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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Kvien TK, Magnusson K, Haugen IK. Hand osteoarthritis phenotypes based on a biopsychosocial approach, and their associations with cross-sectional and longitudinal pain. Osteoarthritis Cartilage 2024:S1063-4584(24)01168-3. [PMID: 38697510 DOI: 10.1016/j.joca.2024.04.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Hand osteoarthritis (OA) pain is characterized as heterogeneous and multifactorial. Differences in pain may be explained by underlying phenotypes, which have not been previously explored DESIGN: Latent class analysis determined classes of participants with hand OA from the Nor-Hand study baseline examination (2016-17) based on a biopsychosocial framework. Outcomes were hand and overall bodily pain intensity (Numeric Rating Scale, 0-10) at baseline and follow-up (2019-21), The relations of the classes to pain outcomes at baseline, follow-up, and change over time were analysed in separate models by linear regression, using the overall healthiest class as reference. RESULTS Five classes differing in radiographic hand OA burden and OA burden in the lower extremities by ultrasound, demographic factors, psychosocial burden and pain sensitization was identified. Persons with the least severe OA but higher burden of biopsychosocial factors reported the most hand pain (beta 3.65, 95% CI 2.53, 4.75). Pain was less pronounced in persons with the most severe hand OA but low burden of biopsychosocial factors (beta 1.03, 95% CI 0.41, 1.65). Results were similar for overall bodily pain and at follow-up. Changes in pain were small, but the association between a separate class defined by higher levels of biopsychosocial burden and pain changes was significant. CONCLUSION The five hand OA phenotypes were associated with pain at baseline and 3.5 years later. The phenotype with the least OA severity, but higher burden of biopsychosocial factors reported more pain than the phenotype with the most severe OA, reflecting the symptom-structure discordance of the hand OA pain experience.
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Affiliation(s)
- Elisabeth Mulrooney
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, United States
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde B Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille S Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karin Magnusson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Sepriano A, Ramiro S, Landewé R, van der Heijde D, Ohrndorf S, FitzGerald O, Backhaus M, Larché M, Homik J, Saraux A, Hammer HB, Terslev L, Østergaard M, Burmester G, Combe B, Dougados M, Hitchon C, Boire G, Lambert RG, Dadashova R, Paschke J, Hutchings EJ, Maksymowych WP. Adding ultrasound to treat-to-target shows no benefit in achieving clinical remission nor in slowing radiographic progression in rheumatoid arthritis: results from a multicenter prospective cohort. Clin Rheumatol 2024:10.1007/s10067-024-06978-5. [PMID: 38684600 DOI: 10.1007/s10067-024-06978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To assess whether using ultrasound (US) in addition to clinical information versus only clinical information in a treat-to-target (T2T) strategy leads to more clinical remission and to less radiographic progression in RA. METHODS Patients with RA from the 2-year prospective BIODAM cohort were included. Clinical and US data (US7-score) were collected every 3 months and hands and feet radiographs every 6 months. At each visit, it was decided whether patients were treated according to the clinical definition of T2T with DAS44 remission as benchmark (T2T-DAS44). T2T-DAS44 was correctly applied if: (i) DAS44 remission had been achieved or (ii) if not, treatment was intensified. A T2T strategy also considering US data (T2T-DAS44-US) was correctly applied if: (i) both DAS44 and US remission (synovitis-score < 2, Doppler-score = 0) were present; or (ii) if not, treatment was intensified. The effect of T2T-DAS44-US on attaining clinical remission and on change in Sharp-van der Heijde score compared to T2T-DAS44 was analysed. RESULTS A total of 1016 visits of 128 patients were included. T2T-DAS44 was correctly followed in 24% of visits and T2T-DAS44-US in 41%. DAS44 < 1.6 was achieved in 39% of visits. Compared to T2T-DAS44, using the T2T-DAS44-US strategy resulted in a 41% lower likelihood of DAS44 remission [OR (95% CI): 0.59 (0.40;0.87)] and had no effect on radiographic progression [β(95% CI): 0.11 (- 0.16;0.39)] assessed at various intervals up to 12 months later. CONCLUSION Our results do not suggest a benefit of using the US7-score in addition to clinical information as a T2T benchmark compared to clinical information alone. Key Points • Ultrasound has a valuable role in diagnostic evaluation of rheumatoid arthritis, but it is unclear whether adding ultrasound to the clinical assessment in a treat-to-target (T2T) strategy leads to more patients achieving remission and reduction in radiographic progression. • Our data from a real-world study demonstrated that adding information from ultrasound to the clinical assessment in a T2T strategy led to a lower rather than a higher likelihood of obtaining clinical remission as compared to using only clinical assessment. • Our data demonstrated that adding ultrasound data to a T2T strategy based only on clinical assessment did not offer additional protection against radiographic progression in patients with RA. • Adding US to a T2T strategy based on clinical assessment led to far more treatment intensifications (with consequences for costs and exposure to adverse events) without yielding a meaningful clinical benefit.
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Affiliation(s)
- Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Zuyderland Medical Center, Heerlen, The Netherlands
- Amsterdam University Medical Center (ARC), Amsterdam, The Netherlands
| | | | - Sarah Ohrndorf
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Academic Hospital of Charité - Universitätsmedizin Berlin, Parkklinik Weissensee, Berlin, Germany
| | - Olivier FitzGerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maggie Larché
- Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Joanne Homik
- Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, T6G 2S2, Canada
| | - Alain Saraux
- LBAI, U1227, University of Brest, Inserm; CHRU Brest, F-29200, Brest, France
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernard Combe
- Departement de Rhumatologie, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Carol Hitchon
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gilles Boire
- Division of Rheumatology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Université de Sherbrooke, Québec, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
- Medical Imaging Consultants, Edmonton, Canada
| | | | | | | | - Walter P Maksymowych
- Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, T6G 2S2, Canada.
- CARE ARTHRITIS LTD, Edmonton, Canada.
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Uhlig T, Karoliussen LF, Sexton J, Kvien TK, Haavardsholm EA, Taylor WJ, Hammer HB. Beliefs about medicines in gout patients: results from the NOR-Gout 2-year study. Scand J Rheumatol 2023; 52:664-672. [PMID: 37395419 DOI: 10.1080/03009742.2023.2213507] [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] [Received: 01/02/2023] [Accepted: 05/10/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Adherence to urate-lowering therapy (ULT) in gout is challenging. This longitudinal study aimed to determine 2 year changes in beliefs about medicines during intervention with ULT. METHOD Patients with a recent gout flare and increased serum urate received a nurse-led ULT intervention with tight control visits and a treatment target. Frequent visits at baseline and 1, 2, 3, 6, 9, 12, and 24 months included the Beliefs about Medicines Questionnaire (BMQ), and demographic and clinical variables. The BMQ subscales on necessity, concerns, overuse, harm, and the necessity-concerns differential were calculated as a measure of whether the patient perceived that necessity outweighed concerns. RESULTS The mean serum urate reduced from 500 mmol/L at baseline to 324 mmol/L at year 2. At years 1 and 2, 85.5% and 78.6% of patients, respectively, were at treatment target. The 2 year mean ± sd BMQ scores increased for the necessity subscale from 17.0 ± 4.4 to 18.9 ± 3.6 (p < 0.001) and decreased for the concerns subscale from 13.4 ± 4.9 to 12.5 ± 2.7 (p = 0.001). The necessity-concerns differential increased from 3.52 to 6.58 (p < 0.001), with a positive change independent of patients achieving treatment targets at 1 or 2 years. BMQ scores were not significantly related to treatment outcomes 1 or 2 years later, and achieving treatment targets did not lead to higher BMQ scores. CONCLUSION Patient beliefs about medicines improved gradually over 2 years, with increased beliefs in the necessity of medication and reduced concerns, but this improvement was unrelated to better outcomes. TRIAL REGISTRATION ACTRN12618001372279.
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Affiliation(s)
- T Uhlig
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - L F Karoliussen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - T K Kvien
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - E A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - W J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
- Rheumatology Department, Hutt Hospital and Gisborne Hospital, Te Whatu Ora (Health New Zealand), Gisborne, New Zealand
| | - H B Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Ramiro S, Landewé R, van der Heijde D, Sepriano A, FitzGerald O, Østergaard M, Homik J, Elkayam O, Thorne JC, Larché MJ, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel AG, Allaart CF, Barnabe C, Bingham CO, van Schaardenburg D, Hammer HB, Dadashova R, Hutchings E, Paschke J, Maksymowych WP. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford) 2023; 62:2989-2997. [PMID: 36645243 DOI: 10.1093/rheumatology/kead021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. METHODS Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. RESULTS In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: -0.04, 0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. CONCLUSIONS In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, School of Medicine, University College Dublin, Ireland
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Carter Thorne
- The Arthritis Program Research Group, University of Toronto, Toronto, Canada
| | - Maggie J Larché
- Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Marina Backhaus
- Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gilles Boire
- Department of Medicine/Division of Rheumatology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), University of Sherbrooke, Sherbrooke, Canada
| | - Bernard Combe
- Department of Rheumatology, Montpellier University, Montpellier, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, France
| | - Alain Saraux
- LBAI, U1227, Université Brest, Inserm, CHU Brest, Brest, France
| | - Maxime Dougados
- Rheumatology Department, Paris Cité University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Luigi Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Alain G Cantagrel
- Department of Rheumatology, CHU Toulouse, Paul Sabatier University, Toulouse, France
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
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Mathiessen A, Hammer HB, Terslev L, Kortekaas MC, D'Agostino MA, Haugen IK, Bruyn GA, Filippou G, Filippucci E, Kloppenburg M, Mancarella L, Mandl P, Möller I, Mortada MA, Naredo E, Sedie AD, Sexton J, Wittoek R, Iagnocco A, Ellegaard K. Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study. Arthritis Care Res (Hoboken) 2022; 74:2005-2012. [PMID: 34137211 DOI: 10.1002/acr.24734] [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] [Received: 12/23/2020] [Revised: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). METHODS The Outcome Measures in Rheumatology Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores. A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with 6 sonographers testing inflammatory and structural features in 12 hand OA patients. We used Cohen's kappa for intrareader and Light's kappa for interreader reliability for all features except PD, in which prevalence-adjusted bias-adjusted kappa (PABAK) was applied. Percentage agreement was also assessed. RESULTS The web-based reliability exercise demonstrated substantial intra- and interreader reliability for all inflammatory features (κ > 0.64). In the patient-based exercise, intra- and interreader reliability, respectively, varied: SH κ = 0.73 and 0.45; JE κ = 0.70 and 0.55; PD PABAK = 0.90 and 0.88; PIP joint cartilage κ = 0.56 and 0.45; and STT osteophytes κ = 0.62 and 0.36. Percentage close agreement was high for all features (>85%). CONCLUSION With ultrasound, substantial to excellent intrareader reliability was found for inflammatory features of hand OA. Interreader reliability was moderate, but overall high close agreement between readers suggests that better reliability is achievable after further training. Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less reliability and the latter is not endorsed.
