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Kasiem FR, Kok MR, Luime JJ, Tchetverikov I, Korswagen LA, Denissen NHAM, Goekoop-Ruiterman YPM, van Oosterhout M, Fodili F, Hazes JMW, Tillett W, Vis M. Construct validity and responsiveness of feasible composite disease activity measures for use in daily clinical practice in patients with psoriatic arthritis. RMD Open 2023; 9:e002972. [PMID: 37880177 PMCID: PMC10603327 DOI: 10.1136/rmdopen-2022-002972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/06/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE There is a need for a widely accepted comprehensive disease activity measure for use in daily practice in patients with psoriatic arthritis (PsA). For this reason, the 3-item Visual Analogue Scale (3VAS) and 4-item Visual Analogue Scale (4VAS) were developed. This study aimed to test construct validity and responsiveness of the 3VAS and 4VAS in a population of patients with newly diagnosed PsA receiving usual care. METHODS Components of the 3VAS (physician global, patient global, patient skin) and 4VAS (physician global, patient pain, patient joint, patient skin) were scored on 0-10 VAS scales. Agreement of low disease activity (LDA) state between 3VAS/4VAS and other composite measures was tested using Venn diagrams. Construct validity and responsiveness (3-month interval) were assessed using Spearman correlation coefficients and standardised response means (SRM) with effect sizes (ES), respectively, following hypothesis generation. Both 3VAS/4VAS were also compared with several patient-reported outcome measures. RESULTS Data from 629 patients were used. Both 3VAS (ES=0.48, SRM 0.52) and 4VAS (ES=0.48, SRM=0.50) showed responsiveness similar to Disease Activity in PSoriatic Arthritis (DAPSA) and Disease Activity Score-28 (DAS28). Both measures had a strong correlation with DAPSA (r=0.80-0.87), Psoriatic Arthritis Disease Activity Score (PASDAS) (r=0.89) and Routine Assessment of Patient Index Data 3 (RAPID3) (r=0.84-0.92). 3VAS and 4VAS had the highest agreement with PASDAS in categorising patients to LDA at 12 months. CONCLUSION This is the first study assessing the performance of the 3VAS and 4VAS in an observational cohort of patients with early PsA. Both measures have promising performance characteristics, showing strong correlations and good discrimination with existing composite measures. The 4VAS may be the preferred version with better face validity.
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Affiliation(s)
- Fazira R Kasiem
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marc R Kok
- Rheumatology and Clinical immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Rheumatology, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, The Netherlands
| | - Lindy-Anne Korswagen
- Rheumatology, Sint Franciscus Gasthuis, Rotterdam, Zuid-Holland, The Netherlands
| | | | | | | | - Faouzia Fodili
- Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, Netherlands
| | | | | | - Marijn Vis
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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2
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Eektimmerman F, Swen JJ, den Broeder AA, Hazes JMW, Kurreeman FS, Verstappen SMM, Nair N, Pawlik A, Nurmohamed MT, Dolžan V, Böhringer S, Allaart CF, Guchelaar HJ. Genome-wide Association Study of Methotrexate-Induced Liver Injury in Rheumatoid Arthritis Patients. Clin Pharmacol Ther 2023; 113:916-923. [PMID: 36708065 DOI: 10.1002/cpt.2858] [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: 10/23/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
Hepatotoxicity is a serious adverse drug reaction related to methotrexate (MTX). However, the cause of drug-induced liver injury (DILI) is still unclear and unpredictable. Genetic risk factors may predispose for MTX-DILI. Therefore, we conducted a nested case-control genome-wide association study to explore genetic risk factors associated with MTX-DILI. Seven international groups contributed blood samples and data of patients with rheumatoid arthritis who used MTX. MTX-DILI was defined as an alanine aminotransferase (ALT) level of at least three times the upper limit of normal (ULN), to increase contrast controls ALT levels did not raise above two times the ULN. Per study site, control subjects and patients with MTX-DILI (ratio 3:1) were matched for age, gender, and duration of MTX use. Patients were genotyped using Illumina GSA MD-24v1-0 and data were imputed using the 1000 Genomes reference panel. Single-nucleotide polymorphisms (SNPs) were analyzed using an additive genetic model, corrected for sex, country, and age. A P-value of ≤ 5 × 10-8 was considered significant, whereas a P-value of ≤ 5 × 10-6 was considered suggestive. A total of 108 MTX-DILI cases and 311 controls were included for association analysis. None of the SNPs were significantly associated with MTX-DILI. However, we found seven suggestive genetic variants associated with MTX-DILI (P-values 7.43 × 10-8 to 4.86 × 10-6 ). Of those, five SNPs were in the intronic protein-coding regions of FTCDNL1, BCOR, FGF14, RBMS3, and PFDN4/DOK5. Investigation of candidates SPATA9 (rs72783407), PLCG2 (rs60427389), RAVER2 (rs72675408), JAK1 (rs72675451), PTPN2 (rs2476601), MTHFR C677T (rs1801133), and into the HLA region did not show significant findings. No genetic variants associated with MTX-DILI were found, whereas suggestive SNPs need further investigation.
