, USA.
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7
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Doubelt I, Springer JM, Kermani TA, Sreih AG, Burroughs C, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach PA, Shaw DG, Seo P, Specks U, Warrington KJ, Young K, Merkel PA, Pagnoux C. Self-Reported Data and Physician-Reported Data in Patients With Eosinophilic Granulomatosis With Polyangiitis: Comparative Analysis. Interact J Med Res 2022; 11:e27273. [PMID: 35612893 PMCID: PMC9178459 DOI: 10.2196/27273] [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: 01/21/2021] [Revised: 07/03/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patient-based registries can help advance research on rare diseases such as eosinophilic granulomatosis with polyangiitis (EGPA), a complex multiorgan form of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis. Objective The aim of this study is to compare patient-reported and physician-reported data on manifestations, treatments, and outcomes for patients with EGPA. Methods We completed a comparative analysis of patients ≥18 years with EGPA in Canada and the United States from the following 2 cohorts: (1) The Vasculitis Patient-Powered Research Network (VPPRN), a self-enrolled secure portal with patient-entered data updated quarterly (2014-2019) and (2) the Vasculitis Clinical Research Consortium (VCRC) observational studies, a physician-entered database (2003-2019) of patients who fulfilled the 1990 American College of Rheumatology classification criteria for EGPA. The studied parameters included demographic characteristics, clinical manifestations, ANCA status, treatments, and relapses. Results Data from 195 patients with a validated diagnosis of EGPA in the VPPRN and 354 patients enrolled in the VCRC were analyzed. Compared to the VCRC cohort, the patients in the VPPRN cohort were more likely to be female (135/195, 69.2% compared to 209/354, 59%; P=.02) and younger at diagnosis (47.3 compared to 50.0 years; P=.03); both cohorts reported similar frequencies of asthma (177/184, 96.2% in the VPPRN cohort compared to 329/354, 92.9% in the VCRC cohort; P=.13) and cardiac manifestations (44/153, 28.8% compared to 75/354, 21.2%; P=.06), but the VPPRN cohort reported less frequent lung manifestations other than asthma and more frequent disease manifestations in all other organ systems. The ANCA positivity was 48.9% (64/131) in the VPPRN patients compared to 38.9% (123/316; P=.05) in the VCRC cohort. Relapsing disease after study enrollment was reported in 32.3% (63/195) of patients in the VPPRN compared to 35.7% (99/277) of patients in the VCRC. Most therapies (GC, cyclophosphamide, mepolizumab) were used at similar frequencies in both groups, except for rituximab with VPPRN patients reporting more use than the VCRC cohort (47/195, 24.1% compared to 29/277, 10.5%; P<.001). Conclusions Overall, patients and physicians report manifestations of EGPA at similar frequencies. However, observed differences between patient and physician reports imply the potential occurrence of selection biases. These results support the use of patient-reported data in EGPA but also the need for careful consideration of disease-specific definitions for the study of EGPA and how patient- and physician-reported data are collected. Trial Registration ClinicalTrials.gov NCT00315380, https://clinicaltrials.gov/ct2/show/NCT00315380; ClinicalTrials.gov NCT01241305, https://clinicaltrials.gov/ct2/show/NCT01241305
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Affiliation(s)
- Irena Doubelt
- Vasculitis Clinic, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Jason M Springer
- Division of Rheumatology and Immunology, Medical Center, Vanderbilt University, Nashville, TN, United States
| | - Tanaz A Kermani
- Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Cristina Burroughs
- Health Informatics Institute, University of South Florida, Tampa, FL, United States
| | - David Cuthbertson
- Health Informatics Institute, University of South Florida, Tampa, FL, United States
| | - Simon Carette
- Vasculitis Clinic, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah Hospital, Salt Lake City, UT, United States
| | - Carol Langford
- Division of Rheumatology, Cleveland Clinic, Cleveland, OH, United States
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Paul A Monach
- Division of Rheumatology, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Dianne G Shaw
- Vasculitis Foundation, Kansas City, MO, United States
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Kenneth J Warrington
- Division of Rheumatology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Kalen Young
- Vasculitis Foundation, Kansas City, MO, United States
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Rheumatology, University of Toronto, Toronto, ON, Canada
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8
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Doubelt I, Cuthbertson D, Carette S, Chung SA, Forbess LJ, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach PA, Seo P, Specks U, Spiera RF, Springer JM, Sreih AG, Warrington KJ, Merkel PA, Pagnoux C. Clinical Manifestations and Long-Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America. ACR Open Rheumatol 2021; 3:404-412. [PMID: 34032390 PMCID: PMC8207688 DOI: 10.1002/acr2.11263] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 11/08/2022] Open
Abstract
Objective To describe clinical manifestations and outcomes in patients with eosinophilic granulomatosis with polyangiitis (EGPA) in North America. Methods Analysis of patients aged 18 years or older who fulfilled the 1990 American College of Rheumatology Classification Criteria for EGPA enrolled in the Vasculitis Clinical Research Consortium from 2003 to 2019. Main clinical characteristics, treatments, outcomes, and accumulated damage were studied. Results The cohort included 354 patients; 59% female; age at diagnosis of 50.0 (±14) years; 39% were antineutrophil cytoplasm antibody (ANCA) positive. Time from diagnosis to last follow‐up was 7.0 (±6.2) years; 49.4% had one or more relapse. Patients positive for ANCA more commonly had neurological and kidney involvement when compared with patients negative for ANCA, who had more cardiac and lung manifestations. At last study visit, only 35 (12.6%) patients had been off all therapy for more than 2 years during their follow‐up. The overall mortality rate was 4.0% and did not differ by ANCA status or cyclophosphamide use. Scores on the Vasculitis Damage Index (VDI) for 134 patients with two or more visits and more than 1 year of follow‐up increased from 1.7 (±1.8) at enrollment (3.7 [±5.1] years after diagnosis) to 3.35 (±2.1) at last follow‐up (7.5 [±5.8] years after diagnosis), mainly represented by chronic asthma (67.5%), peripheral neuropathy (49.6%), and chronic sinusitis (31.3%). Longer duration of glucocorticoid use and relapse were associated with higher VDI scores. Conclusion This analysis describes the many clinical manifestations and varied outcomes of EGPA and highlights the ongoing need to attain more sustained, long‐term remission to limit the accrual of disease‐related damage.
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Affiliation(s)
- Irena Doubelt
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Simon Carette
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Lindsy J Forbess
- Cedars Sinai Medical Center, Los Angeles, California, United States
| | - Nader A Khalidi
- McMaster University and St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | | | | | | | - Larry W Moreland
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Paul A Monach
- Division of Rheumatology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Ulrich Specks
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States
| | - Robert F Spiera
- Hospital for Special Surgery, New York, New York, United States
| | | | | | - Kenneth J Warrington
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States
| | | | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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9
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Sreih AG, Cronin K, Shaw DG, Young K, Burroughs C, Kullman J, Machireddy K, McAlear CA, Merkel PA. Diagnostic delays in vasculitis and factors associated with time to diagnosis. Orphanet J Rare Dis 2021; 16:184. [PMID: 33882989 PMCID: PMC8059170 DOI: 10.1186/s13023-021-01794-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with vasculitis, a set of rare diseases, encounter delays in obtaining an accurate diagnosis which can lead to substantial morbidity and increased mortality. This study sought to describe the diagnostic journey of patients with vasculitis and identify factors associated with time to diagnosis. METHODS Patients with vasculitis enrolled in an online registry completed a two-stage study: Stage 1: survey of open-ended questions about patients' diagnostic journeys and perceived factors associated with rapid or delayed diagnosis; Stage 2: survey with specific questions based on data from Stage 1 and additional investigator-identified factors. RESULTS 375 patients with vasculitis participated in Stage 1; 456 patients participated in Stage 2. 85% of patients were seen by a healthcare provider within 3 months of the onset of symptoms. The median time to diagnosis of vasculitis was 7 months. 313/456 (73%) of patients were misdiagnosed initially. 40% of diagnoses were made in a hospital setting; 2% of diagnoses were made at a specialized vasculitis center. 60% of patients had at least 1 visit to an emergency room prior to diagnosis. Unemployment, time to travel to a medical center > 1 h, initial misdiagnosis, and delays in seeing a specialist were all associated with longer times to diagnosis. 373/456 (82%) of patients reported that a delayed diagnosis had negative consequences on their health. CONCLUSION Patients with vasculitis encounter substantial delays in achieving an accurate diagnosis and these delays are associated with negative health consequences. Both patient-related factors and healthcare-related factors are associated with diagnostic delays.
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Affiliation(s)
- Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, White Building, 5th Floor, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Keri Cronin
- Division of Rheumatology, University of Pennsylvania, White Building, 5th Floor, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | | | - Kalen Young
- The Vasculitis Foundation, Kansas City, MO, USA
| | | | | | - Kirthi Machireddy
- Division of Rheumatology, University of Pennsylvania, White Building, 5th Floor, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, White Building, 5th Floor, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, White Building, 5th Floor, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
- Vasculitis Patient-Powered Research Network, Philadelphia, PA, USA.
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10
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Rhee RL, Lu J, Bittinger K, Lee JJ, Mattei LM, Sreih AG, Chou S, Miner JJ, Cohen NA, Kelly BJ, Lee H, Grayson PC, Collman RG, Merkel PA. Dynamic Changes in the Nasal Microbiome Associated With Disease Activity in Patients With Granulomatosis With Polyangiitis. Arthritis Rheumatol 2021; 73:1703-1712. [PMID: 33682371 DOI: 10.1002/art.41723] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Little is known about temporal changes in nasal bacteria in granulomatosis with polyangiitis (GPA). This study was undertaken to examine longitudinal changes in the nasal microbiome in association with relapse in GPA patients. METHODS Bacterial 16S ribosomal RNA gene sequencing was performed on nasal swabs from 19 patients with GPA who were followed up longitudinally for a total of 78 visits, including 9 patients who experienced a relapse and 10 patients who remained in remission. Relative abundance of bacteria and ratios between bacteria were examined. Generalized estimating equation models were used to evaluate the association between bacterial composition and 1) disease activity and 2) levels of antineutrophil cytoplasmic antibody (ANCA) with specificity for proteinase 3 (PR3), adjusted for medication. RESULTS Corynebacterium and Staphylococcus were the most abundant bacterial genera across all nasal samples. Patients with quiescent disease maintained a stable ratio of Corynebacterium to Staphylococcus across visits. In contrast, in patients who experienced a relapse, a significantly lower ratio was observed at the visit prior to relapse, followed by a higher ratio at the time of relapse (adjusted P < 0.01). Species-level analysis identified an association between a higher abundance of nasal Corynebacterium tuberculostearicum and 1) relapse (adjusted P = 0.04) and 2) higher PR3-ANCA levels (adjusted P = 0.02). CONCLUSION In GPA, significant changes occur in the nasal microbiome over time and are associated with disease activity. The occurrence of these changes months prior to the onset of relapse supports a pathogenic role of nasal bacteria in GPA. Our results uphold existing hypotheses implicating Staphylococcus as an instigator of disease and have generated a novel finding involving Corynebacterium as a potential mediator of disease in GPA.
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Affiliation(s)
| | - Jiarui Lu
- University of Pennsylvania, Philadelphia
| | - Kyle Bittinger
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jung-Jin Lee
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa M Mattei
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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11
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Schnappauf O, Moura NS, Aksentijevich I, Stoffels M, Ombrello AK, Hoffmann P, Barron K, Remmers EF, Hershfield M, Kelly SJ, Cuthbertson D, Carette S, Chung SA, Forbess L, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Springer JM, Sreih AG, Warrington KJ, Ytterberg SR, Kastner DL, Grayson PC, Merkel PA. Sequence-Based Screening of Patients With Idiopathic Polyarteritis Nodosa, Granulomatosis With Polyangiitis, and Microscopic Polyangiitis for Deleterious Genetic Variants in ADA2. Arthritis Rheumatol 2021; 73:512-519. [PMID: 33021335 PMCID: PMC9945880 DOI: 10.1002/art.41549] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Deficiency of adenosine deaminase 2 (DADA2) is a monogenic form of vasculitis that can resemble polyarteritis nodosa (PAN). This study was undertaken to identify potential disease-causing sequence variants in ADA2 in patients with idiopathic PAN, granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA). METHODS Patients with idiopathic PAN (n = 118) and patients with GPA or MPA (n = 1,107) were screened for rare nonsynonymous variants in ADA2 using DNA sequencing methods. ADA-2 enzyme activity was assessed in selected serum samples. RESULTS Nine of 118 patients with PAN (7.6%) were identified as having rare nonsynonymous variants in ADA2. Four patients (3.4%) were biallelic for pathogenic or likely pathogenic variants, and 5 patients (4.2%) were monoallelic carriers for 3 variants of uncertain significance and 2 likely pathogenic variants. Serum samples from 2 patients with PAN with biallelic variants were available and showed markedly reduced ADA-2 enzyme activity. ADA-2 enzyme testing of 86 additional patients revealed 1 individual with strongly reduced ADA-2 activity without detectable pathogenic variants. Patients with PAN and biallelic variants in ADA2 were younger at diagnosis than patients with 1 or no variant in ADA2, with no other clinical differences noted. None of the patients with GPA or MPA carried biallelic variants in ADA2. CONCLUSION A subset of patients with idiopathic PAN meet genetic criteria for DADA2. Given that tumor necrosis factor inhibition is efficacious in DADA2 but is not conventional therapy for PAN, these findings suggest that ADA-2 testing should strongly be considered in patients with hepatitis B virus-negative idiopathic PAN.