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Affiliation(s)
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | | | | | | | | | | | | | | | | | | | - Peter Mandl
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - Ruth Wittoek
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Karen Ellegaard
- Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
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Uhlig T, Karoliussen LF, Sexton J, Kvien TK, Haavardsholm EA, Perez-Ruiz F, Hammer HB. Fluctuation and change of serum urate levels and flares in gout: results from the NOR-Gout study. Clin Rheumatol 2022; 41:3817-3823. [PMID: 36316609 PMCID: PMC9652272 DOI: 10.1007/s10067-022-06416-4] [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: 08/26/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
A gout attack may evolve after a purine-rich diet or alcohol and after starting urate-lowering therapy (ULT). The relationships between fluctuation and change in serum urate (SU) with the occurrence of flares were investigated in this study. In the prospective NOR-Gout study, gout patients with increased SU and a recent flare were treated to target with ULT over 1 year, with follow-up at year 2 with SU and flare as outcomes. SU and flares were assessed at both monthly and 3-monthly intervals until target SU was reached. Fluctuation over periods and changes in SU between two time points were assessed and compared in patients with and without flares. At year 1, 186 patients completed follow-up (88.2%) and 173 (82.0%) at year 2. Mean age (SD) at baseline was 56.4 (13.7) years, disease duration was 7.8 (7.6) years, and 95.3% were men. The first-year SU fluctuation and change were related to flare occurrence during year 1 (both p < 0.05). High fluctuation with an absolute sum of all SU changes during the first 9 months was related to flares over 3-month periods (all p < 0.05), and high fluctuation during the first 3 months was related to flares in months 3-6 (p = 0.04). Monthly and high SU changes or again reaching higher SU levels > 360 µmol/l were not related to flares. Fluctuation and change in SU were related to flare occurrence during the first year of ULT, while changes between visits and reaching SU levels > 360 µmol/L were not related to flares. Key Points • Urate-lowering therapy seeks to achieve a treatment target and prevent gout flares, and changes in serum urate are related to gout flares. • Fluctuation and changes in serum urate were associated with gout flares, suggesting that fluctuation in serum urate is unfavourable during gout treatment. • During urate-lowering therapy in gout in clinical practice, fluctuation of serum urate, for example, due to lack of adherence, should be observed and avoided.
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Affiliation(s)
- T Uhlig
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - L F Karoliussen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway
| | - J Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway
| | - T K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - E A Haavardsholm
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - F Perez-Ruiz
- Division of Rheumatology, OSI EE-Cruces, Cruces University Hospital, Osakidetza, Barakaldo, Spain
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Medicine Department, Medicine School, University of the Basque Country, Leioa, Spain
| | - H B Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Podewski AF, Glimm AM, Fischer I, Bruyn GAW, Hanova P, Hammer HB, Aga AB, Haavardsholm EA, Ramiro S, Burmester GR, Backhaus M, Ohrndorf S. The MCP2 and the wrist plus two extensor compartments are the most affected and responsive joints/tendons out of the US7 score in patients with rheumatoid arthritis-an observational study. Arthritis Res Ther 2022; 24:183. [PMID: 35932087 PMCID: PMC9354335 DOI: 10.1186/s13075-022-02874-y] [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: 05/30/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. Methods RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA. Results A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score’s information. No major differences between the groups of early and established RA could be detected. Conclusions The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02874-y.
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Affiliation(s)
- A F Podewski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany.
| | - A M Glimm
- Department of Endocrinology, Nephrology, Rheumatology, Division Rheumatology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - I Fischer
- Biostatistics Tubingen, Tubingen, Germany
| | - G A W Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, Netherlands
| | - P Hanova
- Department of Rheumatology, First Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - H B Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A B Aga
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Zuyderland Medical Center, Heerlen, The Netherlands
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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8
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Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. Ultraschall Med 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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9
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Gløersen M, Steen Pettersen P, Neogi T, Jafarzadeh SR, Vistnes M, Thudium CS, Bay-Jensen AC, Sexton J, Kvien TK, Hammer HB, Haugen IK. Associations of Body Mass Index With Pain and the Mediating Role of Inflammatory Biomarkers in People With Hand Osteoarthritis. Arthritis Rheumatol 2022; 74:810-817. [PMID: 35137553 PMCID: PMC9050744 DOI: 10.1002/art.42056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/15/2021] [Revised: 11/26/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the association of body mass index (BMI) with pain in people with hand osteoarthritis (OA), and explore whether this association, if causal, is mediated by systemic inflammatory biomarkers. METHODS In 281 Nor-Hand study participants, we estimated associations between BMI and hand pain, as measured by the Australian/Canadian Osteoarthritis Hand Index (AUSCAN; range 0-20) and Numerical Rating Scale (NRS; range 0-10); foot pain, as measured by NRS (range 0-10); knee/hip pain, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0-20); painful total body joint count; and pain sensitization. We fit natural-effects models to estimate natural direct and natural indirect effects of BMI on pain through inflammatory biomarkers. RESULTS Each 5-unit increase in BMI was associated with more severe hand pain (on average increased AUSCAN by 0.64 [95% confidence interval (95% CI) 0.23, 1.08]), foot pain (on average increased NRS by 0.65 [95% CI 0.36, 0.92]), knee/hip pain (on average increased WOMAC by 1.31 [95% CI 0.87, 1.73]), generalized pain, and pain sensitization. Mediation analyses suggested that the effects of BMI on hand pain and painful total body joint count were partially mediated by leptin and high-sensitivity C-reactive protein (hsCRP), respectively. Effect sizes for mediation by leptin were larger for the hands than for the lower extremities, and were statistically significant for the hands only. CONCLUSION In people with hand OA, higher BMI is associated with greater pain severity in the hands, feet, and knees/hips. Systemic effects of obesity, measured by leptin, may play a larger mediating role for pain in the hands than in the lower extremities. Low-grade inflammation, measured by hsCRP, may contribute to generalized pain in overweight/obese individuals.
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Affiliation(s)
- Marthe Gløersen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Pernille Steen Pettersen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, USA
| | - S. Reza Jafarzadeh
- Section of Rheumatology, Boston University School of Medicine, Boston, USA
| | - Maria Vistnes
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway,Division of Medicine, Diakonhjemmet Hospital, Oslo, Norway,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | | | | | - Joe Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K. Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Hilde B. Hammer
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Ida K. Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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10
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. Ultraschall Med 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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11
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Christiansen SN, Hammer HB, Torp-Pedersen S, Terslev L. Comment on: Dual-energy computed tomography vs ultrasound, alone or combined, for the diagnosis of gout: a prospective study of accuracy. Rheumatology (Oxford) 2021; 60:e367-e368. [PMID: 33711101 DOI: 10.1093/rheumatology/keab243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Hilde B Hammer
- Rheumatology Department, Diakonhjemmet Hospital.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Søren Torp-Pedersen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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Ziegelasch M, Eloff E, Hammer HB, Cedergren J, Martinsson K, Reckner Å, Skogh T, Magnusson M, Kastbom A. Bone Erosions Detected by Ultrasound Are Prognostic for Clinical Arthritis Development in Patients With ACPA and Musculoskeletal Pain. Front Med (Lausanne) 2021; 8:653994. [PMID: 33834034 PMCID: PMC8021704 DOI: 10.3389/fmed.2021.653994] [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: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 11/14/2022] Open
Abstract
Anti-citrullinated protein antibodies (ACPA) often precede onset of rheumatoid arthritis (RA) by years, and there is an urgent clinical need for predictors of arthritis development among such at-risk patients. This study assesses the prognostic value of ultrasound for arthritis development among ACPA-positive patients with musculoskeletal pain. We prospectively followed 82 ACPA-positive patients without clinical signs of arthritis at baseline. Ultrasound at baseline assessed synovial hypertrophy, inflammatory activity by power Doppler, and erosions in small joints of hands and feet. We applied Cox regression analyses to examine associations with clinical arthritis development during follow-up (median, 69 months; range, 24–90 months). We also compared the ultrasound findings among the patients to a control group of 100 blood donors without musculoskeletal pain. Clinical arthritis developed in 39/82 patients (48%) after a median of 6 months (range, 1–71 months). One or more ultrasound erosions occurred in 13/82 patients (16%), with none in control subjects (p < 0.001). Clinical arthritis development was more common among patients with baseline ultrasound erosions than those without (77 vs. 42%, p = 0.032), and remained significant in a multivariable Cox regression analysis that included previously described prognostic factors (HR 3.9, 95% CI 1.6–9.4, p = 0.003). Ultrasound-detected tenosynovitis was more frequent among the patients and associated with clinical arthritis development in a univariable analysis (HR 2.5, 95% CI 1.1–5.7, p = 0.031), but did not remain statistically significant in multivariable analysis. Thus, bone erosions detected by ultrasound are independent predictors of clinical arthritis development in an ACPA-positive at-risk population. Trial Registration: Regional Ethics Committee in Linköping, Sweden, Dnr M220-09. Registered 16 December 2009, https://etikprovningsmyndigheten.se/.
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Affiliation(s)
- Michael Ziegelasch
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Emma Eloff
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Jan Cedergren
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Klara Martinsson
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Åsa Reckner
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Thomas Skogh
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mattias Magnusson
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Alf Kastbom
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Taylor W, Dalbeth N, Saag KG, Singh JA, Rahn EJ, Mudano AS, Chen YH, Lin CT, Tan P, Louthreno W, Vazquez-Mellado J, Hernández-Llinas H, Neogi T, Vargas-Santos AB, Castelar-Pinheiro G, Chaves-Amorim RB, Uhlig T, Hammer HB, Eliseev M, Perez-Ruiz F, Cavagna L, McCarthy GM, Stamp LK, Gerritsen M, Fana V, Sivera F, Gaffo AL. Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout. J Rheumatol 2021; 48:293-298. [PMID: 32358154 DOI: 10.3899/jrheum.191242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Accepted: 04/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationship between gout flare rate and self-categorization into remission, low disease activity (LDA), and patient acceptable symptom state (PASS). METHODS Patients with gout self-categorized as remission, LDA, and PASS, and reported number of flares over the preceding 6 and 12 months. Multinomial logistic regression was used to determine the association between being in each disease state (LDA and PASS were combined) and flare count, and self-reported current flare. A distribution-based approach and extended Youden index identified possible flare count thresholds for each state. RESULTS Investigators from 17 countries recruited 512 participants. Remission was associated with a median recalled flare count of zero over both 6 and 12 months. Each recalled flare reduced the likelihood of self-perceived remission compared with being in higher disease activity than LDA/PASS, by 52% for 6 months and 23% for 12 months, and the likelihood of self-perceived LDA/PASS by 15% and 5% for 6 and 12 months, respectively. A threshold of 0 flares in preceding 6 and 12 months was associated with correct classification of self-perceived remission in 58% and 56% of cases, respectively. CONCLUSION Flares are significantly associated with perceptions of disease activity in gout, and no flares over the prior 6 or 12 months is necessary for most people to self-categorize as being in remission. However, recalled flare counts alone do not correctly classify all patients into self-categorized disease activity states, suggesting that other factors may also contribute to self-perceived gout disease activity.