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Affiliation(s)
- Frank Eektimmerman
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Radboudumc and Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, ErasmusMC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fina S Kurreeman
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzanne M M Verstappen
- Division of Musculoskeletal and Dermatological Sciences, Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nisha Nair
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Musculoskeletal Sciences, Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | - Mike T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Vita Dolžan
- Faculty of Medicine, Institute of Biochemistry and Molecular Genetics, University of Ljubljana, Ljubljana, Slovenia
| | - Stefan Böhringer
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
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de Steenwinkel FDO, Dolhain RJEM, Hazes JMW, Hokken-Koelega ACS. Does prednisone use in pregnant women with rheumatoid arthritis induce insulin resistance in the offspring? Clin Rheumatol 2023; 42:47-54. [PMID: 36040672 PMCID: PMC9823030 DOI: 10.1007/s10067-022-06347-0] [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: 06/28/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The use of long-term corticosteroids during pregnancy has been growing over the past decades. Corticosteroids can be given when an auto-inflammatory disease like rheumatoid arthritis (RA) is too active. Several studies have shown that long-term corticosteroids use in pregnancy is associated with maternal and fetal adverse outcomes, like preeclampsia, shorter gestational age, lower birth weight, and rapid catch-up growth. These last two outcomes could influence the insulin resistance later in life. Our objective was to investigate whether prednisone use in pregnant women with RA induces insulin resistance in offspring. METHODS One hundred three children were included after their mother had participated in a prospective cohort study on RA and pregnancy. Forty-two children were in utero exposed to prednisone and 61 were non-exposed. To assess insulin resistance, we measured homeostasis model of assessment insulin resistance (HOMA-IR) and serum adiponectin and lipid levels, corrected for body fat distribution. RESULTS An average of 6 mg prednisone on a daily use gave no difference in mean HOMA-IR (SD) between the children who were prednisone-exposed in utero (1.10 (0.84)) and those non-exposed (1.09 (0.49)). No difference was found in mean adiponectin level, body fat distribution, or lipid levels such as total cholesterol, fasting triglyceride, or high-density lipoprotein. CONCLUSION Children who are prednisone-exposed in utero (low dose) have no increased risk for insulin resistance at the age of approximately 7 years. These findings are reassuring because the prednisone use during pregnancy is increasing worldwide. Further research has to be performed to evaluate if the insulin resistance remains absent in the future. Key Points • What is already known on this topic-long-term corticosteroids use in pregnancy is associated with fetal adverse outcomes, like lower birth weight and rapid catch-up growth which can influence the insulin resistance later in life. • What this study adds-long-term corticosteroids use in pregnant women with rheumatoid arthritis has no increased risk for insulin resistance in the offspring. • How this study might affect research, practice, or policy-findings are reassuring because prednisone use during pregnancy is increasing worldwide. Further research should evaluate if the insulin resistance remains absent in the future.