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Affiliation(s)
- Oskar Schnappauf
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Natalia Sampaio Moura
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Ivona Aksentijevich
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Monique Stoffels
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Amanda K. Ombrello
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Patrycja Hoffmann
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Karyl Barron
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Elaine F. Remmers
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | - Paul A. Monach
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Daniel L. Kastner
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Peter C. Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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12
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Agiro A, Chen X, Eshete B, Sutphen R, Bourquardez Clark E, Burroughs CM, Nowell WB, Curtis JR, Loud S, McBurney R, Merkel PA, Sreih AG, Young K, Haynes K. Data linkages between patient-powered research networks and health plans: a foundation for collaborative research. J Am Med Inform Assoc 2020; 26:594-602. [PMID: 30938759 DOI: 10.1093/jamia/ocz012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 10/17/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Patient-powered research networks (PPRNs) are a valuable source of patient-generated information. Diagnosis code-based algorithms developed by PPRNs can be used to query health plans' claims data to identify patients for research opportunities. Our objective was to implement privacy-preserving record linkage processes between PPRN members' and health plan enrollees' data, compare linked and nonlinked members, and measure disease-specific confirmation rates for specific health conditions. MATERIALS AND METHODS This descriptive study identified overlapping members from 4 PPRN registries and 14 health plans. Our methods for the anonymous linkage of overlapping members used secure Health Insurance Portability and Accountability Act-compliant, 1-way, cryptographic hash functions. Self-reported diagnoses by PPRN members were compared with claims-based computable phenotypes to calculate confirmation rates across varying durations of health plan coverage. RESULTS Data for 21 616 PPRN members were hashed. Of these, 4487 (21%) members were linked, regardless of any expected overlap with the health plans. Linked members were more likely to be female and younger than nonlinked members were. Irrespective of duration of enrollment, the confirmation rates for the breast or ovarian cancer, rheumatoid or psoriatic arthritis or psoriasis, multiple sclerosis, or vasculitis PPRNs were 72%, 50%, 75%, and 67%, increasing to 91%, 67%, 93%, and 80%, respectively, for members with ≥5 years of continuous health plan enrollment. CONCLUSIONS This study demonstrated that PPRN membership and health plan data can be successfully linked using privacy-preserving record linkage methodology, and used to confirm self-reported diagnosis. Identifying and confirming self-reported diagnosis of members can expedite patient selection for research opportunities, shorten study recruitment timelines, and optimize costs.
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Affiliation(s)
| | | | | | - Rebecca Sutphen
- Heath Informatics Institute, University of South Florida, Tampa, Florida, USA
| | | | | | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara Loud
- Accelerated Cure Project, Waltham, Massachusetts, USA
| | | | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kalen Young
- Vasculitis Foundation, Kansas City, Missouri, USA
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13
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Gribbons KB, Ponte C, Carette S, Craven A, Cuthbertson D, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Quinn KA, Robson JC, Seo P, Sreih AG, Suppiah R, Warrington KJ, Ytterberg SR, Luqmani R, Watts R, Merkel PA, Grayson PC. Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2020; 72:1615-1624. [PMID: 31444857 DOI: 10.1002/acr.24055] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). METHODS Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort. RESULTS A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage. CONCLUSION Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis.
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Affiliation(s)
- K Bates Gribbons
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
| | | | - Simon Carette
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Paul A Monach
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | | | - Christian Pagnoux
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin A Quinn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland, and Georgetown University, Washington, DC
| | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | - Richard Watts
- Norwich Medical School, University of East Anglia, Norwich, and University of Oxford, Oxford, UK
| | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
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14
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Rimland CA, Quinn KA, Rosenblum JS, Schwartz MN, Bates Gribbons K, Novakovich E, Sreih AG, Merkel PA, Ahlman MA, Grayson PC. Outcome Measures in Large Vessel Vasculitis: Relationship Between Patient-, Physician-, Imaging-, and Laboratory-Based Assessments. Arthritis Care Res (Hoboken) 2020; 72:1296-1304. [PMID: 31785185 DOI: 10.1002/acr.24117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/26/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the relationship between measures of disease assessment in patients with large vessel vasculitis. METHODS Patients with giant cell arteritis (GCA) or Takayasu arteritis (TAK) were recruited into a prospective, observational cohort. Assessments within the following outcomes were independently recorded: 1) patient-reported outcomes (Multidimensional Fatigue Inventory, patient global assessment of disease activity [PtGA], Short Form 36 health survey [SF-36], Brief Illness Perception Questionnaire), 2) physician global assessment of disease activity (PhGA), 3) laboratory outcomes (C-reactive protein [CRP] level, erythrocyte sedimentation rate [ESR]), and 4) imaging outcomes (PETVAS, a qualitative score of vascular 18 F-fluorodeoxyglucose-positron emission tomography activity). RESULTS Analyses were performed on 112 patients (GCA = 56, TAK = 56), over 296 visits, with a median follow-up of 6 months. Correlation network analysis revealed assessment measures clustered independently by type of outcome. PhGA was centrally linked to all other outcome types, but correlations were modest (ρ = 0.12-0.32; P < 0.05). PETVAS, CRP level, and PtGA were independently associated with clinically active disease. All 4 patient-reported outcomes strongly correlated with each other (ρ = 0.35-0.60; P < 0.0001). Patient-reported outcomes were not correlated with PETVAS, and only PtGA correlated with CRP level (ρ = 0.16; P < 0.01). Patients whose clinical assessment changed from active disease to remission (n = 29) had a corresponding significant decrease in ESR, CRP level, and PETVAS at the remission visit. Patients whose clinical assessment changed from remission to active disease (n = 11) had a corresponding significant increase in CRP level and PtGA at the active visit. CONCLUSION Measures of disease assessment in large vessel vasculitis consist of independent, yet complementary, outcomes, supporting the need to develop composite outcome measures or a standard set of measures covering multiple types of outcomes.
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Affiliation(s)
- Casey A Rimland
- NIH, Bethesda, Maryland, and University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Kaitlin A Quinn
- NIH, Bethesda, Maryland, and MedStar Georgetown University Hospital, Washington, District of Columbia
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15
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Smith RM, Jones RB, Specks U, Bond S, Nodale M, Aljayyousi R, Andrews J, Bruchfeld A, Camilleri B, Carette S, Cheung CK, Derebail V, Doulton T, Forbess L, Fujimoto S, Furuta S, Gewurz-Singer O, Harper L, Ito-Ihara T, Khalidi N, Klocke R, Koening C, Komagata Y, Langford C, Lanyon P, Luqmani RA, Makino H, McAlear CA, Monach P, Moreland LW, Mynard K, Nachman P, Pagnoux C, Pearce F, Peh CA, Pusey C, Ranganathan D, Rhee RL, Spiera R, Sreih AG, Tesar V, Walters G, Weisman MH, Wroe C, Merkel PA, Jayne D. Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis. Ann Rheum Dis 2020; 79:1243-1249. [PMID: 32581088 PMCID: PMC7456549 DOI: 10.1136/annrheumdis-2019-216863] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [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] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/15/2020] [Accepted: 04/29/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Evaluation of rituximab and glucocorticoids as therapy to induce remission after relapse in ANCA-associated vasculitis (AAV) in a prospective observational cohort of patients enrolled into the induction phase of the RITAZAREM trial. METHODS Patients relapsing with granulomatosis with polyangiitis or microscopic polyangiitis were prospectively enrolled and received remission-induction therapy with rituximab (4×375 mg/m2) and a higher or lower dose glucocorticoid regimen, depending on physician choice: reducing from either 1 mg/kg/day or 0.5 mg/kg/day to 10 mg/day by 4 months. Patients in this cohort achieving remission were subsequently randomised to receive one of two regimens to prevent relapse. RESULTS 188 patients were studied: 95/188 (51%) men, median age 59 years (range 19-89), prior disease duration 5.0 years (range 0.4-34.5). 149/188 (79%) had previously received cyclophosphamide and 67/188 (36%) rituximab. 119/188 (63%) of relapses had at least one major disease activity item, and 54/188 (29%) received the higher dose glucocorticoid regimen. 171/188 (90%) patients achieved remission by 4 months. Only six patients (3.2% of the study population) did not achieve disease control at month 4. Four patients died in the induction phase due to pneumonia (2), cerebrovascular accident (1), and active vasculitis (1). 41 severe adverse events occurred in 27 patients, including 13 severe infections. CONCLUSIONS This large prospective cohort of patients with relapsing AAV treated with rituximab in conjunction with glucocorticoids demonstrated a high level of efficacy for the reinduction of remission in patients with AAV who have relapsed, with a similar safety profile to previous studies.
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Affiliation(s)
- Rona M Smith
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Marianna Nodale
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Reem Aljayyousi
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Jacqueline Andrews
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Annette Bruchfeld
- Department of Renal Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Vimal Derebail
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tim Doulton
- East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Lindsy Forbess
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | | | | | - Rainer Klocke
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
| | - Curry Koening
- University of Utah Vasculitis Center, Salt Lake City, Utah, USA
| | | | | | - Peter Lanyon
- Rheumatology, Nottingham University Hospital, Nottingham, UK
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | | | - Carole A McAlear
- Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Monach
- Division of Rheumatology, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | | | - Kim Mynard
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patrick Nachman
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christian Pagnoux
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Pearce
- Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Chen Au Peh
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | - Rennie L Rhee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Antoine G Sreih
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Vladimir Tesar
- Department of Nephrology, Charles University, Prague, Czech Republic
| | - Giles Walters
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | | | - Caroline Wroe
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, Middlesbrough, UK
| | - Peter A Merkel
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Jayne
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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16
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Goel R, Gribbons KB, Carette S, Cuthbertson D, Hoffman GS, Joseph G, Khalidi NA, Koening CL, Kumar S, Langford C, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Nair A, Pagnoux C, Quinn KA, Ravindran R, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Merkel PA, Danda D, Grayson PC. Derivation of an angiographically based classification system in Takayasu's arteritis: an observational study from India and North America. Rheumatology (Oxford) 2020; 59:1118-1127. [PMID: 31580452 DOI: 10.1093/rheumatology/kez421] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/08/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To develop and replicate, using data-driven methods, a novel classification system in Takayasu's arteritis based on distribution of arterial lesions. METHODS Patients were included from four international cohorts at major academic centres: India (Christian Medical College Vellore); North America (National Institutes of Health, Vasculitis Clinical Research Consortium and Cleveland Clinic Foundation). All patients underwent whole-body angiography of the aorta and branch vessels, with categorization of arterial damage (stenosis, occlusion or aneurysm) in 13 territories. K-means cluster analysis was performed to identify subgroups of patients based on pattern of angiographic involvement. Cluster groups were identified in the Indian cohort and independently replicated in the North American cohorts. RESULTS A total of 806 patients with Takayasu's arteritis from India (n = 581) and North America (n = 225) were included. Three distinct clusters defined by arterial damage were identified in the Indian cohort and replicated in each of the North American cohorts. Patients in cluster one had significantly more disease in the abdominal aorta, renal and mesenteric arteries (P < 0.01). Patients in cluster two had significantly more bilateral disease in the carotid and subclavian arteries (P < 0.01). Compared with clusters one and two, patients in cluster three had asymmetric disease with fewer involved territories (P < 0.01). Demographics, clinical symptoms and clinical outcomes differed by cluster. CONCLUSION This large study in Takayasu's arteritis identified and replicated three novel subsets of patients based on patterns of arterial damage. Angiographic-based disease classification requires validation by demonstrating potential aetiological or prognostic implications.
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Affiliation(s)
- Ruchika Goel
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - K Bates Gribbons
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Gary S Hoffman
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Sathish Kumar
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Carol Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Carol A McAlear
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Division of Rheumatology, VA Boston Healthcare System, Boston, MA
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Aswin Nair
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | | | - Kaitlin A Quinn
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA.,Division of Rheumatology, Georgetown University, Washington DC, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Antoine G Sreih
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | | | | | - Peter A Merkel
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Peter C Grayson
- Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD, USA
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17
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Chen X, Agiro A, Nowell WB, Loud S, McBurney R, Young K, Sutphen R, Bourquardez Clark E, Burroughs CM, Curtis JR, Sreih AG, Merkel PA, Haynes K. Harnessing health plan enrollee data to boost membership in patient-powered research networks. BMC Health Serv Res 2020; 20:462. [PMID: 32450857 PMCID: PMC7249317 DOI: 10.1186/s12913-020-05325-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/14/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Patient-powered research networks (PPRNs) have been employing and exploring different methods to engage patients in research activities specific to their conditions. One way to intensify patient engagement is to partner with payer stakeholders. The objective of this study was to evaluate the effectiveness of two common payer-initiated outreach methods (postal mail versus email) for inviting prospective candidates to participate in their initiatives. METHODS This descriptive study linked members of a nationally-representative private insurance network to four disease-specific PPRN registries. Eligible members meeting diagnostic criteria who were not registered in any of the four PPRNs by 02/28/2018 were identified, and randomly assigned to either the mail or email group. They were contacted in two outreach efforts: first on 04/23/2018, and one follow-up on 05/23/2018. New registration rates by outreach method as of 8/31/2018 were determined by relinking. We compared registrants and non-registrants using bivariate analysis. RESULTS A total of 14,571 patients were assigned to the mail group, and 14,574 to the email group. Invitations were successfully delivered to 13,834 (94.9%) mail group and 10,205 (70.0%) email group members. A small but significantly larger proportion of mail group members, (n = 78; 0.54, 95% Confidence Interval [CI] {0.42-0.67%}) registered in PPRNs relative to the email group (n = 24; 0.16, 95% CI {0.11-0.25%}), p < 0.001. Members who registered had more comorbidities, were more likely to be female, and had marginally greater medical utilization, especially emergency room visits, relative to non-registrants (52.0% vs. 42.5%, p = 0.05). CONCLUSION A health plan outreach to invite members to participate in PPRNs was modestly effective. Regular mail outperformed less costly email. Providing more value-add to participants may be a possible way to increase recruitment success.