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Affiliation(s)
- William Taylor
- W. Taylor, MBChB, PhD, FRACP, FAFRM, University of Otago, Wellington, New Zealand
| | - Nicola Dalbeth
- N. Dalbeth, MBChB, MD, FRACP, P. Tan, University of Auckland, Auckland, New Zealand
| | - Kenneth G Saag
- K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder A Singh
- J.A. Singh, MD, MPH, A.L. Gaffo, MD, MSPH, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Elizabeth J Rahn
- K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amy S Mudano
- K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yi-Hsing Chen
- Y.H. Chen, MD, PhD, C.T. Lin, MD, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Tsai Lin
- Y.H. Chen, MD, PhD, C.T. Lin, MD, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Paul Tan
- N. Dalbeth, MBChB, MD, FRACP, P. Tan, University of Auckland, Auckland, New Zealand
| | | | - Janitzia Vazquez-Mellado
- J. Vazquez-Mellado, MD, PhD, H. Hernández-Llinas, MD, Hospital General de Mexico, Mexico City, Mexico
| | - Hansel Hernández-Llinas
- J. Vazquez-Mellado, MD, PhD, H. Hernández-Llinas, MD, Hospital General de Mexico, Mexico City, Mexico
| | - Tuhina Neogi
- T. Neogi, MD, PhD, FRCPC, A.B. Vargas-Santos, MD, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ana B Vargas-Santos
- T. Neogi, MD, PhD, FRCPC, A.B. Vargas-Santos, MD, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Geraldo Castelar-Pinheiro
- G. Castelar-Pinheiro, MD, PhD, R.B. Chaves-Amorim, MD, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo B Chaves-Amorim
- G. Castelar-Pinheiro, MD, PhD, R.B. Chaves-Amorim, MD, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tillman Uhlig
- T. Uhlig, MD, H.B. Hammer, MD, PhD, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde B Hammer
- T. Uhlig, MD, H.B. Hammer, MD, PhD, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxim Eliseev
- M. Eliseev, PhD, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | | | - Lorenzo Cavagna
- L. Cavagna, MD, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Geraldine M McCarthy
- G.M. McCarthy, MD, FRCPI, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lisa K Stamp
- L.K. Stamp, MBChB, FRACP, PhD, University of Otago-Christchurch, Christchurch, New Zealand
| | | | - Viktoria Fana
- V. Fana, MD, Copenhagen Center for Artritis Reserch, Righospitalet Glostrup, Denmark
| | - Francisca Sivera
- F. Sivera, MD, PhD, Hospital General Universitario Elda, Elda, Spain
| | - Angelo L Gaffo
- J.A. Singh, MD, MPH, A.L. Gaffo, MD, MSPH, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, Alabama, USA;
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Sundin U, Aga AB, Skare Ø, Nordberg LB, Uhlig T, Hammer HB, van der Heijde D, Kvien TK, Lillegraven S, Haavardsholm EA. Conventional versus ultrasound treat to target: no difference in magnetic resonance imaging inflammation or joint damage over 2 years in early rheumatoid arthritis. Rheumatology (Oxford) 2021; 59:2550-2555. [PMID: 31999341 DOI: 10.1093/rheumatology/kez674] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/28/2019] [Revised: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To investigate whether an ultrasound-guided treat-to-target strategy for early RA would lead to reduced MRI inflammation or less structural damage progression compared with a conventional treat-to-target strategy. METHODS A total of 230 DMARD-naïve early RA patients were randomized to an ultrasound tight control strategy targeting DAS <1.6, no swollen joints and no power Doppler signal in any joint or a conventional strategy targeting DAS <1.6 and no swollen joints. Patients in both arms were treated according to the same DMARD escalation strategy. MRI of the dominant hand was performed at six time points over 2 years and scored according to the OMERACT RA MRI scoring system. A total of 218 patients had baseline and one or more follow-up MRIs and were included in the analysis. The mean MRI score change from baseline to each follow-up and the 2 year risk for erosive progression were compared between arms. RESULTS MRI bone marrow oedema, synovitis and tenosynovitis improved over the first year and was sustained during the second year of follow-up, with no statistically significant differences between the ultrasound and the conventional arms at any time point. The 2 year risk for progression of MRI erosions was similar in both treatment arms: ultrasound arm 39%, conventional arm 33% [relative risk 1.16 (95% CI 0.81, 1.66), P = 0.40]. CONCLUSION Incorporating ultrasound information in treatment decisions did not lead to reduced MRI inflammation or less structural damage compared with a conventional treatment strategy. The findings support that systematic use of ultrasound does not provide a benefit in the follow-up of patients with early RA. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, http://clinicaltrials.gov, NCT01205854.
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Affiliation(s)
- Ulf Sundin
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | | | - Øivind Skare
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lena B Nordberg
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Désirée van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
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15
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Hammer HB, Hansen I, Järvinen P, Leirisalo-Repo M, Ziegelasch M, Agular B, Terslev L. Major reduction of ultrasound-detected synovitis during subcutaneous tocilizumab treatment: results from a multicentre 24 week study of patients with rheumatoid arthritis. Scand J Rheumatol 2021; 50:262-270. [PMID: 33464147 DOI: 10.1080/03009742.2020.1845394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: Few studies have investigated the efficacy of subcutaneous tocilizumab (TCZ-SC) on ultrasound-detected inflammation. This study aimed to explore the clinical efficacy of TCZ-SC treatment in rheumatoid arthritis (RA) patients and to evaluate the response by ultrasound compared to Composite Disease Activity Scores (CDAS).Method: This open-label, single-arm study enrolled RA patients with inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs initiating TCZ-SC 162 mg once weekly for 24 weeks, with clinical assessments at baseline, 2, 4, 8, 12, 16, 20, and 24 weeks. Ultrasound examinations [semi-quantitative score (0-3) of 36 joints and four tendons] were performed at baseline, 4, 12, and 24 weeks. CDAS and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) response, and sum scores of ultrasound grey scale/Doppler were calculated. Changes during follow-up were explored by the Mann-Whitney test and correlations by Spearman's rho.Results: In total, 133 patients (mean ± sd age 55.9 ± 12.0 years) were assessed clinically and 110 patients were also examined with ultrasound. All clinical and ultrasound scores decreased significantly after 4 weeks (p < 0.001). At 24 weeks there was EULAR good response in 87.7% and ACR 70% response in 47.4%. Ultrasound scores had no or low correlations with patient-reported outcomes. At 24 weeks, CDAS remission was achieved in 27.4-83.5% and a sum score Doppler of 0 was found in 53.3%.Conclusions: Clinical and ultrasound scores decreased rapidly. Ultrasound scores were not associated with patient-reported variables. Half of the patients reached ultrasound remission, while there were large discrepancies in the percentage of patients reaching remission based on different CDAS.Trial registration: Study ML28691, registered 28 January 2014, ClinicalTrials.gov identifier: NCT02046616.
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Affiliation(s)
- H B Hammer
- Departmemt of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Medical Faculty, University of Oslo, Oslo, Norway
| | - Imj Hansen
- Department of Rheumatology, Svendborg Hospital, Svendborg, Denmark
| | - P Järvinen
- Department of Rheumatology, Kiljava Medical Research, Hyvinkää, Finland
| | - M Leirisalo-Repo
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Ziegelasch
- Department of Rheumatology, Linköping University Hospital, Linköping, Sweden
| | | | - L Terslev
- Department of Rheumatology, Rigshospitalet Glostrup, Copenhagen, Denmark
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16
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Christiansen SN, Filippou G, Scirè CA, Balint PV, Bruyn GA, Dalbeth N, Dejaco C, Sedie AD, Filippucci E, Hammer HB, Iagnocco A, Keen HI, Kissin EY, Koski J, Mandl P, Martin J, Miguel ED, Möller I, Naredo E, Pineda C, Schmidt WA, Stewart S, Antonietta D'Agostino M, Terslev L. Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise. Semin Arthritis Rheum 2021; 51:644-649. [PMID: 33468347 DOI: 10.1016/j.semarthrit.2020.11.011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to develop (1) a new ultrasound definition for aggregates and (2) a semi-quantitative ultrasound scoring system (0-3) for tophus, double contour and aggregates. Furthermore, the intra- and inter-reader reliabilities of both the re-defined aggregates and the semi-quantitative scoring system were assessed using static image exercises. METHODS Thirty-seven rheumatologists were invited. A Delphi process was used for re-defining aggregates and for selecting a semi-quantitative scoring system with >75% agreement obligate for reaching consensus. Subsequently, a web-based exercise on static ultrasound images was conducted in order to assess the reliability of both the re-defined aggregates and the semi-quantitative scoring system. RESULTS Twenty rheumatologists contributed to all rounds of the Delphi and image exercises. A consensual re-definition of aggregates was obtained after three Delphi rounds but needed an overarching principle for scoring aggregates in patients. A consensus-based semi-quantitative ultrasound scoring system for gout lesions was developed after two Delphi rounds. The re-definition of aggregates showed good intra- and inter-reader reliability (κ-values 0.71 and 0.61). The reliabilities of the scoring system were good for all lesions with slightly higher intra-reader (κ-values 0.74-0.80) than inter-reader reliabilities (κ-values 0.61-0.67). CONCLUSION A re-definition of aggregates was obtained with a good reliability when assessing static images. The first consensus-based semi-quantitative ultrasound scoring system for gout-specific lesions was developed with good inter- and intra-reader reliability for all lesions when tested in static images. The next step is to assess the reliabilities when scoring lesions in patients.
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Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy; Rheumatology Unit, Luigi Sacco University Hospital of Milan, Milan, Italy
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George Aw Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - Nicola Dalbeth
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria and Hospital of Brunico (SABES-ASDAA), Department of Rheumatology, Brunico, Italy
| | | | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Hilde B Hammer
- Rheumatology Department, Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, DSCB Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | | | - Juhani Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Julia Martin
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz and Universidad Autónoma de Madrid. Madrid, Spain
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Berlin, Germany
| | - Sarah Stewart
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Ambroise Pare´ Hospital, and Versailles Saint-Quentin-en-Yvelines University, Boulogne-Billancourt, France
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Fjellstad CM, Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Associations Between Ultrasound‐Detected Synovitis, Pain, and Function in Interphalangeal and Thumb Base Osteoarthritis: Data From the Nor‐Hand Cohort. Arthritis Care Res (Hoboken) 2020; 72:1530-1535. [DOI: 10.1002/acr.24047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/13/2019] [Indexed: 11/06/2022]
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18
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Abstract
Magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) are sensitive imaging modalities used by clinicians to assist in decision-making in the management of rheumatoid arthritis (RA). This review will examine the utility of MRI and MSUS in diagnosing RA, predicting RA flares, tapering therapy, assessing remission, and examining difficult periarticular features. We will also outline the strengths and weaknesses of utilizing MRI and MSUS as outcome measures in the management of RA.
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Affiliation(s)
- Veena K Ranganath
- University of California, David Geffen School of Medicine, Los Angeles, USA.