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Affiliation(s)
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anita C S Hokken-Koelega
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Kasiem FR, Kok MR, Luime JJ, Tchetverikov I, Wervers K, Korswagen LA, Denissen N, Goekoop-Ruiterman YPM, van Oosterhout M, Fodili F, Hazes JMW, Vis M. Impact of psoriasis remains important in psoriatic arthritis patients with low musculoskeletal disease activity. Clin Exp Rheumatol 2023; 41:88-93. [PMID: 35699074 DOI: 10.55563/clinexprheumatol/q8fh0a] [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: 01/05/2022] [Accepted: 03/28/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Achieving low disease activity (LDA) is important in patients with psoriatic arthritis. It is of value to know if health-related quality of life (HRQoL) of patients who reached musculoskeletal low disease activity can be further improved by additionally achieving remission of their psoriasis. So, the aim of this study was to assess HRQoL in patients with active psoriasis who reached disease activity in psoriatic arthritis (DAPSA) LDA after one year of follow-up. METHODS Data were collected from the Dutch south west Psoriatic Arthritis cohort. Musculoskeletal disease activity was measured using DAPSA. Patients who reached DAPSA-LDA after one year were divided based on reaching psoriasis remission (Psoriasis Area and Severity Index [PASI] <1). HRQoL and work productivity were compared between both groups. RESULTS After one year, 230 (44%) patients with active psoriasis at baseline reached DAPSA-LDA, of which 108 (47%) patients achieved psoriasis remission. The group of patients with active psoriasis (n=122, 53%) contained more men (p=0.023) and scored lower on the 12-item Psoriatic Arthritis Impact of Disease questionnaire (p=0.012). On the Skindex-17 psychosocial subscale, 31% experienced moderate to high impairment and on the symptoms subscale 28% experienced a lot of symptoms. Work productivity did not differ between both groups. CONCLUSIONS The majority of patients with DAPSA-LDA and active psoriasis after one year has a good HRQoL. However, a proportion of these patients still experiences considerable skin burden. We recommend rheumatologists to continue assessing and treating psoriasis to reduce skin burden in PsA patients who achieved musculoskeletal low disease activity.
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Affiliation(s)
- Fazira R Kasiem
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Kim Wervers
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lindy-Anne Korswagen
- Department of Rheumatology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Natasja Denissen
- Department of Rheumatology, Amphia Hospital, Breda, The Netherands
| | | | | | - Faouzia Fodili
- Department of Rheumatology, Reumazorg Zuid West Nederland, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marijn Vis
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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5
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Ghalandari N, Crijns HJMJ, Bergman JEH, Dolhain RJEM, van Puijenbroek EP, Hazes JMW. Reported congenital malformations after exposure to non-tumour necrosis factor inhibitor biologics: A retrospective comparative study in EudraVigilance. Br J Clin Pharmacol 2022; 88:5378-5388. [PMID: 35894810 DOI: 10.1111/bcp.15471] [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: 05/04/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS To evaluate the number and nature of reported congenital malformations (CMs) after intrauterine exposure to non-tumour necrosis factor inhibitor biologics (non-TNFi biologics) compared to certolizumab pegol (CZP). METHODS A retrospective comparative study was conducted in the EudraVigilance (EV) database. A safe biologic (CZP) was considered as the reference group. Odds ratios (ORs) for CMs were calculated for each non-TNFi biologic (including abatacept, anakinra, belimumab, ixekizumab, rituximab, secukinumab, tocilizumab, ustekinumab and vedolizumab), versus CZP (quantitative assessment). Then, CM patterns were reviewed in consultation with a clinical geneticist (qualitative assessment). RESULTS ORs were not statistically significant except for belimumab and vedolizumab (similar in magnitude). Except for vedolizumab, no specific CM patterns were observed for the included non-TNFi biologics. Three cases of corpus callosum agenesis (CCA) were identified for vedolizumab (versus none in CZP and other investigated non-TNFi biologics). Two of the CCA cases were associated with other neurological CMs (one cerebral ventriculomegaly with microcephaly and one polymicrogyria). This may indicate that these CCAs are related to undiagnosed genetic alterations or are associated with the underlying maternal disease, although a definite relationship with vedolizumab exposure cannot be ruled out. CONCLUSION No special safety signal was identified regarding the occurrence of CMs after exposure to abatacept (n = 64), anakinra (n = 20), belimumab (n = 93), ixekizumab (n = 29), rituximab (n = 57), secukinumab (n = 128), tocilizumab (n = 124) and ustekinumab (n = 215). Regarding observed CCAs in the vedolizumab group (n = 113), no firm conclusions can be made based on available information.