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Affiliation(s)
- Xiaoxue Chen
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA.
| | - Abiy Agiro
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
| | | | - Sara Loud
- Accelerated Cure Project, Waltham, MA, USA
| | | | | | | | | | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Antoine G Sreih
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Haynes
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
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18
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Quinn KA, Gribbons KB, Carette S, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Novakovich E, Merkel PA, Grayson PC. Patterns of clinical presentation in Takayasu's arteritis. Semin Arthritis Rheum 2020; 50:576-581. [PMID: 32460147 DOI: 10.1016/j.semarthrit.2020.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Takayasu's arteritis (TAK) is a clinically heterogenous disease. Patterns of clinical presentation in TAK at diagnosis have not been well described, and a "triphasic pattern" of constitutional symptoms evolving into vascular inflammation and fibrosis has been reported but never systematically evaluated. METHODS Patients with TAK were prospectively recruited from the National Institutes of Health (NIH) and the Vasculitis Clinical Research Consortium (VCRC). Based on clinical presentation at diagnosis, patients were divided into five categories: (1) constitutional symptoms alone, (2) carotidynia, (3) other vascular-associated symptoms, (4) major ischemic event, or (5) asymptomatic. Associated clinical characteristics were evaluated in each category. Preceding symptoms were also assessed to determine the presence of a triphasic disease pattern. RESULTS A total of 275 patients with TAK were included (VCRC=208; NIH=67). Similar heterogeneity of clinical presentation was identified in each cohort: constitutional symptoms (8%), carotidynia (13-15%), other vascular symptoms (43-47%), major ischemic event (28-30%), and asymptomatic (2-6%). An increased relative proportion of males was seen in patients who presented with constitutional symptoms or were asymptomatic at diagnosis (p<0.01). Patients who presented with constitutional symptoms and major ischemic events were youngest at diagnosis. Patients in the asymptomatic group were oldest at diagnosis and often were not treated (p<0.01). Relapse was most frequent in patients who presented with carotidynia (p<0.01). A minority of patients (19%) who presented with a major ischemic event reported a triphasic pattern of disease. CONCLUSION There are diverse clinical presentations at diagnosis in TAK. Patients do not necessarily progress sequentially through phases of disease.
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Affiliation(s)
- Kaitlin A Quinn
- Division of Rheumatology, MedStar Georgetown University Hospital, Washington DC, USA; Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA.
| | - K Bates Gribbons
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, CA
| | - David Cuthbertson
- Department of Biostatistics, University of South Florida, Tampa, FL, USA
| | | | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Monach
- Division of Rheumatology, VA Boston Healthcare System, Boston, MA, USA
| | | | - Christian Pagnoux
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, CA
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, MD, USA
| | - Antoine G Sreih
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Elaine Novakovich
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Peter A Merkel
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
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19
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Quinn KA, Gelbard A, Sibley C, Sirajuddin A, Ferrada MA, Chen M, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Ytterberg SR, Merkel PA, Grayson PC. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology (Oxford) 2020; 58:2203-2211. [PMID: 31199488 DOI: 10.1093/rheumatology/kez217] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/03/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe tracheobronchial disease in patients with granulomatosis with polyangiitis (GPA) and evaluate the utility of dynamic expiratory CT to detect large-airway disease. METHODS Demographic and clinical features associated with the presence of subglottic stenosis (SGS) or endobronchial involvement were assessed in a multicentre, observational cohort of patients with GPA. A subset of patients with GPA from a single-centre cohort underwent dynamic chest CT to evaluate the airways. RESULTS Among 962 patients with GPA, SGS and endobronchial disease were identified in 95 (10%) and 59 (6%) patients, respectively. Patients with SGS were more likely to be female (72% vs 53%, P < 0.01), younger at time of diagnosis (36 vs 49 years, P < 0.01), and have saddle-nose deformities (28% vs 10%, P < 0.01), but were less likely to have renal involvement (39% vs 62%, P < 0.01). Patients with endobronchial disease were more likely to be PR3-ANCA positive (85% vs 66%, P < 0.01), with more ENT involvement (97% vs 77%, P < 0.01) and less renal involvement (42% vs 62%, P < 0.01). Disease activity in patients with large-airway disease was commonly isolated to the subglottis/upper airway (57%) or bronchi (32%). Seven of 23 patients screened by dynamic chest CT had large-airway pathology, including four patients with chronic, unexplained cough, discovered to have tracheobronchomalacia. CONCLUSION SGS and endobronchial disease occur in 10% and 6% of patients with GPA, respectively, and may occur without disease activity in other organs. Dynamic expiratory chest CT is a potential non-invasive screening test for large-airway involvement in GPA.
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Affiliation(s)
- Kaitlin A Quinn
- Division of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA.,Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Alexander Gelbard
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA
| | - Cailin Sibley
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
| | | | - Marcela A Ferrada
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Marcus Chen
- National Institutes of Health, NHLBI, Bethesda, MD, USA
| | - David Cuthbertson
- Biostatistics and Informatics, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada
| | - Nader A Khalidi
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Monach
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry W Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, MN, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
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20
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Rodriguez-Pla A, Warner RL, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Ytterberg SR, Johnson KJ, Merkel PA, Monach PA. Evaluation of Potential Serum Biomarkers of Disease Activity in Diverse Forms of Vasculitis. J Rheumatol 2019; 47:1001-1010. [PMID: 31474593 PMCID: PMC7050393 DOI: 10.3899/jrheum.190093] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We evaluated potential circulating biomarkers of disease activity in giant cell arteritis (GCA), Takayasu arteritis (TA), polyarteritis nodosa (PAN), and eosinophilic granulomatosis with polyangiitis (EGPA). METHODS A panel of 22 serum proteins was tested in patients enrolled in the Vasculitis Clinical Research Consortium Longitudinal Studies of GCA, TA, PAN, or EGPA. Mixed models were used for most analyses. A J48 classification tree method was used to find the most relevant markers to differentiate between active and inactive GCA. RESULTS Tests were done on 418 samples from 152 patients (60 GCA, 29 TA, 26 PAN, 37 EGPA), during both active vasculitis and remission. In GCA, these showed significant (p < 0.05) differences between disease states: B cell-attracting chemokine 1 (BCA)-1/CXC motif ligand 13 (CXCL13), erythrocyte sedimentation rate (ESR), interferon-γ-induced protein 10/CXC motif chemokine 10, soluble interleukin 2 receptor α (sIL-2Rα), and tissue inhibitor of metalloproteinase-1 (TIMP-1). In EGPA, these showed significant increases during active disease: granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage-CSF, interleukin (IL)-6, IL-15, and sIL-2Rα. BCA-1/CXCL13 also showed such increases, but only after adjustment for treatment. In PAN, ESR and matrix metalloprotease (MMP)-3 showed significant differences between disease states. Differences in biomarker levels between diseases were significant for 11 markers and were more striking (all p < 0.01) than differences related to disease activity. A combination of lower values of TIMP-1, IL-6, interferon-γ, and MMP-3 correctly classified 87% of samples with inactive GCA. CONCLUSION We identified novel biomarkers of disease activity in GCA and EGPA. Differences of biomarker levels between diseases, independent of disease activity, were more apparent than differences related to disease activity. Further studies are needed to determine whether these serum proteins have potential for clinical use in distinguishing active disease from remission or in predicting longer-term outcomes.
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Affiliation(s)
- Alicia Rodriguez-Pla
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Roscoe L Warner
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - David Cuthbertson
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Simon Carette
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Nader A Khalidi
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Curry L Koening
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Carol A Langford
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Carol A McAlear
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Larry W Moreland
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Christian Pagnoux
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Philip Seo
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Ulrich Specks
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Antoine G Sreih
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Steven R Ytterberg
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Kent J Johnson
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Peter A Merkel
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
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Mandel-Brehm C, Retallack H, Knudsen GM, Yamana A, Hajj-Ali RA, Calabrese LH, Tihan T, Sample HA, Zorn KC, Gorman MP, Madan Cohen J, Sreih AG, Marcus JF, Josephson SA, Douglas VC, Gelfand JM, Wilson MR, DeRisi JL. Exploratory proteomic analysis implicates the alternative complement cascade in primary CNS vasculitis. Neurology 2019; 93:e433-e444. [PMID: 31270218 DOI: 10.1212/wnl.0000000000007850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 03/12/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify molecular correlates of primary angiitis of the CNS (PACNS) through proteomic analysis of CSF from a biopsy-proven patient cohort. METHODS Using mass spectrometry, we quantitatively compared the CSF proteome of patients with biopsy-proven PACNS (n = 8) to CSF from individuals with noninflammatory conditions (n = 11). Significantly enriched molecular pathways were identified with a gene ontology workflow, and high confidence hits within enriched pathways (fold change >1.5 and concordant Benjamini-Hochberg-adjusted p < 0.05 on DeSeq and t test) were identified as differentially regulated proteins. RESULTS Compared to noninflammatory controls, 283 proteins were differentially expressed in the CSF of patients with PACNS, with significant enrichment of the complement cascade pathway (C4-binding protein, CD55, CD59, properdin, complement C5, complement C8, and complement C9) and neural cell adhesion molecules. A subset of clinically relevant findings were validated by Western blot and commercial ELISA. CONCLUSIONS In this exploratory study, we found evidence of deregulation of the alternative complement cascade in CSF from biopsy-proven PACNS compared to noninflammatory controls. More specifically, several regulators of the C3 and C5 convertases and components of the terminal cascade were significantly altered. These preliminary findings shed light on a previously unappreciated similarity between PACNS and systemic vasculitides, especially anti-neutrophil cytoplasmic antibody-associated vasculitis. The therapeutic implications of this common biology and the diagnostic and therapeutic utility of individual proteomic findings warrant validation in larger cohorts.
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Affiliation(s)
- Caleigh Mandel-Brehm
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Hanna Retallack
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Giselle M Knudsen
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Alex Yamana
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Rula A Hajj-Ali
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Leonard H Calabrese
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Tarik Tihan
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Hannah A Sample
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Kelsey C Zorn
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Mark P Gorman
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Jennifer Madan Cohen
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Antoine G Sreih
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Jacqueline F Marcus
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - S Andrew Josephson
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Vanja C Douglas
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Jeffrey M Gelfand
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Michael R Wilson
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Joseph L DeRisi
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA.
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Sreih AG, Shaw D, Young K, Burroughs C, Kullman J, Machireddy K, McAlear CA, Casey G, Merkel PA. 122. DIAGNOSTIC DELAYS IN VASCULITIS AND FACTORS ASSOCIATED WITH TIME TO DIAGNOSIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Dianne Shaw
- University of North Carolina, Chapel Hill, NC USA
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Aydin SZ, Robson JC, Sreih AG, Hill C, Alibaz-Oner F, Mackie S, Beard S, Gul A, Hatemi G, Kermani TA, Mahr A, Meara A, Milman N, Shea B, Tómasson G, Tugwell P, Direskeneli H, Merkel PA. Update on Outcome Measure Development in Large-vessel Vasculitis: Report from OMERACT 2018. J Rheumatol 2019; 46:1198-1201. [PMID: 30877212 DOI: 10.3899/jrheum.181072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group seeks to develop validated outcome measures for use in trials for large-vessel vasculitis (LVV). METHODS An international Delphi exercise conducted among investigators identified items considered important to measure active disease. In parallel, qualitative research with patients was conducted, including interviews and focus groups. RESULTS Next steps prioritized by the group for LVV include (1) defining disease states (remission, flare, and patient-acceptable symptom state) and (2) selection of patient-reported outcome tools. CONCLUSION The ultimate goal is to develop an OMERACT-endorsed core set of outcome measures for use in clinical trials of LVV.
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Affiliation(s)
- Sibel Z Aydin
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Joanna C Robson
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Antoine G Sreih
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Catherine Hill
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Fatma Alibaz-Oner
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Sarah Mackie
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Susan Beard
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Ahmet Gul
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Gülen Hatemi
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Tanaz A Kermani
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Alfred Mahr
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Alexa Meara
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Nataliya Milman
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Beverley Shea
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Gunnar Tómasson
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Peter Tugwell
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Haner Direskeneli
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Peter A Merkel
- From the Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine; Leeds Teaching Hospitals NHS Trust, Leeds, UK; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Discipline of Medicine, University of Adelaide; The Queen Elizabeth Hospital, Adelaide, Australia; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Department of Internal Medicine, University Paris Diderot, Paris, France; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland. .,S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; C. Hill, MD, Professor, Discipline of Medicine, University of Adelaide, and Consultant Rheumatologist, The Queen Elizabeth Hospital; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; S. Mackie, MRCP, PhD, Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Honorary Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust; S. Beard, Bmus, Adelaide, Australia; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine; G. Hatemi, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine; T.A. Kermani, MD, MS, Associate Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; A. Meara, MD, Assistant Professor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; B. Shea, PhD, Clinical Investigator and Adjunct Professor, Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; G. Tómasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; P. Tugwell, MD, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania.