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
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19
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Mandl P, Studenic P, Filippucci E, Bachta A, Backhaus M, Bong D, Bruyn GAW, Collado P, Damjanov N, Dejaco C, Delle-Sedie A, De Miguel E, Duftner C, Gessl I, Gutierrez M, Hammer HB, Hernandez-Diaz C, Iagnocco A, Ikeda K, Kane D, Keen H, Kelly S, Kővári E, Möller I, Møller-Dohn U, Naredo E, Nieto JC, Pineda C, Platzer A, Rodriguez A, Schmidt WA, Supp G, Szkudlarek M, Terslev L, Thiele R, Wakefield RJ, Windschall D, D'Agostino MA, Balint PV. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis. Rheumatology (Oxford) 2020; 58:1802-1811. [PMID: 31034077 DOI: 10.1093/rheumatology/kez153] [Citation(s) in RCA: 13] [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] [Received: 01/12/2019] [Revised: 03/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To develop and test the reliability of a new semiquantitative scoring system for the assessment of cartilage changes by ultrasound in a web-based exercise as well as a patient exercise of patients with RA. METHODS A taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group performed a systematic literature review on the US assessment of cartilage in RA, followed by a Delphi survey on cartilage changes and a new semiquantitative US scoring system, and finally a web-based exercise as well as a patient exercise. For the web-based exercise, taskforce members scored a dataset of anonymized static images of MCP joints in RA patients and healthy controls, which also contained duplicate images. Subsequently, 12 taskforce members used the same US to score cartilage in MCP and proximal interphalangeal joints of six patients with RA in in a patient reliability exercise. Percentage agreement and prevalence of lesions were calculated, as intrareader reliability was assessed by weighted kappa and interreader reliability by Light's kappa. RESULTS The three-grade semiquantitative scoring system demonstrated excellent intrareader reliability (kappa: 0.87 and 0.83) in the web-based exercise and the patient exercise, respectively. Interreader reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.48) in the patient exercise. CONCLUSION Our study demonstrates that ultrasound is a reliable tool for evaluating cartilage changes in the MCP joints of patients with RA and supports further development of a new reliable semiquantitative ultrasound scoring system for evaluating cartilage involvement in RA.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Paul Studenic
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Emilio Filippucci
- Department of Rheumatology, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Artur Bachta
- Department of Rheumatology, Military Institute of Medicine, Warsaw, Poland
| | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee Academic Hospital of the Charité, Berlin, Germany
| | - David Bong
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | | | - Paz Collado
- Department of Rheumatology, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute for Rheumatology, Belgrade, Serbia
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria.,Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | | | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck/Tirol Kliniken, Innsbruck, Austria
| | - Irina Gessl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Cristina Hernandez-Diaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Annmaria Iagnocco
- Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - David Kane
- Department of Rheumatology, School of Medicine, Trinity College Dublin, Ireland
| | - Helen Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | - Stephen Kelly
- Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, London, UK
| | - Eszter Kővári
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Uffe Møller-Dohn
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University
| | - Juan C Nieto
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Alex Platzer
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Ana Rodriguez
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Wolfgang A Schmidt
- Medical Center for Rheumatology, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Gabriela Supp
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Marcin Szkudlarek
- Department of Rheumatology, Zealand's University Hospital at Køge, Denmark
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Richard J Wakefield
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - Daniel Windschall
- Department of Pediatrics, Asklepios Hospital Weissenfels, Weissenfels, Germany
| | - Maria-Antonietta D'Agostino
- Department of Rheumatology, APHP, Hopital Ambroise Paré, Paris, France.,Department of Rheumatology, INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Versailles, France
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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20
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Hammer HB, Michelsen B, Provan SA, Sexton J, Lampa J, Uhlig T, Kvien TK. Tender Joint Count and Inflammatory Activity in Patients With Established Rheumatoid Arthritis: Results From a Longitudinal Study. Arthritis Care Res (Hoboken) 2019; 72:27-35. [DOI: 10.1002/acr.23815] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - Brigitte Michelsen
- Diakonhjemmet Hospital, Oslo, Norway, and Hospital of Southern Norway Trust Kristiansand Norway
| | | | | | - Jon Lampa
- Karolinska InstituteKarolinska University Hospital Stockholm Sweden
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21
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Bruyn GA, Iagnocco A, Naredo E, Balint PV, Gutierrez M, Hammer HB, Collado P, Filippou G, Schmidt WA, Jousse-Joulin S, Mandl P, Conaghan PG, Wakefield RJ, Keen HI, Terslev L, D'Agostino MA. OMERACT Definitions for Ultrasonographic Pathologies and Elementary Lesions of Rheumatic Disorders 15 Years On. J Rheumatol 2019; 46:1388-1393. [PMID: 30709946 DOI: 10.3899/jrheum.181095] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [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] [Accepted: 01/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group (WG) operates research activities for the validation of US as an outcome measurement instrument according to the Filter 2.0 framework. METHODS Original publications on definitions and scoring systems for pathophysiological manifestations and elementary lesions of various rheumatic disorders were reviewed from the onset of the WG research in 2005. RESULTS Definitions and scoring systems according to new terminology are provided. CONCLUSION We have redefined OMERACT US pathology and elementary lesions as well as scoring systems, which are now proposed for OMERACT approval for application in clinical trials.
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Affiliation(s)
- George A Bruyn
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Annamaria Iagnocco
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Esperanza Naredo
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Peter V Balint
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Marwin Gutierrez
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Hilde B Hammer
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Paz Collado
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Georgios Filippou
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Wolfgang A Schmidt
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Sandrine Jousse-Joulin
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Peter Mandl
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Philip G Conaghan
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Richard J Wakefield
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Helen I Keen
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Lene Terslev
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
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Provan SA, Rollefstad S, Ikdahl E, Mathiessen A, Berg IJ, Eeg I, Wilkinson IB, McEniery CM, Kvien TK, Hammer HB, Østerås N, Haugen IK, Semb AG. Biomarkers of cardiovascular risk across phenotypes of osteoarthritis. BMC Rheumatol 2019; 3:33. [PMID: 31410391 PMCID: PMC6686275 DOI: 10.1186/s41927-019-0081-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/24/2019] [Indexed: 01/19/2023] Open
Abstract
Background The objective of this study was to explore the associations between ultrasonographic and radiographic joint scores and levels of arterial CVD risk markers in patients with osteoarthritis (OA). Secondly, to compare the levels of arterial CVD risk markers between OA phenotypes and controls. Method The "Musculoskeletal pain in Ullensaker" Study (MUST) invited residents of Ullensaker municipality with self-reported OA to a medical examination. OA was defined according to the American College of Rheumatology (ACR) criteria and phenotyped based on joint distribution. Joints of the hands, hips and knees were examined by ultrasonography and conventional radiography, and scored for osteosteophytes. Hands were also scored for inflammation by grey scale (GS) synovitis and power Doppler (PD) signal. Control populations were a cohort of inhabitants of Oslo (OCP), and for external validation, a UK community-based register (UKPC).Pulse pressure augmentation index (AIx) and pulse wave velocity (PWV) were measured using the Sphygmocor apparatus (Atcor®). Ankel-brachial index (ABI) was estimated in a subset of patients. In separate adjusted regression models we explored the associations between ultrasonography and radiograph joint scores and AIx, PWV and ABI. CVD risk markers were also compared between phenotypes of OA and controls in adjusted analyses. Results Three hundred and sixty six persons with OA were included (mean age (range); 63.0 (42.0-75.0)), (females (%); 264 (72)). Of these, 155 (42.3%) had isolated hand OA, 111 (30.3%) had isolated lower limb OA and 100 (27.3%) had generalized OA. 108 persons were included in the OCP and 963 persons in the UKPC; (mean age (range); OCP: 57.2 (40.4-70.4), UKPC: 63.9 (40.0-75.0), females (%); OCP: 47 (43.5), UKPC: 543 (56.4%). Hand osteophytes were associated with AIx while GS and PD scores were not related to CVD risk markers. All OA phenotypes had higher levels of AIx compared to OCP in adjusted analyses. External validation against UKPC confirmed these findings. Conclusions Hand osteophytes might be related to higher risk of CVD. People with OA had higher augmented central pressure compared to controls.Words 330.
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Affiliation(s)
- S A Provan
- Department of Rheumatology, Oslo, Norway
| | - S Rollefstad
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - I J Berg
- Department of Rheumatology, Oslo, Norway
| | - I Eeg
- Department of Rheumatology, Oslo, Norway
| | - I B Wilkinson
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - C M McEniery
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - T K Kvien
- Department of Rheumatology, Oslo, Norway
| | - H B Hammer
- Department of Rheumatology, Oslo, Norway
| | - N Østerås
- 4National Resource Centre for rehabilitation in Rheumatology. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - I K Haugen
- Department of Rheumatology, Oslo, Norway
| | - A G Semb
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Terslev L, Christensen R, Aga AB, Sexton J, Haavardsholm EA, Hammer HB. Assessing synovitis in the hands in patients with rheumatoid arthritis by ultrasound: an agreement study exploring the most inflammatory active side from two Norwegian trials. Arthritis Res Ther 2019; 21:166. [PMID: 31277679 PMCID: PMC6612125 DOI: 10.1186/s13075-019-1930-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/04/2019] [Indexed: 11/21/2022] Open
Abstract
Objective To assess if the right hand, the dominant hand, or the hand with more clinically swollen joints (SwJ) is per se the most inflamed and exhibits the greatest change during treatment and hence preferred for unilateral scoring of synovitis by ultrasound in rheumatoid arthritis (RA) patients. Methods Using data from two previously published Norwegian RA patient cohorts initiating treatment, bilateral metacarpophalangeal joint 1–5, proximal phalangeal joint 2+3, and wrists were evaluated by ultrasound. Using a 0–3 scoring system a grey-scale (GS), power Doppler (PD) and global synovitis score (GLOESS) was calculated for each hand (0–30). For precision, a difference of < ± 3 in sum score was pre-specified as indicating clinically insignificant difference in inflammatory activity for all three scores. Results Four hundred thirty-seven RA patients were included. Baseline ultrasound inflammation was statistically significantly higher in hands with more vs fewer SwJ ([mean difference, 95%CI] GS sum score 2.21[1.30 to 3.12], PD sum score 1.70 [0.94 to 2.47] and GLOESS 2.31[1.36 to 3.26]) and also exhibited significantly more change for all sum scores at 3 months follow-up (GS sum score 1.34 [0.60 to 2.08], PD sum score 1.17 [0.44 to 1.91], and GLOESS 1.43 [0.63 to 2.22]). No such differences were found between the dominant and the non-dominant or the right and the left hands at any time points. Conclusion The hand with clinically more SwJ is statistically more inflammatory active according to GS, Doppler, and GLOESS sum scores, exhibits a change during treatment, and is potentially the best choice for unilateral scoring systems. Electronic supplementary material The online version of this article (10.1186/s13075-019-1930-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens vej 17, Glostrup, DK-2600, Copenhagen, Denmark. .,Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Clinical Research, Research Unit of Rheumatology, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | | | - Joe Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Sande JS, Ulvik A, Midttun Ø, Ueland PM, Hammer HB, Valen M, Apalset EM, Gjesdal CG. Vitamin B-6 Status Correlates with Disease Activity in Rheumatoid Arthritis Patients During Treatment with TNFα Inhibitors. J Nutr 2019; 149:770-775. [PMID: 31050750 DOI: 10.1093/jn/nxz001] [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] [Received: 05/15/2018] [Revised: 06/18/2018] [Accepted: 01/03/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A frequent observation in inflammatory conditions, including rheumatoid arthritis (RA), is low circulating amounts of pyridoxal 5'-phosphate (PLP), the metabolically active form of vitamin B-6. Recently, a functional marker of vitamin B-6 status, the ratio of 3-hydroxykynurenine (HK): xanthurenic acid (XA) in plasma (HK: XA), was proposed. OBJECTIVE We investigated vitamin B-6 status in patients with RA before and after established treatment with TNFα inhibitors. METHODS We performed a longitudinal study of RA patients (n = 106, 36% men, median age 54 y) starting first treatment with a TNFα inhibitor (infliximab, etanercept, adalimumab, golimumab, or certolizumab). Clinical assessment (Disease Activity Score for 28 standard joints, DAS28), joint ultrasonography, and blood draw were performed at baseline and after 3 mo treatment. Plasma concentrations of PLP, HK, and XA were measured by liquid chromatography-tandem mass spectrometry. Associations of changes in vitamin B-6 markers with change in DAS28 were assessed by generalized additive models regression and with European League Against Rheumatism (EULAR) response categories by linear regression. RESULTS At baseline PLP was inversely correlated with CRP (ρ = -0.27, P = 0.007), whereas HK: XA correlated with DAS28 (ρ = 0.46, P < 0.001), CRP (ρ = 0.36, P < 0.001), and ultrasonography scores (ρ = 0.29-0.35, P ≤ 0.003). After 3 mo treatment, the change (a 33% overall reduction) in DAS28 was related to changes in both PLP (ß = -0.28, P = 0.01) and HK: XA (ß = 0.33, P < 0.001). Good responders (45%) according to EULAR criteria experienced a 31% increase in PLP (P = 0.003) and an 11% decrease in HK: XA (P = 0.1), whereas nonresponders (24%) experienced a 25% increase in HK: XA (P = 0.02). CONCLUSION Two independent measures of vitamin B-6 status confirm an association with disease activity in RA patients. The association of HK: XA with disease activity may also imply perturbations in kynurenine metabolism in RA. This trial was registered at helseforskning.etikkom.no as 2011/490.