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Gribbons K, Goel R, Cuthbertson D, Carette S, Hoffman GS, Joseph G, Khalidi NA, Koening CL, Langford C, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Nair A, Pagnoux C, Ravindran R, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Merkel PA, Danda D, Grayson PC. 084. DISCOVERY AND VALIDATION OF A NOVEL ANGIOGRAPHIC CLASSIFICATION SCHEME IN TAKAYASU’S ARTERITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tomasson G, Farrar JT, Cuthbertson D, McAlear CA, Ashdown S, Cronholm PF, Dawson J, Gebhart D, Lanier G, Luqmani RA, Milman N, Peck J, Robson JC, Shea JA, Carette S, Khalidi N, Koening CL, Langford CA, Monach PA, Moreland L, Pagnoux C, Specks U, Sreih AG, Ytterberg SR, Merkel PA. Feasibility and Construct Validation of the Patient Reported Outcomes Measurement Information System in Systemic Vasculitis. J Rheumatol 2019; 46:928-934. [PMID: 30824648 DOI: 10.3899/jrheum.171405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Patient Reported Outcome Measurement Information System (PROMIS) is a collection of item banks of self-reported health. This study assessed the feasibility and construct validity of using PROMIS instruments in vasculitis. METHODS Data from a multicenter longitudinal cohort of subjects with systemic vasculitis were used. Instruments from 10 PROMIS item banks were selected with direct involvement of patients. Subjects completed PROMIS instruments using computer adaptive testing (CAT). The Medical Outcomes Study Short Form-36 (SF-36) was also administered. Cross-sectional construct validity was assessed by calculating correlations of PROMIS scores with SF-36 measures and physician and patient global scores for disease activity. Longitudinal construct validity was assessed by correlations of between-visit differences in PROMIS scores with differences in other measures. RESULTS During the study period, 973 subjects came for 2306 study visits and the PROMIS collection was completed at 2276 (99%) of visits. The median time needed to complete each PROMIS instrument ranged from 40 to 55 s. PROMIS instruments correlated cross-sectionally with individual scales of the SF-36, most strongly with subscales of the SF-36 addressing the same domain as the PROMIS instrument. For example, PROMIS fatigue correlated with both the physical component score (PCS; r = -0.65) and with the mental component score (MCS; r = -0.54). PROMIS physical function correlated strongly with PCS (r = 0.81) but weakly with MCS (r = 0.29). Weaker correlations were observed longitudinally between change in PROMIS scores with change in PCS and MCS. CONCLUSION Collection of data using CAT PROMIS instruments is feasible among patients with vasculitis and has some cross-sectional and longitudinal construct validity.
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Affiliation(s)
- Gunnar Tomasson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada. .,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania.
| | - John T Farrar
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - David Cuthbertson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Carol A McAlear
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Susan Ashdown
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Peter F Cronholm
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Jill Dawson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Don Gebhart
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Georgia Lanier
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Raashid A Luqmani
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Nataliya Milman
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Jacqueline Peck
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Joanna C Robson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Judy A Shea
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Simon Carette
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Nader Khalidi
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Curry L Koening
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Carol A Langford
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Paul A Monach
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Larry Moreland
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Christian Pagnoux
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Ulrich Specks
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Antoine G Sreih
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Steven R Ytterberg
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Peter A Merkel
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
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Sreih AG, Ezzedine R, Leng L, Fan J, Yao J, Reid D, Piecychna M, Carette S, Cuthbertson D, Dellaripa P, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Mahr A, McAlear CA, Maksimowicz-Mckinnon K, Monach PA, Seo P, Specks U, St Clair EW, Stone JH, Ytterberg SR, Edberg J, Merkel PA, Bucala R. Role of Macrophage Migration Inhibitory Factor in Granulomatosis With Polyangiitis. Arthritis Rheumatol 2018; 70:2077-2086. [PMID: 29953750 DOI: 10.1002/art.40655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/26/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the association between macrophage migration inhibitory factor (MIF) promoter polymorphisms and granulomatosis with polyangiitis (GPA) in human subjects, and to assess the role of MIF in a murine model of granulomatous vasculitis. METHODS The human study involved 1,077 patients with GPA and healthy controls whose serum was genotyped by capillary electrophoresis for the MIF -794 CATT5-8 promoter microsatellite (rs5844572). MIF promoter, CATT-length-dependent gene expression in response to β-glucan was assessed by gene reporter assays. In mouse studies, granulomatous disease was induced by injection of Candida albicans β-glucan into wild-type (WT) or Mif-knockout (Mif-KO) C57BL/6 mice and C57BL/6 mice transgenically overexpressing Mif in lung epithelium (Mif lung-Tg2.1). Mice were treated with a neutralizing anti-MIF antibody and analyzed for the density of pulmonary granulomas, expression of inflammatory chemokines, and frequency of mortality. RESULTS The percentage of human subjects carrying >5 CATT repeats in each MIF allele (high genotypic MIF expressers) was 60.2% among patients with GPA and 53.9% among healthy controls (adjusted P = 0.049). In response to granulomatous stimulation, human MIF gene expression increased proportionally with CATT length. Mif lung-Tg2.1 mice exhibited more pulmonary granulomas than WT mice, which in turn showed more granulomas than Mif-KO mice. A significantly higher percentage of Mif lung-Tg2.1 mice, compared to Mif-KO or WT mice, died when injected with Candida albicans β-glucan, and treatment of these mice with an anti-MIF monoclonal antibody protected against a lethal outcome. Levels of MIF-dependent neutrophil/macrophage chemokines were elevated in the bronchoalveolar lavage fluid or plasma of Mif lung-Tg2.1 mice. CONCLUSION Patients with GPA have an increased frequency of high MIF expression CATT alleles. Higher Mif expression increases the incidence of mortality and pulmonary granulomas in Mif lung-Tg2.1 mice, while anti-MIF treatment protects these mice against death. Blockade of MIF in high genotypic MIF expressers may therefore offer a selective pharmacologic therapy for GPA.
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Affiliation(s)
| | | | - Lin Leng
- Yale School of Medicine, New Haven, Connecticut
| | - Juan Fan
- Yale School of Medicine, New Haven, Connecticut
| | - Jie Yao
- Yale School of Medicine, New Haven, Connecticut
| | - Duncan Reid
- Yale School of Medicine, New Haven, Connecticut
| | | | - Simon Carette
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Dellaripa
- Brigham and Women's Hospital, and Harvard University, Boston, Massachusetts
| | | | - Nader A Khalidi
- St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | - Ulrich Specks
- Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - John H Stone
- Massachusetts General Hospital and Harvard University, Boston, Massachusetts
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Rhee RL, Sreih AG, Najem CE, Grayson PC, Zhao C, Bittinger K, Collman RG, Merkel PA. Characterisation of the nasal microbiota in granulomatosis with polyangiitis. Ann Rheum Dis 2018; 77:1448-1453. [PMID: 29997110 DOI: 10.1136/annrheumdis-2018-213645] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Prior studies have suggested a potential link between nasal microbes and granulomatosis with polyangiitis (GPA; Wegener's), but these studies relied on culture-dependent methods. This study comprehensively examined the entire community of nasal microbiota (bacteria and fungi) in participants with GPA compared with healthy controls using deep sequencing methods. METHODS 16S rRNA and internal transcribed spacer gene sequencing were performed on nasal microbial DNA isolated from nasal swabs of 60 participants with GPA and 41 healthy controls. Alpha and beta diversity were assessed as well as the relative abundance of the most abundant bacterial and fungal taxa. The effects of covariates including disease activity and immunosuppressive therapies on microbial composition were evaluated. RESULTS Compared with controls, participants with GPA had a significantly different microbial composition (weighted UniFrac p=0.04) and lower relative abundance of Propionibacterium acnes and Staphylococcus epidermidis (for both, false discovery rate-corrected p=0.02). Disease activity in GPA was associated with a lower abundance of fungal order Malasseziales compared with participants with GPA in remission (p=0.04) and controls (p=0.01). Use of non-glucocorticoid immunosuppressive therapy was associated with 'healthy' nasal microbiota while participants with GPA who were off immunosuppressive therapy had more dysbiosis (weighted UniFrac p=0.01). No difference in the relative abundance of Staphylococcus aureus was observed between GPA and controls. CONCLUSIONS GPA is associated with an altered nasal microbial composition, at both the bacterial and fungal levels. Use of immunosuppressive therapies and disease remission are associated with healthy microbial communities.
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Affiliation(s)
- Rennie L Rhee
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine E Najem
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter C Grayson
- Vasculitis Translational Research Program, National Institutes of of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Chunyu Zhao
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kyle Bittinger
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ronald G Collman
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter A Merkel
- Division of Rheumatology and the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kermani TA, Sreih AG, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Warrington KJ, Ytterberg SR, Merkel PA. Evaluation of damage in giant cell arteritis. Rheumatology (Oxford) 2018; 57:322-328. [PMID: 29112740 DOI: 10.1093/rheumatology/kex397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate damage and variables associated with damage in GCA. Methods Patients with GCA enrolled in a prospective, multicentre, longitudinal study were included. Per-protocol assessments were made with the Vasculitis Damage Index and the Large-Vessel Vasculitis Index of Damage. Results The study included 204 patients: 156 women (76%), mean age at diagnosis 71.3 years (s.d. 8.3), mean follow-up of 3.5 years (s.d. 1.9). One or more damage item was present in 54% at baseline and 79% at the last follow-up on the Vasculitis Damage Index, and 60% at baseline and 82% at the last follow-up on the Large-Vessel Vasculitis Index of Damage. The most frequently observed damage items were large-artery complications (29% cohort) and ocular (22%). Among 117 patients with new damage, most new items were ocular (63 patients), cardiac/vascular (48) and musculoskeletal (34). Of these, treatment-associated items were frequently observed, including cataracts (46 patients), osteoporosis (22) and weight gain (22). Disease-associated new damage included ischaemic optic neuropathy (3 patients), limb claudication (13), arterial occlusions (10) and damage requiring vascular intervention (10). In univariate analysis, the risk of damage increased 22% for every additional year of disease duration [odds ratio (OR) 1.22 (95% CI 1.04, 1.45)]. In 94 patients enrolled within ⩽90 days of diagnosis of GCA, the risk of new damage at the last follow-up decreased 30% for each additional relapse [OR 0.70 (95% CI 0.51, 0.97)]. Conclusions Large-artery complications and ocular manifestations are the most commonly occurring items of damage in GCA. Most new damage is associated with treatment. These findings emphasize the cumulative burden of disease in GCA.
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Affiliation(s)
- Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, Los Angeles, CA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - David Cuthbertson
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Gary S Hoffman
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Nader A Khalidi
- Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Larry Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | | | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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Kermani TA, Diab S, Sreih AG, Cuthbertson D, Borchin R, Carette S, Forbess L, Koening CL, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Spiera RF, Warrington KJ, Ytterberg SR, Langford CA, Merkel PA, Khalidi NA. Arterial lesions in giant cell arteritis: A longitudinal study. Semin Arthritis Rheum 2018; 48:707-713. [PMID: 29880442 DOI: 10.1016/j.semarthrit.2018.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate large-vessel (LV) abnormalities on serial imaging in patients with giant cell arteritis (GCA) and discern predictors of new lesions. METHODS Clinical and imaging data from patients with GCA (including subjects diagnosed by LV imaging) enrolled in a prospective, multicenter, longitudinal study and/or a randomized clinical trial were included. New arterial lesions were defined as a lesion in a previously unaffected artery. RESULTS The study included 187 patients with GCA, 146 (78%) female, mean (±SD) age at diagnosis 68.5 ± 8.5 years; 39% diagnosed by LV imaging. At least one arterial lesion was present in 123 (66%) on the first study. The most frequently affected arteries were subclavian (42%), axillary (32%), and thoracic aorta (20%). In 106 patients (57%) with serial imaging, new arterial lesions were noted in 41 patients (39%), all of whom had a baseline abnormality, over a mean (±SD) follow-up of 4.39 (2.22) years. New abnormalities were observed in 33% patients by year 2; clinical features of active disease were present at only 50% of these cases. There were no differences in age, sex, temporal artery biopsy positivity, or disease activity in patients with or without new lesions. CONCLUSIONS In this cohort of patients with GCA, LV abnormalities on first imaging were common. Development of new arterial lesions occurred in patients with arterial abnormalities at first imaging, often in the absence of symptoms of active disease. Arterial imaging should be considered in all patients with GCA at diagnosis and serial imaging at least in patients with baseline abnormalities.
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Affiliation(s)
- Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540 Santa Monica, CA 90404.
| | - Sehriban Diab
- Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - David Cuthbertson
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL
| | - Renée Borchin
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lindsy Forbess
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Larry Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Robert F Spiera
- Division of Rheumatology, Hospital for Special Surgery, New York, NY
| | | | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH
| | - Peter A Merkel
- Division of Rheumatology and the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Nader A Khalidi
- Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
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Barra L, Borchin RL, Burroughs C, Casey GC, McAlear CA, Sreih AG, Young K, Merkel PA, Pagnoux C. Impact of vasculitis on employment and income. Clin Exp Rheumatol 2018; 36 Suppl 111:58-64. [PMID: 29352849 PMCID: PMC6003628] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Work disability associated with rheumatic diseases accounts for a substantial financial burden. However, few studies have investigated disability among patients with vasculitis. The purpose of this study was to examine the impact of vasculitis on patient employment and income. METHODS Patients enrolled in the Vasculitis Clinical Research Consortium (VCRC) Patient Contact Registry, living in the USA or Canada, and followed for >1 year post-diagnosis, participated in an online survey-based study. RESULTS 421 patients with different systemic vasculitides completed the survey between June and December 2015. The majority of patients were female (70%) and Caucasian (90%); granulomatosis with polyangiitis (GPA) was the most common type of vasculitis (49%), and the mean age at the time of diagnosis was 53 years. At the time of their diagnosis of vasculitis 76% of patients were working a paid job, 6% were retired, and 2% were on disability. Over the course of their disease, and with a mean follow-up of 8±6.4 years post-diagnosis, 26% of participants became permanently work disabled or had to retire early due to vasculitis. Variables that were independently associated with permanent work disability included work physicality, less supportive work environment, and symptoms such as respiratory disease, pain, and cognitive impairment. Overall, patients reported a mean productivity loss of 6.9% and income was reduced by a median of 45%. CONCLUSIONS Due to their vasculitis, patients frequently suffer substantial limitations in work and productivity, and personal income loss.
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Affiliation(s)
- Lillian Barra
- Division of Rheumatology, Western University, London, Ontario, Canada
| | - Renée L Borchin
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Cristina Burroughs
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | | | - Carol A McAlear
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Antoine G Sreih
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Peter A Merkel
- Vasculitis Center, Division of Rheumatology; and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Pagnoux
- Vasculitis clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
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Sreih AG, Alibaz-Oner F, Easley E, Davis T, Mumcu G, Milman N, Robson J, Direskeneli H, Merkel PA, Cronholm P. Health-related outcomes of importance to patients with Takayasu's arteritis. Clin Exp Rheumatol 2018; 36 Suppl 111:51-57. [PMID: 28980910] [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] [Received: 04/14/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The need to include patients' perspectives as key outcomes in clinical trials is widely accepted. No disease-specific patient-reported outcomes have been developed in Takayasu's arteritis. This project was designed to identify outcomes of importance to patients with Takayasu's arteritis during active disease and remission across 2 different cultures. METHODS Patients with Takayasu's arteritis from the US and Turkey were recruited to participate in semi-structured, one-on-one interviews or focus groups. The interviews and group sessions were recorded, transcribed, and entered into an Nvivo database. A line-by-line review of narrative data was used to develop themes describing the impact of Takayasu's arteritis on patients' life. US Patients were invited to freelist terms that they associated with disease states (active disease and remission). The Smith's Salience Index (SSI) was used to identify the most salient terms. RESULTS Results. A total of 31 patients with Takayasu's arteritis participated in this study. Interviews and focus groups identified pain, fatigue, and emotional impact as common themes. Outcomes did not differ between the 2 countries. The most salient terms identified through freelisting were pain/discomfort and fatigue/low energy levels (SSI=0.56 and 0.33, respectively) during active disease and pain/discomfort and emotional impact (SSI=0.51 and 0.37, respectively) during remission. CONCLUSIONS Patients with Takayasu's arteritis report a range of disease-specific symptoms across different cultures and disease states that are generally not specifically captured by generic patient-reported outcome tools currently used in research. Identifying disease-specific outcomes would advance clinical trials methodology to best capture the full spectrum of disease activity in Takayasu's arteritis.
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Affiliation(s)
- Antoine G Sreih
- The University of Pennsylvania, Penn Vasculitis Center, Division of Rheumatology, Philadelphia, PA, USA.
| | | | - Ebony Easley
- The University of Pennsylvania, Division of Family Medicine, Philadelphia, PA, USA
| | - Trocon Davis
- The University of Pennsylvania, Division of Family Medicine, Philadelphia, PA, USA
| | - Gonca Mumcu
- Marmara University, Department of Rheumatology, Istanbul, Turkey
| | - Nataliya Milman
- The Ottawa Hospital Research Institute and the University of Ottawa, Division of Rheumatology, Ottawa, ON, Canada
| | - Joanna Robson
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, the School of Clinical Sciences, University of Bristol and the University Hospitals Bristol NHS Trust Academic Rheumatology Unit, The Courtyard, Bristol Royal Infirmary, UK
| | | | - Peter A Merkel
- Penn Vasculitis Center, Division of Rheumatology, and Department of Epidemiology, Biostatistics, and Informatics, The University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Cronholm
- The University of Pennsylvania, Division of Family Medicine, Philadelphia, PA, USA
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Sreih AG, Alibaz-Oner F, Kermani TA, Aydin SZ, Cronholm PF, Davis T, Easley E, Gul A, Mahr A, McAlear CA, Milman N, Robson JC, Tomasson G, Direskeneli H, Merkel PA. Development of a Core Set of Outcome Measures for Large-vessel Vasculitis: Report from OMERACT 2016. J Rheumatol 2017; 44:1933-1937. [PMID: 28864646 DOI: 10.3899/jrheum.161467] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Among the challenges in conducting clinical trials in large-vessel vasculitis (LVV), including both giant cell arteritis (GCA) and Takayasu arteritis (TA), is the lack of standardized and meaningful outcome measures. The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group initiated an international effort to develop and validate data-driven outcome tools for clinical investigation in LVV. METHODS An international Delphi exercise was completed to gather opinions from clinical experts on LVV-related domains considered important to measure in trials. Patient interviews and focus groups were completed to identify outcomes of importance to patients. The results of these activities were presented and discussed in a "Virtual Special Interest Group" using telephone- and Internet-based conferences, discussions through electronic mail, and an in-person session at the 2016 OMERACT meeting. A preliminary core set of domains common for all forms of LVV with disease-specific elements was proposed. RESULTS The majority of experts agree with using common outcome measures for GCA and TA, with the option of supplementation with disease-specific items. Following interviews and focus groups, pain, fatigue, and emotional effect emerged as health-related quality of life domains important to patients. Current disease assessment tools, including the Birmingham Vasculitis Activity Score, were found to be inadequate to assess disease activity in GCA and standardized assessment of imaging tests were felt crucial to study LVV, especially TA. CONCLUSION Initial data from a clinician Delphi exercise and structured patient interviews have provided themes toward an OMERACT-endorsed core set of domains and outcome measures.
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Affiliation(s)
- Antoine G Sreih
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Fatma Alibaz-Oner
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Tanaz A Kermani
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Sibel Z Aydin
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Peter F Cronholm
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Trocon Davis
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Ebony Easley
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Ahmet Gul
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Alfred Mahr
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Carol A McAlear
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Nataliya Milman
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Joanna C Robson
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Gunnar Tomasson
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Haner Direskeneli
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Peter A Merkel
- From the Division of Rheumatology, and Department of Family Medicine and Community Health, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Fatih Sultan Mehmet Training and Research Hospital; Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Internal Medicine, University Paris Diderot, Paris, France; University of the West of England; University of Bristol; University Hospitals Bristol National Health Service (NHS) Trust, Bristol, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland. .,A.G. Sreih, MD, Assistant Professor of Medicine, Division of Rheumatology, University of Pennsylvania; F. Alibaz-Oner, MD, Associate Professor of Rheumatology, Fatih Sultan Mehmet Training and Research Hospital; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, University of California at Los Angeles; S.Z. Aydin, Associate Professor in Rheumatology, Division of Rheumatology, University of Ottawa; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; T. Davis, Department of Family Medicine and Community Health, University of Pennsylvania; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University, Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Epidemiology, Department of Public Health Sciences, University of Iceland; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University, School of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania.
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Robson JC, Tomasson G, Milman N, Ashdown S, Boonen A, Casey GC, Cronholm PF, Cuthbertson D, Dawson J, Direskeneli H, Easley E, Kermani TA, Farrar JT, Gebhart D, Lanier G, Luqmani RA, Mahr A, McAlear CA, Peck J, Shea B, Shea JA, Sreih AG, Tugwell PS, Merkel PA. OMERACT Endorsement of Patient-reported Outcome Instruments in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol 2017; 44:1529-1535. [PMID: 28864650 DOI: 10.3899/jrheum.161139] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The antineutrophil cytoplasmic antibody-associated vasculitides (AAV) are multiorgan diseases. Patients with AAV report impairment in their health-related quality of life (HRQOL) and have different priorities regarding disease assessment compared with physicians. The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group previously received endorsement for a core set of domains in AAV. Two approaches to measure patient-reported outcomes (PRO) were presented at OMERACT 2016. METHODS A novel 5-step tool was used to facilitate assessment of the instruments by delegates: the OMERACT Filter 2.0 Instrument Selection Algorithm, with a red-amber-green checklist of questions, including (1) good match with domain (face and content validity), (2) feasibility, (3) do numeric scores make sense (construct validity)?, (4) overall ratings of discrimination, and (5) can individual thresholds of meaning be defined? Delegates gave an overall endorsement. Three generic Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (fatigue, physical functioning, and pain interference) and a disease-specific PRO, the AAV-PRO (6 domains related to symptoms and HRQOL), were presented. RESULTS OMERACT delegates endorsed the use of the PROMIS instruments for fatigue, physical functioning, and pain interference (87.6% overall endorsement) and the disease-specific AAV-PRO instrument (89.4% overall endorsement). CONCLUSION The OMERACT Vasculitis Working Group gained endorsement by OMERACT for use of the PROMIS and the AAV-PRO in clinical trials of vasculitis. These instruments are complementary to each other. The PROMIS and the AAV-PRO need further work to assess their utility in longitudinal settings, including their ability to discriminate between treatments of varying efficacy in the setting of a randomized controlled trial.
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Affiliation(s)
- Joanna C Robson
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Gunnar Tomasson
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Nataliya Milman
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Sue Ashdown
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Annelies Boonen
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - George C Casey
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Peter F Cronholm
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - David Cuthbertson
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Jill Dawson
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Haner Direskeneli
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Ebony Easley
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Tanaz A Kermani
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - John T Farrar
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Don Gebhart
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Georgia Lanier
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Raashid A Luqmani
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Alfred Mahr
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Carol A McAlear
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Jacqueline Peck
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Beverley Shea
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Judy A Shea
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Antoine G Sreih
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Peter S Tugwell
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France.,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania
| | - Peter A Merkel
- From the University of the West of England; University of Bristol; University Hospitals Bristol UK National Health Service (NHS) Trust, Bristol; Nuffield Department of Population Health, University of Oxford; Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Rheumatology, University of Ottawa; Division of Rheumatology, The Ottawa Hospital; Department of Clinical Epidemiology, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Centre; Caphri Graduate School, Maastricht, the Netherlands; Vasculitis Foundation, Denver, Colorado; Department of Family Medicine and Community Health, University of Pennsylvania; Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Department of Medicine, University of Pennsylvania; Clinical Medicine, Division of Rheumatology, University of Pennsylvania; Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, Department of Medicine, University of California, Los Angeles, USA; Division of Rheumatology, Marmara University, School of Medicine, Marmara, Turkey; Medicine, Hopital Saint Louis, Paris, France. .,J.C. Robson, MRCP, PhD, Consultant Senior Lecturer, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant in Rheumatology, University Hospitals Bristol UK NHS Trust; G. Tomasson, MD, PhD, Assistant Professor of Medicine, Department of Public Health Sciences, University of Iceland; N. Milman, MD, Assistant Professor, Division of Rheumatology, University of Ottawa, and Division of Rheumatology, The Ottawa Hospital, and Department of Clinical Epidemiology, Ottawa Hospital Research Institute; S. Ashdown, RGN, RM, Patient-Partner; A. Boonen, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Graduate School; George C. Casey, MBA, Patient-Partner, Vasculitis Foundation; P.F. Cronholm, MD, MSCE, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; D. Cuthbertson, MA, Division of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; J. Dawson, MA, MSc, DPhil, SRN, SCM, Associate Professor, Nuffield Department of Population Health, University of Oxford; H. Direskeneli, MD, Professor of Medicine, Division of Rheumatology, Marmara University, School of Medicine; E. Easley, Department of Family Medicine and Community Health, University of Pennsylvania; T.A. Kermani, MD, MS, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, University of California; J.T. Farrar, MD, PhD, Associate Professor of Epidemiology, Neurology, and Anesthesiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Gebhart, MD, Patient-Partner; G. Lanier, Patient-Partner; R.A. Luqmani, DM, FRCP, FRCP(E), Professor of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; A. Mahr, MD, PhD, Professor of Medicine, Hopital Saint Louis; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; J. Peck, RN, Patient-Partner; B. Shea, MSc, PhD, Senior Methodologist, Ottawa Hospital Research Institute, Adjunct Professor School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; J.A. Shea, PhD, Professor of Medicine, Department of Medicine, University of Pennsylvania; A.G. Sreih, MD, Assistant Professor of Clinical Medicine, Division of Rheumatology, University of Pennsylvania; P.S. Tugwell, MD, MSc, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, and Department of Medicine, University of Pennsylvania.