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Affiliation(s)
| | - Arve Ulvik
- Bevital A/S, Laboratoriebygget, Bergen, Norway
| | | | - Per M Ueland
- Department of Clinical Science.,Laboratory of Clinical Biochemistry
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Merete Valen
- Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Ellen M Apalset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Clara G Gjesdal
- Department of Clinical Science.,Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
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25
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Bruyn GAW, Siddle HJ, Hanova P, Costantino F, Iagnocco A, Delle Sedie A, Gutierrez M, Hammer HB, Jernberg E, Loeille D, Micu MC, Moller I, Pineda C, Richards B, Stoenoiu MS, Suzuki T, Terslev L, Vlad V, Wonink R, d'Agostino MA, Wakefield RJ. Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions. J Rheumatol 2019; 46:351-359. [PMID: 30385707 DOI: 10.3899/jrheum.171490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA). METHODS Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively. CONCLUSION Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.
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Affiliation(s)
- George A W Bruyn
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands.
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work.
| | - Heidi J Siddle
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Petra Hanova
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Félicie Costantino
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Annamaria Iagnocco
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Andrea Delle Sedie
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Marwin Gutierrez
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Hilde B Hammer
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Elizabeth Jernberg
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Damien Loeille
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Mihaela C Micu
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Ingrid Moller
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Carlos Pineda
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Bethan Richards
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Maria S Stoenoiu
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Takeshi Suzuki
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Lene Terslev
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Violeta Vlad
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Robert Wonink
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Maria-Antonietta d'Agostino
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Richard J Wakefield
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
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Paulshus Sundlisæter N, Olsen IC, Aga AB, Hammer HB, Uhlig T, van der Heijde D, Kvien TK, Lillegraven S, Haavardsholm EA, Fremstad H, Magne T, Stavland Å, Haukeland H, Rødevand E, Høili C, Stray H, Bendvold AN, Soldal DM, Bakland G. Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol. Rheumatology (Oxford) 2018; 57:2022-2031. [DOI: 10.1093/rheumatology/key202] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nina Paulshus Sundlisæter
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inge C Olsen
- Research Support Services CTU, Oslo University Hospital, Oslo, Norway
| | | | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Désirée van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Medical Department, Leiden University, Leiden, The Netherlands
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Nordberg LB, Lillegraven S, Aga AB, Sexton J, Lie E, Hammer HB, Olsen IC, Uhlig T, van der Heijde D, Kvien TK, Haavardsholm EA. The Impact of Ultrasound on the Use and Efficacy of Intraarticular Glucocorticoid Injections in Early Rheumatoid Arthritis: Secondary Analyses From a Randomized Trial Examining the Benefit of Ultrasound in a Clinical Tight Control Regimen. Arthritis Rheumatol 2018; 70:1192-1199. [PMID: 29575737 DOI: 10.1002/art.40494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/08/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Intraarticular glucocorticoid injections are common in rheumatoid arthritis (RA) treatment. This study was undertaken to investigate whether ultrasound in combination with clinical examination is better than clinical examination alone at identifying joints that will benefit from intraarticular injections, and to compare the efficacy of ultrasound-guided versus palpation-guided procedures. METHODS In the treat-to-target Aiming for Remission in Rheumatoid Arthritis: a Randomised Trial Examining the Benefit of Ultrasonography in a Clinical Tight Control Regimen (ARCTIC), patients with early RA were randomized 1:1 to follow-up with or without ultrasound. In addition to disease-modifying antirheumatic drugs, intraarticular glucocorticoids were used to treat inflamed joints. The distribution of injections was assessed in both study groups. The relationship of clinical and ultrasound findings at the time of injection with treatment efficacy was examined, with non-swollen joint at the next visit as the outcome measure. Treatment success was compared across study groups to evaluate ultrasound-guided versus palpation-guided procedures. RESULTS More injections were administered in the ultrasound group than in the conventional strategy group (n = 770 versus 548), especially in intercarpal joints (n = 58 versus 5) and metatarsophalangeal joints (n = 200 versus 104). Injecting clinically swollen joints without power Doppler (PD) activity on ultrasound was not efficacious compared to not injecting (odds ratio [OR] 1.3; P = 0.59). Efficacy was best in swollen joints (OR 9.0; P = 0.001) and non-swollen joints (OR 8.4; P = 0.016) with moderate PD activity. Treatment success was similar for the ultrasound-guided and palpation-guided procedures. CONCLUSION Our findings indicate that the efficacy of intraarticular glucocorticoid injections varies according to ultrasound findings at the time of injection, supporting the use of ultrasound as a tool to select joints that will benefit from intraarticular injections. However, ultrasound needle guidance was not superior to palpation guidance.
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Affiliation(s)
| | | | | | | | | | | | - Inge C Olsen
- Oslo University Hospital, Research Support Services CTU and Diakonhjemmet Hospital, Oslo, Norway
| | | | - Désirée van der Heijde
- Leiden University Medical Center, Leiden, The Netherlands, and Diakonhjemmet Hospital, Oslo, Norway
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Hammer HB, Uhlig T, Kvien TK, Lampa J. Pain Catastrophizing, Subjective Outcomes, and Inflammatory Assessments Including Ultrasound: Results From a Longitudinal Study of Rheumatoid Arthritis Patients. Arthritis Care Res (Hoboken) 2018; 70:703-712. [DOI: 10.1002/acr.23339] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/08/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | - Jon Lampa
- Karolinska Institute; Karolinska University Hospital; Stockholm Sweden
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Gaffo AL, Dalbeth N, Saag KG, Singh JA, Rahn EJ, Mudano AS, Chen YH, Lin CT, Bourke S, Louthrenoo W, Vazquez-Mellado J, Hernández-Llinas H, Neogi T, Vargas-Santos AB, da Rocha Castelar-Pinheiro G, Amorim RBC, Uhlig T, Hammer HB, Eliseev M, Perez-Ruiz F, Cavagna L, McCarthy GM, Stamp LK, Gerritsen M, Fana V, Sivera F, Taylor W. Brief Report: Validation of a Definition of Flare in Patients With Established Gout. Arthritis Rheumatol 2018; 70:462-467. [DOI: 10.1002/art.40381] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/14/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Angelo L. Gaffo
- University of Alabama at Birmingham and Birmingham VA Medical Center; Birmingham Alabama
| | | | | | - Jasvinder A. Singh
- University of Alabama at Birmingham and Birmingham VA Medical Center; Birmingham Alabama
| | | | | | | | | | | | | | | | | | - Tuhina Neogi
- Boston University School of Medicine; Boston Massachusetts
| | - Ana Beatriz Vargas-Santos
- Boston University School of Medicine, Boston, Massachusetts; and Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
| | | | | | | | | | - Maxim Eliseev
- Research Institute of Rheumatology of Russia; Moscow Russia
| | - Fernando Perez-Ruiz
- University of the Basque Country; Cruces University Hospital, and Biocruces Health Research Institute; Vizcaya Spain
| | - Lorenzo Cavagna
- University and IRCCS Policlinico S. Matteo Foundation; Pavia Italy
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Magnusson K, Mathiessen A, Hammer HB, Kvien TK, Slatkowsky-Christensen B, Natvig B, Hagen KB, Østerås N, Haugen IK. Smoking and alcohol use are associated with structural and inflammatory hand osteoarthritis features. Scand J Rheumatol 2017; 46:388-395. [PMID: 28145147 DOI: 10.1080/03009742.2016.1257736] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To explore whether smoking and alcohol use are associated with hand osteoarthritis (OA) features in two different OA cohorts. METHOD We studied 530 people with radiographic hand OA from the Musculoskeletal pain in Ullensaker STudy (MUST) and 187 people from the Oslo hand OA cohort [mean (sd) age 65 (8.0) and 62 (5.7) years, 71% and 91% women, respectively]. Smoking, alcohol use and hand pain were self-reported. Participants underwent conventional hand radiographs and ultrasound examination of 30 hand joints. The Kellgren-Lawrence sum score for radiographic OA severity (0-120 scale) and the proportion of participants having at least one joint with grey-scale synovitis (grade ≥1) were calculated. We studied whether smoking and alcohol use were cross-sectionally associated with radiographic OA, synovitis, and pain using adjusted linear and logistic regression analyses. RESULTS Smoking was associated with less radiographic OA in both cohorts [β = -4.71, 95% confidence interval (CI) -8.36 to -1.06 for current smoking in MUST and β = -0.15, 95% CI -0.29 to -0.02 for smoking pack-years in the Oslo hand OA cohort]. Stratified analyses indicated that the association was present in men only. Being a monthly drinker (examined in MUST only) was significantly associated with present synovitis compared to never drinkers (odds ratio = 2.35, 95% CI 1.27 to 4.34) (no gender differences). Neither smoking nor alcohol was associated with hand pain. CONCLUSIONS Smoking was associated with less radiographic hand OA whereas alcohol consumption was associated with present joint inflammation in hand OA. Future longitudinal studies are needed to explore the causal associations and explanatory mechanisms behind gender differences.