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Abstract
Patient-reported outcomes (PROs) are assessment tools coming directly from patients about their feelings, perceptions, health-related functions, and treatment effects without interpretation by health-care providers. There is a global interest for more "patient-centered care" and PROs in rheumatology. Assessment of disease impact through patient-reported outcome (PRO) measures is a key element for clinical care and clinical research in Takayasu's arteritis (TAK). Currently there are no disease-specific PRO measures to assess quality of life for patients with TAK. Impaired health-related quality of life (HRQoL), functional status, increased anxiety, and depression were shown in patients with TAK in a few studies with generic PRO instruments such as the Short Form-36. However, it is difficult to capture disease-specific effects on patients' daily life and quality of life with these generic tools. There are ongoing efforts of Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group to develop disease-specific outcome measures in TAK.
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Affiliation(s)
- Fatma Alibaz-Oner
- Marmara university, school of medicine, division of rheumatology, Istanbul, Turkey.
| | - Antoine G Sreih
- University of Pennsylvania, division of rheumatology, Philadelphia, PA, USA
| | - Peter A Merkel
- University of Pennsylvania, department of biostatistics and epidemiology, division of rheumatology, Philadelphia, PA, USA
| | - Haner Direskeneli
- Marmara university, school of medicine, division of rheumatology, Istanbul, Turkey
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36
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Langford CA, Cuthbertson D, Ytterberg SR, Khalidi N, Monach PA, Carette S, Seo P, Moreland LW, Weisman M, Koening CL, Sreih AG, Spiera R, McAlear CA, Warrington KJ, Pagnoux C, McKinnon K, Forbess LJ, Hoffman GS, Borchin R, Krischer JP, Merkel PA. A Randomized, Double-Blind Trial of Abatacept (CTLA-4Ig) for the Treatment of Takayasu Arteritis. Arthritis Rheumatol 2017; 69:846-853. [PMID: 28133931 DOI: 10.1002/art.40037] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/05/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the efficacy of abatacept to that of placebo for the treatment of Takayasu arteritis (TAK). METHODS In this multicenter trial, patients with newly diagnosed or relapsing TAK were treated with abatacept 10 mg/kg intravenously on days 1, 15, and 29 and week 8, together with prednisone administered daily. At week 12, patients in remission underwent a double-blinded randomization to continue to receive abatacept monthly or switch to placebo. Patients in both study arms received a standardized prednisone taper, reaching a dosage of 20 mg daily at week 12, with discontinuation of prednisone at week 28. All patients remained on their randomized assignment until meeting criteria for early termination or until 12 months after enrollment of the last patient. The primary end point was duration of remission (relapse-free survival). RESULTS Thirty-four eligible patients with TAK were enrolled and treated with prednisone and abatacept; of these, 26 reached the week 12 randomization and underwent a blinded randomization to receive either abatacept or placebo. The relapse-free survival rate at 12 months was 22% for those receiving abatacept and 40% for those receiving placebo (P = 0.853). Treatment with abatacept in patients with TAK enrolled in this study was not associated with a longer median duration of remission (median duration 5.5 months for abatacept versus 5.7 months for placebo). There was no difference in the frequency or severity of adverse events, including infection, between the treatment arms. CONCLUSION In patients with TAK, the addition of abatacept to a treatment regimen with prednisone did not reduce the risk of relapse.
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Affiliation(s)
| | | | | | - Nader Khalidi
- St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
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Langford CA, Cuthbertson D, Ytterberg SR, Khalidi N, Monach PA, Carette S, Seo P, Moreland LW, Weisman M, Koening CL, Sreih AG, Spiera R, McAlear CA, Warrington KJ, Pagnoux C, McKinnon K, Forbess LJ, Hoffman GS, Borchin R, Krischer JP, Merkel PA. A Randomized, Double-Blind Trial of Abatacept (CTLA-4Ig) for the Treatment of Giant Cell Arteritis. Arthritis Rheumatol 2017; 69:837-845. [PMID: 28133925 DOI: 10.1002/art.40044] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the efficacy of abatacept to that of placebo for the treatment of giant cell arteritis (GCA). METHODS In this multicenter trial, patients with newly diagnosed or relapsing GCA were treated with abatacept 10 mg/kg intravenously on days 1, 15, and 29 and week 8, together with prednisone administered daily. At week 12, patients in remission underwent a double-blinded randomization to continue to receive abatacept monthly or switch to placebo. Patients in both study arms received a standardized prednisone taper, with discontinuation of prednisone at week 28. All patients remained on their randomized assignment until meeting criteria for early termination or until 12 months after enrollment of the last patient. The primary end point was duration of remission (relapse-free survival rate). RESULTS Forty-nine eligible patients with GCA were enrolled and treated with prednisone and abatacept; of these, 41 reached the week 12 randomization and underwent a blinded randomization to receive abatacept or placebo. Prednisone was tapered using a standardized schedule, reaching a daily dosage of 20 mg at week 12 with discontinuation in all patients at week 28. The relapse-free survival rate at 12 months was 48% for those receiving abatacept and 31% for those receiving placebo (P = 0.049). A longer median duration of remission was seen in those receiving abatacept compared to those receiving placebo (median duration 9.9 months versus 3.9 months; P = 0.023). There was no difference in the frequency or severity of adverse events, including infection, between the treatment arms. CONCLUSION In patients with GCA, the addition of abatacept to a treatment regimen with prednisone reduced the risk of relapse and was not associated with a higher rate of toxicity compared to prednisone alone.
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Affiliation(s)
| | | | | | - Nader Khalidi
- St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
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Krischer J, Cronholm PF, Burroughs C, McAlear CA, Borchin R, Easley E, Davis T, Kullman J, Carette S, Khalidi N, Koening C, Langford CA, Monach P, Moreland L, Pagnoux C, Specks U, Sreih AG, Ytterberg S, Merkel PA. Experience With Direct-to-Patient Recruitment for Enrollment Into a Clinical Trial in a Rare Disease: A Web-Based Study. J Med Internet Res 2017; 19:e50. [PMID: 28246067 PMCID: PMC5350442 DOI: 10.2196/jmir.6798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/18/2017] [Accepted: 01/21/2017] [Indexed: 12/28/2022] Open
Abstract
Background The target sample size for clinical trials often necessitates a multicenter (center of excellence, CoE) approach with associated added complexity, cost, and regulatory requirements. Alternative recruitment strategies need to be tested against this standard model. Objectives The aim of our study was to test whether a Web-based direct recruitment approach (patient-centric, PC) using social marketing strategies provides a viable option to the CoE recruitment method. Methods PC recruitment and Web-based informed consent was compared with CoE recruitment for a randomized controlled trial (RCT) of continuing versus stopping low-dose prednisone for maintenance of remission of patients with granulomatosis with polyangiitis (GPA). Results The PC approach was not as successful as the CoE approach. Enrollment of those confirmed eligible by their physician was 10 of 13 (77%) and 49 of 51 (96%) in the PC and CoE arms, respectively (P=.05). The two approaches were not significantly different in terms of eligibility with 34% of potential participants in the CoE found to be ineligible as compared with 22% in the PC arm (P=.11) nor in provider acceptance, 22% versus 26% (P=.78). There was no difference in the understanding of the trial as reflected in the knowledge surveys of individuals in the PC and CoE arms. Conclusions PC recruitment was substantially less successful than that achieved by the CoE approach. However, the PC approach was good at confirming eligibility and was as acceptable to providers and as understandable to patients as the CoE approach. The PC approach should be evaluated in other clinical settings to get a better sense of its potential.
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Affiliation(s)
- Jeffrey Krischer
- Rare Diseases Clinical Research Network Data Coordinating Center, Health Informatics Institute, University of South Florida, Tampa, FL, United States
| | | | - Cristina Burroughs
- Rare Diseases Clinical Research Network Data Coordinating Center, Health Informatics Institute, University of South Florida, Tampa, FL, United States
| | | | - Renee Borchin
- Rare Diseases Clinical Research Network Data Coordinating Center, Health Informatics Institute, University of South Florida, Tampa, FL, United States
| | - Ebony Easley
- University of Pennsylvania, Philadelphia, PA, United States
| | - Trocon Davis
- University of Pennsylvania, Philadelphia, PA, United States
| | - Joyce Kullman
- Vasculitis Foundation, Kansas City, MO, United States
| | | | - Nader Khalidi
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Curry Koening
- University of Utah, Salt Lake City, UT, United States
| | | | - Paul Monach
- Boston University School of Medicine, Boston, MA, United States
| | | | | | | | | | | | - Peter A Merkel
- University of Pennsylvania, Philadelphia, PA, United States
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- Vasculitis Clinical Research Consortium, Philadelphia, PA, United States
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Petkovic J, Barton JL, Flurey C, Goel N, Bartels CM, Barnabe C, de Wit MPT, Lyddiatt A, Lacaille D, Welch V, Boonen A, Shea B, Christensen R, Maxwell LJ, Campbell W, Jull J, Toupin-April K, Singh JA, Goldsmith CH, Sreih AG, Pohl C, Hofstetter C, Beaton DE, Buchbinder R, Guillemin F, Tugwell PS. Health Equity Considerations for Developing and Reporting Patient-reported Outcomes in Clinical Trials: A Report from the OMERACT Equity Special Interest Group. J Rheumatol 2017; 44:1727-1733. [PMID: 28202740 DOI: 10.3899/jrheum.160975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Despite advances integrating patient-centered outcomes into rheumatologic studies, concerns remain regarding their representativeness across diverse patient groups and how this affects equity. The Outcome Measures in Rheumatology (OMERACT) Equity Working Group aims to determine whether and how to address equity issues within the core outcome sets of domains and instruments. METHODS We surveyed current and previous OMERACT meeting attendees and members of the Campbell and Cochrane Equity Group regarding whether to address equity issues within the OMERACT Filter 2.0 Core Outcome Sets and how to assess the appropriateness of domains, instruments, and measurement properties among diverse patients. At OMERACT 2016, results of the survey and a narrative review of differential psychosocial effects of rheumatoid arthritis (i.e., on men) were presented to stimulate discussion and develop a research agenda. RESULTS We proposed 6 moments for which an equity lens could be added to the development, selection, or testing of patient-reported outcome measures (PROM): (1) recruitment, (2) domain selection, (3) feasibility in diverse settings, (4) instrument validity, (5) thresholds of meaning, and (6) consideration of statistical power of subgroup analyses for outcome reporting. CONCLUSION There is a need to (1) conduct a systematic review to assess how equity and population characteristics have been considered in PROM development and whether these differences influence the ranking of importance of outcome domains or a patient's response to questionnaire items, and (2) conduct the same survey described above with patients representing groups experiencing health inequities.
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Affiliation(s)
- Jennifer Petkovic
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France. .,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work. .,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa.