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Affiliation(s)
- K Magnusson
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.,b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - A Mathiessen
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - H B Hammer
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - T K Kvien
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | | | - B Natvig
- c Department of General Practice, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - K B Hagen
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.,b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - N Østerås
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.,b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - I K Haugen
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
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Haavardsholm EA, Aga AB, Olsen IC, Lillegraven S, Hammer HB, Uhlig T, Fremstad H, Madland TM, Lexberg ÅS, Haukeland H, Rødevand E, Høili C, Stray H, Noraas A, Hansen IJW, Bakland G, Nordberg LB, van der Heijde D, Kvien TK. Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial. BMJ 2016; 354:i4205. [PMID: 27530741 PMCID: PMC4986519 DOI: 10.1136/bmj.i4205] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine whether a treatment strategy based on structured ultrasound assessment would lead to improved outcomes in rheumatoid arthritis, compared with a conventional strategy. DESIGN Multicentre, open label, two arm, parallel group, randomised controlled strategy trial. SETTING Ten rheumatology departments and one specialist centre in Norway, from September 2010 to September 2015. PARTICIPANTS 238 patients were recruited between September 2010 and April 2013, of which 230 (141 (61%) female) received the allocated intervention and were analysed for the primary outcome. The main inclusion criteria were age 18-75 years, fulfilment of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis, disease modifying anti-rheumatic drug naivety with indication for disease modifying drug therapy, and time from first patient reported swollen joint less than two years. Patients with abnormal kidney or liver function or major comorbidities were excluded. INTERVENTIONS 122 patients were randomised to an ultrasound tight control strategy targeting clinical and imaging remission, and 116 patients were randomised to a conventional tight control strategy targeting clinical remission. Patients in both arms were treated according to the same disease modifying anti-rheumatic drug escalation strategy, with 13 visits over two years. MAIN OUTCOME MEASURES The primary endpoint was the proportion of patients with a combination between 16 and 24 months of clinical remission, no swollen joints, and non-progression of radiographic joint damage. Secondary outcomes included measures of disease activity, radiographic progression, functioning, quality of life, and adverse events. All participants who attended at least one follow-up visit were included in the full analysis set. RESULTS 26 (22%) of the 118 analysed patients in the ultrasound tight control arm and 21 (19%) of the 112 analysed patients in the clinical tight control arm reached the primary endpoint (mean difference 3.3%, 95% confidence interval -7.1% to 13.7%). Secondary endpoints (disease activity, physical function, and joint damage) were similar between the two groups. Six (5%) patients in the ultrasound tight control arm and seven (6%) patients in the conventional arm had serious adverse events. CONCLUSIONS The systematic use of ultrasound in the follow-up of patients with early rheumatoid arthritis treated according to current recommendations is not justified on the basis of the ARCTIC results. The findings highlight the need for randomised trials assessing the clinical application of medical technology.Trial registration Clinical trials NCT01205854.
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Affiliation(s)
- Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway
| | - Anna-Birgitte Aga
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway
| | | | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway
| | | | - Tor Magne Madland
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Hilde Haukeland
- Department of Rheumatology, Martina Hansens Hospital AS, Sandvika, Norway
| | - Erik Rødevand
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Christian Høili
- Department of Rheumatology, Hospital Østfold HF Moss, Grålum, Norway
| | - Hilde Stray
- Haugesund Rheumatism Hospital AS, Haugesund, Norway
| | - Anne Noraas
- The Rheumatology Clinic Dovland/Bendvold, Kristiansand, Norway
| | | | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Lena Bugge Nordberg
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway
| | - Désirée van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319 Oslo, Norway
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Michelsen B, Diamantopoulos AP, Hammer HB, Soldal DM, Kavanaugh A, Haugeberg G. Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity. Ann Rheum Dis 2016; 75:2108-2113. [PMID: 27091837 DOI: 10.1136/annrheumdis-2015-208806] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the association between clinical and ultrasonographic (US) evidence of inflammation in psoriatic arthritis (PsA), as well as to compare clinical and US remission criteria. METHODS In this cross-sectional study 141 PsA outpatients were included. Minimal disease activity (MDA), 28-joint Disease Activity Score (DAS28), Disease Activity Index for PSoriatic Arthritis (DAPSA) and modified versions of Composite Psoriatic Disease Activity Index (CPDAI) and Psoriatic ArthritiS Disease Activity Score (PASDAS) were assessed. Remission criteria were explored. US evaluation was performed on 34 joints, in addition to joints being tender/swollen by 66/68 joint count, 30 tendons, 10 entheses and additionally entheses found to be tender by clinical examination of 19 other entheses. Power Doppler (PD) and grey scale global scores on joints, entheses and tendons were assessed. US remission was defined as no PD activity in joints, entheses and tendons. RESULTS DAPSA and DAS28, but not CPDAI and PASDAS, were associated with PD activity. MDA was fulfilled in 22.7% and the clinical remission criteria in 5.7%-9.9% of the patients. US remission was found in 49.6% of the patients. The prevalence of PD activity at joints, entheses and tendons was similar for patients fulfilling versus not fulfilling MDA/clinical remission criteria. MDA (OR 2.3, p=0.048), DAPSA ≤3.3 (OR 4.2, p=0.025) and Boolean's (OR=7.8, p=0.033) definitions of remission were found to predict US remission. CONCLUSIONS We found major discrepancies between US and clinical findings. DAPSA and DAS28 reflected US findings better than CPDAI and PASDAS. MDA, DAPSA and Boolean's remission criteria predicted US remission.
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Affiliation(s)
- Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Andreas P Diamantopoulos
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.,Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dag M Soldal
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, USA
| | - Glenn Haugeberg
- Department of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
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Haugen IK, Mathiessen A, Slatkowsky-Christensen B, Magnusson K, Bøyesen P, Sesseng S, van der Heijde D, Kvien TK, Hammer HB. Synovitis and radiographic progression in non-erosive and erosive hand osteoarthritis: is erosive hand osteoarthritis a separate inflammatory phenotype? Osteoarthritis Cartilage 2016; 24:647-54. [PMID: 26620088 DOI: 10.1016/j.joca.2015.11.014] [Citation(s) in RCA: 52] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/30/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the prevalence of synovitis, pain and radiographic progression in non-erosive and erosive hand osteoarthritis (HOA), and to explore whether the different rate of disease progression is explained by different levels of synovitis and structural damage. DESIGN We included 31 and 34 participants with non-erosive and erosive HOA at baseline, respectively. Using Generalized Estimating Equations, we explored whether participants with erosive HOA had more synovitis (by MRI, ultrasound and clinical examination) independent of the degree of structural damage. Similarly, we explored whether pain at baseline and radiographic progression after 5 years were higher in erosive HOA, independent of the levels of synovitis and structural damage. All analyses were adjusted for age and sex. RESULTS Power Doppler activity was found mainly in erosive HOA. Participants with erosive HOA demonstrated more moderate-to-severe synovitis, assessed by MRI (OR = 1.73, 95% CI 1.11-2.70), grey-scale ultrasound (OR = 2.02, 95% CI 1.25-3.26) and clinical examination (OR = 1.80, 95% CI 1.44-2.25). The associations became non-significant when adjusting for more structural damage. The higher frequency of joint tenderness in erosive HOA was at least partly explained more structural damage and inflammation. Radiographic progression (OR = 2.53, 95% CI 1.73-3.69) was more common in erosive HOA independent of radiographic HOA severity and synovitis (here: adjusted for grey-scale synovitis by ultrasound). CONCLUSION Erosive HOA is characterized by higher frequency and more severe synovitis, pain and radiographic progression compared to non-erosive HOA. The higher rate of disease progression was independent of baseline synovitis and structural damage.
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Affiliation(s)
- I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - A Mathiessen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | | | - K Magnusson
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - P Bøyesen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - S Sesseng
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology, Kongsvinger Hospital, Oslo, Norway
| | - D van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - T K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Haugen IK, Hammer HB. A need for new imaging modality to detect inflammation in rheumatoid arthritis and osteoarthritis? Ann Rheum Dis 2015; 75:479-80. [PMID: 26698851 DOI: 10.1136/annrheumdis-2015-208661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Terslev L, Gutierrez M, Christensen R, Balint PV, Bruyn GA, Delle Sedie A, Filippucci E, Garrido J, Hammer HB, Iagnocco A, Kane D, Kaeley GS, Keen H, Mandl P, Naredo E, Pineda C, Schicke B, Thiele R, D'Agostino MA, Schmidt WA. Assessing Elementary Lesions in Gout by Ultrasound: Results of an OMERACT Patient-based Agreement and Reliability Exercise. J Rheumatol 2015; 42:2149-54. [PMID: 26472419 DOI: 10.3899/jrheum.150366] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To test the reliability of the consensus-based ultrasound (US) definitions of elementary gout lesions in patients. METHODS Eight patients with microscopically proven gout were evaluated by 16 sonographers for signs of double contour (DC), aggregates, erosions, and tophi in the first metatarsophalangeal joint and the knee bilaterally. The patients were examined twice using B-mode US to test agreement and inter- and intraobserver reliability of the elementary components. RESULTS The prevalence of the lesions were DC 52.8%, tophus 61.1%, aggregates 29.8%, and erosions 32.4%. The intraobserver reliability was good for all lesions except DC, where it was moderate. The best reliability per lesion was seen for tophus (κ 0.73, 95% CI 0.61-0.85) and lowest for DC (κ 0.53, 95% CI 0.38-0.67). The interobserver reliability was good for tophus and erosions, but fair to moderate for aggregates and DC, respectively. The best reliability was seen for erosions (κ 0.74, 95% CI 0.65-0.81) and lowest for aggregates (κ 0.21, 95% CI 0.04-0.37). CONCLUSION This is the first step to test consensus-based US definitions on elementary lesions in patients with gout. High intraobserver reliability was found when applying the definition in patients on all elementary lesions while interobserver reliability was moderate to low. Further studies are needed to improve the interobserver reliability, particularly for DC and aggregates.
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Iagnocco A, Terslev L, Backhaus M, Balint P, Bruyn GAW, Damjanov N, Filippucci E, Hammer HB, Jousse-Joulin S, Kane D, Koski JM, Mandl P, Möller I, Peetrons P, Schmidt W, Szkudlarek M, Vojinovic J, Wakefield RJ, Hofer M, D'Agostino MA, Naredo E. Educational recommendations for the conduct, content and format of EULAR musculoskeletal ultrasound Teaching the Teachers Courses. RMD Open 2015; 1:e000139. [PMID: 26535148 PMCID: PMC4623365 DOI: 10.1136/rmdopen-2015-000139] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/06/2015] [Accepted: 08/22/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To produce educational guidelines for the conduct, content and format of theoretical and practical teaching at EULAR musculoskeletal ultrasound (MSUS) Teaching the Teachers (TTT) Courses. METHODS A Delphi-based procedure with 24 recommendations covering five main areas (Duration and place of the course; Faculty members; Content of the course; Evaluation of the teaching skills; TTT competency assessment) was distributed among a group of experts involved in MSUS teaching, in addition to an advisory educational expert being present. Consensus for each recommendation was considered achieved when the percentage of agreement was >75%. RESULTS 21 of 24 invited participants responded to the first Delphi questionnaire (88% response rate). All 21 participants also responded to the second round. Agreement on 19 statements was obtained after two rounds. CONCLUSIONS This project has led to the development of guidelines for the conduct, content and format of teaching at the EULAR MSUS TTT Courses that are organised annually, with the aim of training future teachers of EULAR MSUS Courses, EULAR Endorsed MSUS Courses, as well as national and local MSUS Courses. The presented work gives indications on how to homogenise the teaching at the MSUS TTT Courses, thus resolving current discrepancies in the field.
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Affiliation(s)
- A Iagnocco
- Ultrasound Unit, Rheumatology Department , Sapienza Università di Roma , Rome , Italy
| | - L Terslev
- Centre of Rheumatology and Spine Diseases, Rigshospitalet-Glostrup , Copenhagen , Denmark
| | - M Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology , Park-Klinik Weissensee Berlin, Academic Hospital of the Charité , Berlin , Germany
| | - P Balint
- 3rd Rheumatology Department , National Institute of Rheumatology and Physiotherapy , Budapest , Hungary
| | - G A W Bruyn
- Department of Rheumatology , MC Groep Hospitals , Lelystad , The Netherlands
| | - N Damjanov
- Institute of Rheumatology, Belgrade University School of Medicine , Belgrade , Serbia
| | - E Filippucci
- Clinica Reumatologica , Università Politecnica delle Marche , Jesi (Ancona) , Italy
| | - H B Hammer
- Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - S Jousse-Joulin
- Department of Rheumatology , Cavale Blanche Hospital , Brest , France
| | - D Kane
- Trinity College Dublin , Dublin , Ireland
| | - J M Koski
- Mikkeli Central Hospital , Mikkeli , Finland
| | - P Mandl
- Division of Rheumatology, 3rd Department of Internal Medicine , Medical University of Vienna , Vienna , Austria
| | - I Möller
- Instituto Poal de Reumatologia , Barcelona , Spain
| | - P Peetrons
- Radiology Department , Free University of Brussels, Hopitaux Iris Sud , Brussels , Belgium
| | - W Schmidt
- Immanuel Krankenhaus Medical Center for Rheumatology Berlin , Buch , Germany
| | - M Szkudlarek
- Department of Rheumatology , University of Copenhagen Hospital at Køge , Køge , Denmark
| | - J Vojinovic
- Department of Pediatric Rheumatology, Faculty of Medicine , University of Nis , Nis , Serbia
| | - R J Wakefield
- Department of Rheumatology , Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital , Leeds , UK
| | - M Hofer
- Diagnostic Radiologist, Department for Medical Education , H Heine University , Duesseldorf , Germany
| | - M A D'Agostino
- APHP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt, France
| | - E Naredo
- Department of Rheumatology , Hospital GU Gregorio Marañón. Complutense University , Madrid , Spain
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Rollefstad S, Ikdahl E, Hisdal J, Olsen IC, Holme I, Hammer HB, Smerud KT, Kitas GD, Pedersen TR, Kvien TK, Semb AG. Rosuvastatin-Induced Carotid Plaque Regression in Patients With Inflammatory Joint Diseases: The Rosuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and Other Inflammatory Joint Diseases Study. Arthritis Rheumatol 2015; 67:1718-28. [PMID: 25778850 DOI: 10.1002/art.39114] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/10/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) and carotid artery plaques have an increased risk of acute coronary syndromes. Statin treatment with the goal of achieving a low-density lipoprotein (LDL) cholesterol level of ≤1.8 mmoles/liter (≤70 mg/dl) is recommended for individuals in the general population who have carotid plaques. The aim of the ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases (RORA-AS) study was to evaluate the effect of 18 months of intensive lipid-lowering treatment with rosuvastatin with regard to change in carotid plaque height. METHODS Eighty-six patients (60.5% of whom were female) with carotid plaques and inflammatory joint disease (55 with RA, 21 with AS, and 10 with psoriatic arthritis) were treated with rosuvastatin to obtain the LDL cholesterol goal. Carotid plaque height was evaluated by B-mode ultrasonography. RESULTS The mean ± SD age of the patients was 60.8 ± 8.5 years, and the median compliance with rosuvastatin treatment was 97.9% (interquartile range [IQR] 96.0-99.4). At baseline, the median number and height of the carotid plaques were 1.0 (range 1-8) and 1.80 mm (IQR 1.60-2.10), respectively. The mean ± SD change in carotid plaque height after 18 months of treatment with rosuvastatin was -0.19 ± 0.35 mm (P < 0.0001). The mean ± SD baseline LDL cholesterol level was 4.0 ± 0.9 mmoles/liter (154.7 ± 34.8 mg/dl), and the mean reduction in the LDL cholesterol level was -2.3 mmoles/liter (95% confidence interval [95% CI] -2.48, -2.15) (-88.9 mg/dl [95% CI -95.9, -83.1]). The mean ± SD LDL cholesterol level during the 18 months of rosuvastatin treatment was 1.7 ± 0.4 mmoles/liter (area under the curve). After adjustment for age/sex/blood pressure, no linear relationship between a reduction in carotid plaque height and the level of LDL cholesterol exposure during the study period was observed. Attainment of the LDL cholesterol goal of ≤1.8 mmoles/liter (≤70 mg/dl) or the amount of change in the LDL cholesterol level during the study period did not influence the degree of carotid plaque height reduction. CONCLUSION Intensive lipid-lowering treatment with rosuvastatin induced atherosclerotic regression and reduced the LDL cholesterol level significantly in patients with inflammatory joint disease.
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Affiliation(s)
| | - E Ikdahl
- Diakonhjemmet Hospital, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital, Aker, Oslo, Norway
| | - I C Olsen
- Diakonhjemmet Hospital, Oslo, Norway
| | - I Holme
- Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - K T Smerud
- Smerud Medical Research International AS, Oslo, Norway
| | - G D Kitas
- The Dudley Group NHS Foundation Trust, West Midlands, UK
| | - T R Pedersen
- Centre of Preventive Medicine, Oslo University Hospital, Ullevål, and University of Oslo, Oslo, Norway
| | - T K Kvien
- Diakonhjemmet Hospital, Oslo, Norway
| | - A G Semb
- Diakonhjemmet Hospital, Oslo, Norway
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Hammer HB, Iagnocco A, Mathiessen A, Filippucci E, Gandjbakhch F, Kortekaas MC, Möller I, Naredo E, Wakefield RJ, Aegerter P, D'Agostino MA. Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints. Ann Rheum Dis 2014; 75:402-7. [PMID: 25520476 DOI: 10.1136/annrheumdis-2014-206289] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/01/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Ultrasonography is sensitive for the evaluation of cartilage pathology and degree of osteophytes in patients with hand osteoarthritis (OA). High consistency of assessments is essential, and the OMERACT (Outcome Measures in Rheumatology) ultrasonography group took the initiative to explore the reliability of a global ultrasonography score in patients with hand OA using semiquantitative ultrasonography score of cartilage and osteophytes in finger joints. METHODS Ten patients with hand OA were examined by 10 experienced sonographers over the course of two days. Semiquantitative scoring (0-3) was performed on osteophytes (carpo-metacarpal 1, metacarpo-phalangeal (MCP) 1-5, proximal interphalangeal 1-5 and distal interphalangeal 2-5 joints bilaterally with an ultrasonography atlas as reference) and cartilage pathology (MCP 2-5 bilaterally). A web-based exercise on static cartilage images was performed a month later. Reliability was assessed by use of weighted κ analyses. RESULTS Osteophyte scores were evenly distributed, and the intraobserver and interobserver reliabilities were substantial to excellent (κ range 0.68-0.89 and mean κ 0.65 (day 1) and 0.67 (day 2), respectively). Cartilage scores were unevenly distributed, and the intraobserver and interobserver reliability was fair to moderate (κ range 0.46-0.66 and mean κ 0.39 (day 1) and 0.33 (day 2), respectively). The web-based exercise showed acceptable agreement for cartilage being normal (κ 0.47) or with complete loss (κ 0.68), but poor for the intermediate scores (κ 0.22-0.30). CONCLUSIONS Use of the present semiquantitative ultrasonography scoring system for cartilage pathology in hand OA is not recommended (while normal or total loss of cartilage may be assessed). However, the OMERACT ultrasonography group will endorse the use of semiquantitative scoring of osteophytes with the ultrasonography atlas as reference.
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Affiliation(s)
- H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - A Iagnocco
- Rheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - A Mathiessen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Filippucci
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - F Gandjbakhch
- Department of Rheumatology, AP-HP, Pitie-Salpetriere Hospital, Paris, France UPMC Université Paris 06, Paris, France
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Department of Rheumatology, Flevoziekenhuis, The Netherlands
| | - I Möller
- Instituto Poal de Reumatologia, Barcelona, Spain
| | - E Naredo
- Department of Rheumatology, Hospital GU Gregorio Marañón, Madrid, Spain
| | - R J Wakefield
- Leeds Institute of Rheumatic and Rehabilitation Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - P Aegerter
- Université Versailles-Saint Quentin En Yvelines, Paris, France Department of Public Health, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - M-A D'Agostino
- Université Versailles-Saint Quentin En Yvelines, Inserm U987, Boulogne-Billancourt, France Department of Rheumatology, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
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Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, Aydin SZ, Bachta A, Hammer HB, Bruyn GAW, Filippucci E, Gandjbakhch F, Mandl P, Pineda C, Schmidt WA, D'Agostino MA. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014; 66:741-8. [PMID: 24151222 DOI: 10.1002/acr.22191] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/24/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To standardize ultrasound (US) in enthesitis. METHODS An initial Delphi exercise was undertaken to define US-detected enthesitis and its core components. These definitions were subsequently tested on static images taken from spondyloarthritis patients in order to evaluate their reliability. RESULTS Excellent agreement (>80%) was obtained for including hypoechogenicity, increased thickness of the tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity as core elementary lesions of US-detected enthesitis. US definitions were subsequently obtained for each elementary component. On static images, the intraobserver reliability showed a high degree of variability for the detection of elementary lesions, with kappa coefficients ranging from 0.13-1. The interobserver kappa values were variable, with the lowest kappa coefficient for enthesophytes (0.24) and the highest coefficient for Doppler activity at the enthesis (0.63). CONCLUSION This is the first consensus-based US definition of enthesitis and its elementary components and the first step performed to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work.
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Affiliation(s)
- L Terslev
- Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
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Terslev L, Hammer HB, Torp-Pedersen S, Szkudlarek M, Iagnocco A, D'Agostino MA, Schmidt WA, Uson J, Bruyn GA, Filippucci E, Möller I, Balint P, Wakefield R, Naredo E. EFSUMB minimum training requirements for rheumatologists performing musculoskeletal ultrasound. Ultraschall Med 2013; 34:475-477. [PMID: 23696065 DOI: 10.1055/s-0033-1335143] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In order to optimize and standardize musculoskeletal ultrasonography education for rheumatologists, there is a need for competency assessments addressing the required training and practical and theoretical skills. This paper describes how these competency assessments for rheumatologists were developed and what they contain.