| | - Jennifer L Barton
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Caroline Flurey
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Niti Goel
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Christie M Bartels
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Cheryl Barnabe
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Maarten P T de Wit
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Anne Lyddiatt
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Diane Lacaille
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Vivian Welch
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Annelies Boonen
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Beverley Shea
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Robin Christensen
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Lara J Maxwell
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Willemina Campbell
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Janet Jull
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Karine Toupin-April
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Jasvinder A Singh
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Charles H Goldsmith
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Antoine G Sreih
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Christoph Pohl
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Catherine Hofstetter
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Dorcas E Beaton
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Rachelle Buchbinder
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Francis Guillemin
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Peter S Tugwell
- From the Bruyère Research Institute, University of Ottawa; Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; Cochrane Musculoskeletal Group, University of Ottawa; Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; Department of Medicine, Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Clinical Epidemiology Program; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Work and Health; Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Division of Rheumatology Department of Medicine, University of British Columbia (UBC); Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC, Vancouver; Arthritis Research Canada, Richmond; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, Oregon; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; Quintiles IMS, Denver, Colorado; Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Alabama at Birmingham; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota; Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of the West of England, Bristol, UK; VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute, Amsterdam; Department Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; Caphri Graduate School Maastricht University, Maastricht, the Netherlands; Musculoskeletal Statistics Unit, The Parker Institute; Frederiksberg Hospital, Copenhagen, Denmark; Department Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, Charité - Medical University Berlin, Berlin, Germany; Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Lorraine, Nancy, France.,J.A. Singh has received research grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology. J.A. Singh serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA Inc., a 501 (c)(3) entity. J.A. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. C. Bartels receives institutional peer-reviewed grant support from Independent Grants for Learning and Change (Pfizer) unrelated to this work.,J. Petkovic, MSc, Bruyère Research Institute, University of Ottawa; J.L. Barton, MD, Veterans Affairs Portland Health Care System, Oregon Health and Science University; C. Flurey, PhD, University of the West of England; N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, and Advisory Services, Quintiles IMS, and Patient Research Partner; C.M. Bartels, MD, MS, Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health; C. Barnabe, MD, Departments of Medicine and Community Health Sciences, University of Calgary; M.P. de Wit, PhD, Patient Researcher, VU University Medical Centre, Department Medical Humanities, EMGO+ Research Institute; A. Lyddiatt, Patient Research Partner; D. Lacaille, MD, MHSc, Professor, Division of Rheumatology Department of Medicine, UBC, and Senior Scientist, Arthritis Research Canada; V. Welch, PhD, Bruyère Research Institute, University of Ottawa; A. Boonen, MD, PhD, Department Internal Medicine, Division of Rheumatology Maastricht, University Medical Center, and Caphri Graduate School Maastricht University; B. Shea, PhD, Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, and Frederiksberg Hospital; L.J. Maxwell, PhD, Cochrane Musculoskeletal Group, University of Ottawa; W. Campbell, LLB, Patient Research Partner; J. Jull, PhD, Bruyere Research Institute; K. Toupin-April, PhD, Children's Hospital of Eastern Ontario Research Institute, and Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa; J.A. Singh, MBBS, MPH, Professor of Medicine and Epidemiology, University of Alabama at Birmingham, and Staff Physician, Birmingham Veterans Affairs Medical Center, and Research Collaborator, Department of Orthopedics, Mayo Clinic College of Medicine; C.H. Goldsmith, BSc, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, and Adjunct Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC; A.G. Sreih, MD, Penn Vasculitis Center, Division of Rheumatology, The University of Pennsylvania; C. Pohl, MD, Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Berlin, University Medicine Berlin; C. Hofstetter, Patient Research Partner; D.E. Beaton, PhD, Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Institute for Work and Health, and Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Institute of Health Policy Management and Evaluation, University of Toronto; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; F. Guillemin, MD, PhD, University of Lorraine; P.S. Tugwell, MD, MSc, Department of Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa
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Tiao J, Feng R, Bird S, Choi JK, Dunham J, George M, Gonzalez-Rivera TC, Kaufman JL, Khan N, Luo JJ, Micheletti R, Payne AS, Price R, Quinn C, Rubin AI, Sreih AG, Thomas P, Okawa J, Werth VP. The reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) among dermatologists, rheumatologists and neurologists. Br J Dermatol 2016; 176:423-430. [PMID: 28004387 DOI: 10.1111/bjd.15140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have shown that skin disease in dermatomyositis (DM) is best assessed using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). Although the CDASI has been validated for use by dermatologists, it has not been validated for use by other physicians such as rheumatologists and neurologists, who also manage patients with DM and assess skin activity in clinical trials. OBJECTIVES To assess the reliability of the CDASI among dermatologists, rheumatologists and neurologists. METHODS Fifteen patients with cutaneous DM were assessed using the CDASI and the Physician Global Assessment (PGA) by five dermatologists, five rheumatologists and five neurologists. RESULTS The mean CDASI activity scores for dermatologists, rheumatologists and neurologists were 21·0, 21·8 and 20·8, respectively. These mean scores were not different among the specialists. The CDASI damage score means for dermatologists, rheumatologists and neurologists were 5·3, 7·0 and 4·8, respectively. The mean scores between dermatologists and rheumatologists were significantly different, but the means between dermatologists and neurologists were not. The intraclass correlation coefficients (ICCs) for interrater reliability for CDASI activity and damage were good to excellent for dermatologists and rheumatologists, and moderate to excellent for neurologists. The ICCs for intrarater reliability for CDASI activity and damage were excellent for dermatologists and rheumatologists and moderate to excellent for neurologists. The PGA displayed lower interrater and intrarater reliability relative to the CDASI. CONCLUSIONS Our results confirm the reliability of the CDASI when used by dermatologists and rheumatologists. The data for its use by neurologists were not as robust.
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Affiliation(s)
- J Tiao
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A
| | - R Feng
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - S Bird
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J K Choi
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A
| | - J Dunham
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - M George
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - T C Gonzalez-Rivera
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Department of Neurology, GlaxoSmithKline USA, Philadelphia, PA, U.S.A
| | - J L Kaufman
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - N Khan
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A
| | - J J Luo
- Department of Neurology, Temple University School of Medicine, Philadelphia, PA, U.S.A
| | - R Micheletti
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - A S Payne
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - R Price
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - C Quinn
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - A I Rubin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - A G Sreih
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - P Thomas
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J Okawa
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - V P Werth
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A
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Sreih AG, Annapureddy N, Springer J, Casey G, Byram K, Cruz A, Estephan M, Frangiosa V, George MD, Liu M, Parker A, Sangani S, Sharim R, Merkel PA. Development and validation of case-finding algorithms for the identification of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis in large healthcare administrative databases. Pharmacoepidemiol Drug Saf 2016; 25:1368-1374. [PMID: 27804171 DOI: 10.1002/pds.4116] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to develop and validate case-finding algorithms for granulomatosis with polyangiitis (Wegener's, GPA), microscopic polyangiitis (MPA), and eosinophilic GPA (Churg-Strauss, EGPA). METHODS Two hundred fifty patients per disease were randomly selected from two large healthcare systems using the International Classification of Diseases version 9 (ICD9) codes for GPA/EGPA (446.4) and MPA (446.0). Sixteen case-finding algorithms were constructed using a combination of ICD9 code, encounter type (inpatient or outpatient), physician specialty, use of immunosuppressive medications, and the anti-neutrophil cytoplasmic antibody type. Algorithms with the highest average positive predictive value (PPV) were validated in a third healthcare system. RESULTS An algorithm excluding patients with eosinophilia or asthma and including the encounter type and physician specialty had the highest PPV for GPA (92.4%). An algorithm including patients with eosinophilia and asthma and the physician specialty had the highest PPV for EGPA (100%). An algorithm including patients with one of the diagnoses (alveolar hemorrhage, interstitial lung disease, glomerulonephritis, and acute or chronic kidney disease), encounter type, physician specialty, and immunosuppressive medications had the highest PPV for MPA (76.2%). When validated in a third healthcare system, these algorithms had high PPV (85.9% for GPA, 85.7% for EGPA, and 61.5% for MPA). Adding the anti-neutrophil cytoplasmic antibody type increased the PPV to 94.4%, 100%, and 81.2% for GPA, EGPA, and MPA, respectively. CONCLUSION Case-finding algorithms accurately identify patients with GPA, EGPA, and MPA in administrative databases. These algorithms can be used to assemble population-based cohorts and facilitate future research in epidemiology, drug safety, and comparative effectiveness. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Antoine G Sreih
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Narender Annapureddy
- Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Springer
- Division of Rheumatology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Kevin Byram
- Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andy Cruz
- Penn Medicine Academic Computing Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Maya Estephan
- Division of Rheumatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Vince Frangiosa
- Penn Medicine Academic Computing Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael D George
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mei Liu
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Adam Parker
- Division of Rheumatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sapna Sangani
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Sharim
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter A Merkel
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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Mizus MC, Sreih AG, Rogers WT, Zhang L, Schretzenmair R, Moore JS, Merkel PA, Mohler ER. Abstract 355: Progenitor Cells and Extracellular Vesicles as Biomarkers for Vasculitis. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.355] [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: 11/16/2022]
Abstract
Background:
Patients with vasculitis (VS) have complex organ- and life-threatening disease manifestations due to autoimmune-mediated inflammatory vascular damage and an increased risk of cardiovascular disease (CVD). Accurate biomarkers do not exist for VS. Cells release extracellular vesicles (EVs) in the setting of activation, injury, or death. In patients with diabetes mellitus and CVD, the effects of the inflammatory cascade, platelets and endothelium, positively correlate with levels of EVs bearing receptors for CD3, CD41, or CD105, and negatively correlate with levels of circulating endothelial progenitor cells (CPCs). Because VS is characterized by systemic inflammation, platelet activation and endothelial damage, this group of diseases may have unique effects on EVs and CPCs. This study evaluated a high dimensional flow cytometry approach to profiling EVs and CPCs in plasma to discern a biomarker pattern in VS.
Methods:
Levels of CPCs and EVs were measured with a panel of cell surface markers in 10 VS patients and 5 age-similar healthy controls (HC). Data were acquired on a modified Becton Dickinson FACSCanto.
Results:
Although no significant increase in CPCs in VS compared with HC was detected, the standard deviation of CPC levels in VS was more than double that in HC (SD=574 vs. 165, p=0.081), suggesting heterogeneity in the VS group. EV subsets with lower concentrations in VS, compared with HC, included: Annexin
+
CD3
+
double-positive T Lymphocyte (p=0.026) and CD105
+
CD64
+
double-positive activated Macrophage (p=0.030). CD144
+
CD105
+
double-positive endothelial EVs were only detected in a subset of VS and not in HC. CD31
+
CD41a
+
double-positive platelet EVs were increased in VS compared with HC (894 (580) vs. 416 (128), p=0.004).
Conclusion:
This proof of concept study discovered a distinct EV pattern that correlates with a diagnosis of VS, suggesting that cell- and vesicle-based assays could be useful biomarkers in evaluating VS. This pattern is different from that found in patients with diabetes mellitus and CVD. Larger studies could seek to elucidate correlations between CPCs and disease activity and identify a unique EV signature for VS with increased risk for CVD.
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Affiliation(s)
- Marisa C Mizus
- Cardiology, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
| | - Antoine G Sreih
- Rheumatology, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
| | - Wade T Rogers
- Pathology and Laboratory Medicine, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
| | - Lifeng Zhang
- Pathology and Laboratory Medicine, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
| | - Richard Schretzenmair
- Pathology and Laboratory Medicine, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
| | - Jonni S Moore
- Pathology and Laboratory Medicine, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
| | - Peter A Merkel
- Rheumatology, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
| | - Emile R Mohler
- Cardiology, Perelman Sch of Medicine at the Univ of Pennsylvania, Philadelphia, PA
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Tracey EH, Huen AO, Sreih AG, Evans T, Kobrin S, Rubin AI, Rosenbach M. Paraneoplastic microscopic polyangiitis presenting after thymectomy. JAAD Case Rep 2016; 2:153-5. [PMID: 27222874 PMCID: PMC4864238 DOI: 10.1016/j.jdcr.2016.03.003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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44
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Robson JC, Milman N, Tomasson G, Dawson J, Cronholm PF, Kellom K, Shea J, Ashdown S, Boers M, Boonen A, Casey GC, Farrar JT, Gebhart D, Krischer J, Lanier G, McAlear CA, Peck J, Sreih AG, Tugwell PS, Luqmani RA, Merkel PA. Exploration, Development, and Validation of Patient-reported Outcomes in Antineutrophil Cytoplasmic Antibody-associated Vasculitis Using the OMERACT Process. J Rheumatol 2015; 42:2204-9. [PMID: 26329344 DOI: 10.3899/jrheum.141143] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 11/22/2022]
Abstract
OBJECTIVE Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of linked multisystem life- and organ-threatening diseases. The Outcome Measures in Rheumatology (OMERACT) vasculitis working group has been at the forefront of outcome development in the field and has achieved OMERACT endorsement of a core set of outcomes for AAV. Patients with AAV report as important some manifestations of disease not routinely collected through physician-completed outcome tools; and they rate common manifestations differently from investigators. The core set includes the domain of patient-reported outcomes (PRO). However, PRO currently used in clinical trials of AAV do not fully characterize patients' perspectives on their burden of disease. The OMERACT vasculitis working group is addressing the unmet needs for PRO in AAV. METHODS Current activities of the working group include (1) evaluating the feasibility and construct validity of instruments within the PROMIS (Patient-Reported Outcome Measurement Information System) to record components of the disease experience among patients with AAV; (2) creating a disease-specific PRO measure for AAV; and (3) applying The International Classification of Functioning, Disability and Health to examine the scope of outcome measures used in AAV. RESULTS The working group has developed a comprehensive research strategy, organized an investigative team, included patient research partners, obtained peer-reviewed funding, and is using a considerable research infrastructure to complete these interrelated projects to develop evidence-based validated outcome instruments that meet the OMERACT filter of truth, discrimination, and feasibility. CONCLUSION The OMERACT vasculitis working group is on schedule to achieve its goals of developing validated PRO for use in clinical trials of AAV.