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Affiliation(s)
- L Terslev
- Center of Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Glostrup University Hospital, Glostrup
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Terslev L, Hammer HB, Torp-Pedersen S, Szkudlarek M, Iagnocco A, D'Agostino MA, Schmidt WA, Uson J, Bruyn GA, Filippucci E, Möller I, Balint P, Wakefield R, Naredo E. EFSUMB Minimum Training Requirements for Rheumatologists Performing Musculoskeletal Ultrasound. Ultraschall Med 2013; 34:e11. [PMID: 23775447 DOI: 10.1055/s-0033-1335890] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- L Terslev
- Center of Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Glostrup University Hospital, Glostrup
| | - H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | | | - M Szkudlarek
- Department of Rheumatology, University of Copenhagen Hospital at Koege
| | - A Iagnocco
- Department of Rheumatology, Sapienza Università di Roma, Rome
| | - M A D'Agostino
- Rheumatology Department, Paris Ouest-Versailles-Saint Quentin en Yvelines University, Paris
| | - W A Schmidt
- Medical Centre for Rheumatology, Immanuel Krankenhaus, Berlin
| | - J Uson
- Department of Rheumatology, Hospital Universitario de Móstoles, Madrid
| | - G A Bruyn
- Department of Rheumatology, MC Groep, Lelystad
| | - E Filippucci
- Department of Rheumatology, Clinica Reumatologica, Università Politecnica delle Marche, Jesi
| | - I Möller
- Rheumatology Department, Instituto Poal, Barcelona
| | - P Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest
| | - R Wakefield
- LIMM Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds
| | - E Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid
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Fagerhol MK, Larsen A, Brun JG, Hammer HB, Angel K, Kvien TK, Kinne I, Madland TM. Large molecular size EDTA-resistant complexes containing S100A12, ERAC, in serum during inflammatory conditions. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:129-36. [DOI: 10.3109/00365513.2011.643819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Halvorsen EH, Strønen E, Hammer HB, Goll GL, Sollid LM, Molberg O. Interleukin-15 induces interleukin-17 production by synovial T cell lines from patients with rheumatoid arthritis. Scand J Immunol 2011; 73:243-9. [PMID: 21204897 DOI: 10.1111/j.1365-3083.2010.02498.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IL-17-producing T cells (Th17 cells) are believed to contribute to local inflammation and joint damage in rheumatoid arthritis (RA). Limited data exist on Th17 cells located within the inflamed synovial tissue (ST) of patients with RA. Here, we aimed to generate polyclonal T cell lines (TCLs) from the RA ST and assess their cytokine production, including the effects of exogenous IL-15 on IL-17 production in vitro. For five patients with RA, polyclonal TCLs were established from ST obtained by joint surgery. Synovial TCLs were expanded and stimulated by anti-CD3/CD28 microbeads and exogenous cytokines. Cytokine production was assessed by culture supernatant analyses and intracellular flow cytometry, and TCLs were sorted based on their surface expression of CCR6. In addition to IL-17, we detected IL-6, IL-10, IFN-γ and TNF-α in the synovial TCL culture supernatants. Exogenous IL-15 increased the production of IL-17 as well as the other cytokines except IFN-γ. For IL-17, this effect was more pronounced after prolonged culture times. Intracellular flow cytometry confirmed the presence of IL-17+ and IL-17+ IFN-γ+ CD4+ T cells in the TCLs. IL-17+ and IL-17+ IFN-γ+ T cells were enriched in the CD4+ CCR6+ population. In conclusion, Th17 cells can be detected after polyclonal expansion and stimulation of RA synovial TCLs generated by joint surgery. The Th17 cells from the RA ST were enriched in the CD4+ CCR6+ population, and they were sensitive to exogenous IL-15. Th17 cells present within the synovial compartment may contribute to the RA pathogenesis and local joint damage.
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Affiliation(s)
- E H Halvorsen
- Centre for Immune Regulation, Institute of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway.
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Hammer HB, Kvien TK. Ultrasonography shows significant improvement in wrist and ankle tenosynovitis in rheumatoid arthritis patients treated with adalimumab. Scand J Rheumatol 2010; 40:178-82. [PMID: 21091275 DOI: 10.3109/03009742.2010.517549] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Tenosynovitis is common in rheumatoid arthritis (RA) but knowledge is limited regarding its response to anti-inflammatory treatment. This study used ultrasonography (US) to examine the distribution and responsiveness of tenosynovitis to anti-tumour necrosis factor (anti-TNF) treatment in RA patients. METHODS Twenty patients with RA were examined at baseline and 1, 3, 6, and 12 months after starting adalimumab treatment, and grey-scale (GS) and power Doppler (PD) US scoring (semi-quantitative range 0-3) of wrist and ankle tendons was performed in addition to assessment of the 28-joint Disease Activity Score (DAS28), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). RESULTS The extensor carpi ulnaris (ECU) tendon in the wrists and the closely related tendons tibialis posterior (TB) and flexor digitorum longus (FDL) in the ankles were most often inflamed. Median sum scores for this reduced number of tendons at baseline/12-month follow-up were 5/0.5 for GS (p < 0.001) and 4/0 for PD (p < 0.05), with reductions in the US scores during follow-up as large as those found for sum scores of all tendons. The standardized response means (SRMs) for sum GS or PD scores of the reduced number of tendons were higher (range -0.53 to -0.93) than for the sum scores of all tendons (-0.23 to -0.74), and showed larger responsiveness than CRP (-0.10 to -0.43) and ESR (-0.03 to -0.71). CONCLUSION Bilateral assessments of ECU, TB, and FDL tendons were as sensitive to change as the sum scores of all tendons, and scoring of this reduced number of tendons is suggested to be included in US scorings for follow-up of RA patients.
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Affiliation(s)
- H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Naredo E, D’Agostino MA, Conaghan PG, Backhaus M, Balint P, Bruyn GAW, Filippucci E, Grassi W, Hammer HB, Iagnocco A, Kane D, Koski JM, Szkudlarek M, Terslev L, Wakefield RJ, Ziswiler HR, Schmidt WA. Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford) 2010; 49:2438-43. [DOI: 10.1093/rheumatology/keq243] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haavardsholm EA, Ostergaard M, Hammer HB, Boyesen P, Boonen A, van der Heijde D, Kvien TK. Monitoring anti-TNF treatment in rheumatoid arthritis: responsiveness of magnetic resonance imaging and ultrasonography of the dominant wrist joint compared with conventional measures of disease activity and structural damage. Ann Rheum Dis 2008; 68:1572-9. [DOI: 10.1136/ard.2008.091801] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hammer HB, Hovden IAH, Haavardsholm EA, Kvien TK. Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology (Oxford) 2005; 45:584-8. [PMID: 16332951 DOI: 10.1093/rheumatology/kei218] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [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: 11/13/2022] Open
Abstract
OBJECTIVES To examine whether patients with arthritic diseases and carpal tunnel syndrome (CTS) have increased cross-sectional areas of the median nerves measured by ultrasonography (US). Enlarged cross-sectional areas have previously been found in non-arthritic patients with idiopathic CTS. METHODS During 1 yr, all 12 patients with rheumatoid arthritis (RA) or other arthritic diseases hospitalized in our department for surgery for CTS were included. Nine of the patients had bilateral CTS, giving a total of 21 pathological nerves. The median duration of CTS symptoms was 9.5 months. The controls were 30 randomly selected RA patients without symptoms of CTS and 30 healthy persons. Both CTS patients and controls were examined bilaterally by use of US at the entrance of the carpal tunnel, and the cross-sectional areas of the median nerves were calculated. RESULTS Cross-sectional areas of the median nerves were significantly higher in the CTS patients compared with the RA controls and healthy persons; median (range) areas were 15.7 mm(2) (11.1-21.8), 8.5 mm(2) (5.8-11.0) and 8.0 mm(2) (4.9-12.0), respectively (P<0.0001). No significant differences in cross-sectional areas were observed between the two control groups, or between the right and left hand in the control groups. CONCLUSIONS Higher cross-sectional areas were found in the arthritic patients with CTS than in RA patients and healthy persons without CTS. This supports previous studies of idiopathic CTS in which increased cross-sectional areas have been found. Thus, as in idiopathic CTS, arthritic patients may be examined by US of the median nerve when CTS is suspected.
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Affiliation(s)
- H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23, Vinderen, N-0319 Oslo, Norway.
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Kjeldsen-Kragh J, Mellbye OJ, Haugen M, Mollnes TE, Hammer HB, Sioud M, Førre O. Changes in laboratory variables in rheumatoid arthritis patients during a trial of fasting and one-year vegetarian diet. Scand J Rheumatol 1995; 24:85-93. [PMID: 7747149 DOI: 10.3109/03009749509099290] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have previously reported that significant improvement may be obtained in rheumatoid arthritis patients by fasting followed by a vegetarian diet for one year. The present study was carried out to examine to what extent biochemical and immunological variables changed during the clinical trial of fasting and vegetarian diet. For the patients who were randomised to the vegetarian diet there was a significant decrease in platelet count, leukocyte count, calprotectin, total IgG, IgM rheumatoid factor (RF), C3-activation products, and the complement components C3 and C4 after one month of treatment. None of the measured parameters changed significantly during this period in the group of omnivores. The course of 14 of 15 measured variables favored the vegetarians compared with the omnivores, but the difference was only significant for leukocyte count, IgM RF, and the complement components C3 and C4. Most of the laboratory variables declined considerably in the vegetarians who improved according to clinical variables, indicating a substantial reduction in inflammatory activity. The leukocyte count, however, decreased in the vegetarians irrespective of the clinical results. Thus, the decline in leukocyte count may be attributed to vegetarian diet per se and not to the reduction in disease activity. The results of the present study are in accordance with the findings from the clinical trial, namely that dietary treatment can reduce the disease activity in some patients with rheumatoid arthritis.
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Affiliation(s)
- J Kjeldsen-Kragh
- Institute of Immunology and Rheumatology, National Hospital, Oslo, Norway
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Hammer HB, Kvien TK, Glennås A, Melby K. A longitudinal study of calprotectin as an inflammatory marker in patients with reactive arthritis. Clin Exp Rheumatol 1995; 13:59-64. [PMID: 7774104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the value of calprotectin, a major granulocyte protein with bactericide properties, as an inflammatory marker in patients with reactive arthritis. METHODS Twenty-five patients with Chlamydia-induced and 27 patients with enterobacteria-induced reactive arthritis were analysed. At the first visit and after 3, 12, 24, 52 and 104 weeks, calprotectin concentrations were measured in plasma and when possible, in synovial fluid. C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were analysed and clinical assessments of disease activity were performed. RESULTS Of the inflammatory markers, the plasma calprotectin concentrations were the first to normalize during recovery. Calprotectin concentrations in the plasma were highly correlated with CRP and ESR, and calprotectin was found to have high correlation coefficients with the clinical assessments of disease activity. High calprotectin concentrations were found in the synovial fluid. CONCLUSION The high correlations between calprotectin in plasma and clinical and laboratory markers of inflammation, as well as the rapid normalization following clinical improvement, demonstrate that calprotectin may be used as an inflammatory marker in patients with reactive arthritis.
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Affiliation(s)
- H B Hammer
- Oslo City Department of Rheumatology, Norwegian Lutheran Hospital
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Høgåsen K, Mollnes TE, Harboe M, Götze O, Hammer HB, Oppermann M. Terminal complement pathway activation and low lysis inhibitors in rheumatoid arthritis synovial fluid. J Rheumatol Suppl 1995; 22:24-8. [PMID: 7535360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate terminal complement activation and lysis inhibitors in rheumatoid arthritis (RA). METHODS C5a, vitronectin and clusterin were quantitated by enzyme immunoassays in plasma and synovial fluid (SF) in RA (n = 30) and osteoarthritis (OA) (n = 11). RESULTS In RA the concentration of C5a was 3-fold increased in plasma (21.9 vs 7.2 micrograms/l) and 5-fold increased in SF (7.8 vs 1.7 micrograms/l) compared to OA. The SF/plasma ratios for C5a, vitronectin and clusterin were 0.35, 0.36 and 0.23, respectively, not significantly different in the 2 diseases. CONCLUSION SF terminal pathway activation in RA combined with low local levels of lysis inhibitors might allow lytic or sublytic attacks on local cells, resulting in inflammation and cell damage.
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Affiliation(s)
- K Høgåsen
- Institute of Immunology and Rheumatology, National Hospital, University of Oslo, Norway
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