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Affiliation(s)
- Joanna C Robson
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Nataliya Milman
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Gunnar Tomasson
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Jill Dawson
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Peter F Cronholm
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Katherine Kellom
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Judy Shea
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Susan Ashdown
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Maarten Boers
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Annelies Boonen
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - George C Casey
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - John T Farrar
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Don Gebhart
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Jeffrey Krischer
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Georgia Lanier
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Carol A McAlear
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Jacqueline Peck
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Antoine G Sreih
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Peter S Tugwell
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Raashid A Luqmani
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
| | - Peter A Merkel
- From the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK; Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada; Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK; Department of Family Medicine and Community Health, and Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, and Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Epidemiology and Biostatistics; and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, University Maastricht, Maastricht, The Netherlands; Vasculitis Foundation, Denver, Colorado, USA; Division of Biostatistics and Informatics, Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA; Vasculitis Clinical Research Consortium, and Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.J.C. Robson, MBBS, PhD, Clinical Lecturer in Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; N. Milman, MD, FRCPC, Clinical Lecturer in Rheumatology, Division of Rheumatology, University of Ottawa; G. Tomasson, MD, Department of Public Health Sciences, University of Iceland; J. Dawson, MA, MSc, DPhil, University Research Lecturer and Senior Research Scientist, Nuffield Department of Population Health (HSRU), University of Oxford; P.F. Cronholm, MD, MSCE, FAAFP, Associate Professor, Department of Family Medicine and Community Health, University of Pennsylvania; K. Kellom, BA, Senior Research Coordinator, Department of Family Medicine and Community Health, University of Pennsylvania; J. Shea, PhD, Professor of Medici
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Renauer PA, Saruhan-Direskeneli G, Coit P, Adler A, Aksu K, Keser G, Alibaz-Oner F, Aydin SZ, Kamali S, Inanc M, Carette S, Cuthbertson D, Hoffman GS, Akar S, Onen F, Akkoc N, Khalidi NA, Koening C, Karadag O, Kiraz S, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Ozbalkan Z, Ates A, Karaaslan Y, Duzgun N, Monach PA, Ozer HTE, Erken E, Ozturk MA, Yazici A, Cefle A, Onat AM, Kisacik B, Pagnoux C, Kasifoglu T, Seyahi E, Fresko I, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Cobankara V, Cunninghame-Graham DS, Vyse TJ, Pamuk ON, Tunc SE, Dalkilic E, Bicakcigil M, Yentur SP, Wren JD, Merkel PA, Direskeneli H, Sawalha AH. Identification of Susceptibility Loci in IL6, RPS9/LILRB3, and an Intergenic Locus on Chromosome 21q22 in Takayasu Arteritis in a Genome-Wide Association Study. Arthritis Rheumatol 2015; 67:1361-8. [PMID: 25604533 DOI: 10.1002/art.39035] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/13/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Takayasu arteritis is a rare large vessel vasculitis with incompletely understood etiology. This study was undertaken to perform the first unbiased genome-wide association analysis of Takayasu arteritis. METHODS Two independent cohorts of patients with Takayasu arteritis from Turkey and North America were included in our study. The Turkish cohort consisted of 559 patients and 489 controls, and the North American cohort consisted of 134 patients and 1,047 controls of European ancestry. Genotyping was performed using the Omni1-Quad and Omni2.5 genotyping arrays. Genotyping data were subjected to rigorous quality control measures and subsequently analyzed to discover genetic susceptibility loci for Takayasu arteritis. RESULTS We identified genetic susceptibility loci for Takayasu arteritis with a genome-wide level of significance in IL6 (rs2069837) (odds ratio [OR] 2.07, P = 6.70 × 10(-9)), RPS9/LILRB3 (rs11666543) (OR 1.65, P = 2.34 × 10(-8)), and an intergenic locus on chromosome 21q22 (rs2836878) (OR 1.79, P = 3.62 × 10(-10)). The genetic susceptibility locus in RPS9/LILRB3 lies within the leukocyte receptor complex gene cluster on chromosome 19q13.4, and the disease risk variant in this locus correlates with reduced expression of multiple genes including the inhibitory leukocyte immunoglobulin-like receptor gene LILRB3 (P = 2.29 × 10(-8)). In addition, we identified candidate susceptibility genes with suggestive levels of association (P < 1 × 10(-5)) with Takayasu arteritis, including PCSK5, LILRA3, PPM1G/NRBP1, and PTK2B. CONCLUSION Our findings indicate novel genetic susceptibility loci for Takayasu arteritis and uncover potentially important aspects of the pathophysiology of this form of vasculitis.
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Petkovic J, Epstein J, Buchbinder R, Welch V, Rader T, Lyddiatt A, Clerehan R, Christensen R, Boonen A, Goel N, Maxwell LJ, Toupin-April K, De Wit M, Barton J, Flurey C, Jull J, Barnabe C, Sreih AG, Campbell W, Pohl C, Duruöz MT, Singh JA, Tugwell PS, Guillemin F. Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures. J Rheumatol 2015; 42:2448-59. [PMID: 26077410 DOI: 10.3899/jrheum.141168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 12/11/2022]
Abstract
OBJECTIVE The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. METHODS The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. RESULTS Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. CONCLUSION Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.
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Affiliation(s)
- Jennifer Petkovic
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Jonathan Epstein
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Rachelle Buchbinder
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Vivian Welch
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Tamara Rader
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Anne Lyddiatt
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Rosemary Clerehan
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Robin Christensen
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Annelies Boonen
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Niti Goel
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Lara J Maxwell
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Karine Toupin-April
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Maarten De Wit
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Jennifer Barton
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Caroline Flurey
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Janet Jull
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Cheryl Barnabe
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Antoine G Sreih
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Willemina Campbell
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Christoph Pohl
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Mehmet Tuncay Duruöz
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Jasvinder A Singh
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Peter S Tugwell
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
| | - Francis Guillemin
- From the Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; University of Lorraine, EA 4360 Apemac, Nancy, France; Cabrini Institute and Monash University, Melbourne, Australia; Bruyère Research Institute, and the Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Denmark; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands; Quintiles Inc.; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; VU Medical Centre, Amsterdam, The Netherlands; University of California at San Francisco, San Francisco, California, USA; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine II Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Marmara, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Rheumatology Clinics, Istanbul, Turkey; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Ottawa Hospital Research Institute, Ottawa; University Health Network (UHN)-Toronto Western Hospital, Toronto, Ontario
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Carmona F, Mackie S, Martín JE, Taylor J, Vaglio A, Eyre S, Bossini-Castillo L, Castañeda S, Cid M, Hernández-Rodríguez J, Prieto-González S, Solans R, Ramentol-Sintas M, González-Escribano M, Ortiz-Fernández L, Morado I, Narváez J, Miranda-Filloy J, Beretta L, Lunardi C, Cimmino MA, Gianfreda D, Santilli D, Ramirez GA, Soriano A, Muratore F, Pazzola G, Addimanda O, Wijmenga C, Witte T, Schirmer JH, Moosig F, Schönau V, Franke A, Palm Ø, Molberg Ø, Diamantopoulos AP, Carette S, Cuthbertson D, Forbess LJ, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland L, Monach PA, Pagnoux C, Seo P, Spiera R, Sreih AG, Warrington KJ, Ytterberg SR, Gregersen PK, Pease CT, Gough A, Green M, Hordon L, Jarrett S, Watts R, Levy S, Patel Y, Kamath S, Dasgupta B, Worthington J, Koeleman BP, de Bakker PI, Barrett JH, Salvarani C, Merkel PA, González-Gay MA, Morgan AW, Martín J, Martínez-Berriochoa A, Unzurrunzaga A, Hidalgo-Conde A, Madroñero-Vuelta A, Fernández-Nebro A, Ordóñez-Cañizares M, Escalante B, Marí-Alfonso B, Sopeña B, Magro C, Raya E, Grau E, Román J, de Miguel E, López-Longo F, Martínez L, Gómez-Vaquero C, Fernández-Gutiérrez B, Rodríguez-Rodríguez L, Díaz-López J, Caminal-Montero L, Martínez-Zapico A, Monfort J, Tío L, Sánchez-Martín J, Alegre-Sancho J, Sáez-Comet L, Pérez-Conesa M, Corbera-Bellalta M, García-Villanueva M, Fernández-Contreras M, Sanchez-Pernaute O, Blanco R, Ortego-Centeno N, Ríos-Fernández R, Callejas J, Fanlo-Mateo P, Martínez-Taboada V. A large-scale genetic analysis reveals a strong contribution of the HLA class II region to giant cell arteritis susceptibility. Am J Hum Genet 2015; 96:565-80. [PMID: 25817017 DOI: 10.1016/j.ajhg.2015.02.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/12/2015] [Indexed: 02/08/2023] Open
Abstract
We conducted a large-scale genetic analysis on giant cell arteritis (GCA), a polygenic immune-mediated vasculitis. A case-control cohort, comprising 1,651 case subjects with GCA and 15,306 unrelated control subjects from six different countries of European ancestry, was genotyped by the Immunochip array. We also imputed HLA data with a previously validated imputation method to perform a more comprehensive analysis of this genomic region. The strongest association signals were observed in the HLA region, with rs477515 representing the highest peak (p = 4.05 × 10(-40), OR = 1.73). A multivariate model including class II amino acids of HLA-DRβ1 and HLA-DQα1 and one class I amino acid of HLA-B explained most of the HLA association with GCA, consistent with previously reported associations of classical HLA alleles like HLA-DRB1(∗)04. An omnibus test on polymorphic amino acid positions highlighted DRβ1 13 (p = 4.08 × 10(-43)) and HLA-DQα1 47 (p = 4.02 × 10(-46)), 56, and 76 (both p = 1.84 × 10(-45)) as relevant positions for disease susceptibility. Outside the HLA region, the most significant loci included PTPN22 (rs2476601, p = 1.73 × 10(-6), OR = 1.38), LRRC32 (rs10160518, p = 4.39 × 10(-6), OR = 1.20), and REL (rs115674477, p = 1.10 × 10(-5), OR = 1.63). Our study provides evidence of a strong contribution of HLA class I and II molecules to susceptibility to GCA. In the non-HLA region, we confirmed a key role for the functional PTPN22 rs2476601 variant and proposed other putative risk loci for GCA involved in Th1, Th17, and Treg cell function.
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Annapureddy N, Elsallabi O, Baker J, Sreih AG. Patient-reported outcomes in ANCA-associated vasculitis. A comparison between Birmingham Vasculitis Activity Score and routine assessment of patient index data 3. Clin Rheumatol 2015; 35:395-400. [PMID: 25822996 DOI: 10.1007/s10067-015-2921-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 03/12/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
The objective of this study was to determine health-related quality of life (HRQoL) in patients with ANCA-associated vasculitis (AAV) as measured by the "routine assessment of patient index data 3" (RAPID3) and whether RAPID3 is correlated with disease activity as determined by the Birmingham Vasculitis Activity Score (BVAS). Data from patients at an academic institution vasculitis clinic seen between Jan 2010 and Jan 2012 were collected using chart review. BVAS and RAPID3 scores were calculated at each patient visit. RAPID3 was compared between patients in remission (BVAS = 0) and patients with active disease (BVAS > =1) at all visits for four consecutive visits, when data available, at least 3 months apart during the period mentioned. Robust generalized estimating equations (GEE) in linear regression models evaluated associations between the RAPID3 and BVAS over all available observations, adjusting for intra-subject correlations. Thirty-four patients were included in the study, 26 had granulomatosis with polyangiitis (GPA), five microscopic polyangiitis (MPA), and three eosinophilic granulomatosis with polyangiitis (EGPA). Patients at first visit had impaired HRQoL as measured by RAPID3 [6.8 (3.1-12.6)]. The median RAPID3 scores were higher in patients with active disease as compared to patients in remission (7.0 vs. 3.0, p = 0.115; 8.8 vs. 1.0, p = 0.011; 6.1 vs. 2.0, p = 0.032; and 11.7 vs. 2.0, p = 0.128 for visits 1, 2, 3, and 4, respectively). In longitudinal GEE models incorporating all observations there was a strong association between the RAPID3 (per 1 unit) and BVAS (per 1 unit) [β 0.21 (0.10, 0.32) p < 0.001]. RAPID3 can be used to measure HRQoL in patients with AAV. RAPID3 correlated significantly with BVAS. RAPID3 can discriminate between disease states in AAV. This instrument may help document patient experience and add to clinical decisions.
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Affiliation(s)
- Narender Annapureddy
- Division of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USA.,Division of Rheumatology, Rush University, Chicago, IL, USA
| | - Osama Elsallabi
- Department of Medicine, Creighton University, Omaha, NE, USA
| | - Joshua Baker
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.,Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 1407 Penn tower, Philadelphia, PA, 19104, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 1407 Penn tower, Philadelphia, PA, 19104, USA. .,Division of Rheumatology, Rush University, Chicago, IL, USA.
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Sreih AG, Mehta R. Prosthetic valve endocarditis presenting as loss of the metallic click sound. South Med J 2004; 97:1018-9. [PMID: 15558936 DOI: 10.1097/01.smj.0000141305.37717.66] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prosthetic valve endocarditis is a significant infection. It is often serious, and may result in a complicated course leading to valvular malfunction. We present the case of a 50-year-old male with an aortic Medtronic Hall valve, who presented with loss of his normal metallic click. A transthoracic echocardiogram confirmed the diagnosis of endocarditis and of an aortic-root abscess. Blood cultures were positive for nutritionally deficient Streptococcus. He underwent successful surgery and later was discharged. Patients with mechanical heart valves are often bothered by the metallic sound. It can interfere with their daily life. However, the loss of the click may indicate valvular dysfunction, dehiscence of the prosthesis, and/or tissue infection with abscess formation.
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Affiliation(s)
- Antoine G Sreih
- Yale University School of Medicine, Department of Medicine, The Hospital of Saint Raphael, New Haven, CT 06511, USA.
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Abstract
Although intravenous immunoglobulin (IVIg) generally is considered a safe treatment for various autoimmune and inflammatory disorders, rare cases of thrombosis may occur. We describe two patients who experienced thrombotic complications associated with IVIg therapy. A 54-year-old woman with idiopathic thrombocytopenia received IVIg 1 g/kg/day for 2 days. While receiving her infusion on day 2, she had an ischemic stroke with hemiparesis; 3 days later she developed deep vein thrombosis. A 33-year-old woman with Evans' syndrome received IVIg 400 mg/kg/day for 5 days and developed deep vein thrombosis 1 week after therapy was completed; she then received warfarin. Six months later, she received an additional course of IVIg for recurrent hemolytic anemia; 1 day later she died of pulmonary thromboembolism. We suggest that IVIg may promote thrombosis by increasing blood viscosity, activating platelets, or causing vasospasm and should be administered with caution.
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Affiliation(s)
- Geoffrey G Emerson
- Wilmer Eye Institute, Johns Hopkins Medical Center, Baltimore, Maryland, USA
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