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Affiliation(s)
- Nafise Ghalandari
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Medicines Evaluation Board (MEB), Utrecht, The Netherlands.,Academic Center of Inflammunity, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jorieke E H Bergman
- Department of Genetics, Eurocat Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Academic Center of Inflammunity, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eugène P van Puijenbroek
- Unit of Pharmacotherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands.,Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Academic Center of Inflammunity, Erasmus University Medical Center, Rotterdam, The Netherlands
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6
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Kasiem FR, Pasma A, Luime JJ, Tchetverikov I, Wervers K, Korswagen LA, Denissen N, Goekoop-Ruiterman YPM, van Oosterhout M, Fodili F, Hazes JMW, van Doorn MBA, Kok MR, Vis M. A practical guide for assessment of skin burden in patients with psoriatic arthritis. J Rheumatol 2022; 49:1117-1123. [PMID: 35649550 DOI: 10.3899/jrheum.210550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Rheumatologists play a pivotal role in the management of patients with Psoriatic Arthritis (PsA). Due to time constraints, the skin may not receive the attention that is needed for optimal patient outcome. Therefore, the aim of this study was to select a set of core questions that can help rheumatologists to identify PsA patients with a high skin burden in daily rheumatology clinical practice. METHODS Baseline data from patients included in the Dutch south west Psoriatic Arthritis cohort were used. Questions were derived from the Skindex-17 and Dermatology Life Quality Index (DLQI) questionnaires. Underlying clusters of questions were identified with an exploratory principal component analysis (PCA) with varimax rotation, after which a 2-parameter logistic model was fitted per cluster. Questions were selected based on their discrimination and difficulty. Subsequently, two flowcharts were made with categories of skin burden severity. Clinical consideration were specified per category. RESULTS In total, 413 patients were included. The PCA showed 2 underlying clusters; a psychosocial domain and a domain assessing physical symptoms. We selected these 2 domains. The psychosocial domain contains 3 questions and specifies 4 categories of skin burden severity. The physical symptoms domain contains 2 questions and categorizes patients in one out of 3 categories. CONCLUSION We have selected a set of maximum 5 questions which rheumatologists can easily implement in their consult to assess skin burden in PsA patients. This practical guide makes assessment of skin burden more accessible to rheumatologists and can aid in clinical decision making.
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Affiliation(s)
- Fazira R Kasiem
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Annelieke Pasma
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Jolanda J Luime
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Ilja Tchetverikov
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Kim Wervers
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Lindy-Anne Korswagen
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Natasja Denissen
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Yvonne P M Goekoop-Ruiterman
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Maikel van Oosterhout
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Faouzia Fodili
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Johanna M W Hazes
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Martijn B A van Doorn
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
| | - Marc R Kok
- Erasmus Medical Center, dep. of Rheumatology, Albert Schweitzer Hospital, dep. of Rheumatology, Franciscus Gasthuis & Vlietland, dep. of Rheumatology, Amphia Hospital, dep. of Rheumatology, Haga Hospital, dep. of Rheumatology, Groene Hart Ziekenhuis dep. of Rheumatology, Reumazorg Zuid West Nederland, dep. of Rheumatology, Erasmus Medical Center, dep. of Dermatology, Maasstad Hospital, dep. of Rheumatology and clinical immunology. Statement of ethics and consent: This study was approved by the local medical research ethics committee of the University Medical Center Rotterdam (MEC-2012-549) and written informed consent was obtained for all study participants according to the Declaration of Helsinki. Address correspondence to Fazira. R. Kasiem, MD; Doctor Molewaterplein 40, 3015 GD Rotterdam. Email address:
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7
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Perez-Garcia LF, Röder E, Smeele HTW, Goekoop R, Hazes JMW, Kok MR, Tchetverikov I, van der Helm-van Mil A, van der Kaap J, Kok P, Krijthe P BP, Dolhain RJEM. Paternal inflammatory arthritis is associated with a higher risk of miscarriage: results of a large multicenter study (iFAME-Fertility). Rheumatology (Oxford) 2021; 61:3390-3395. [PMID: 34875039 PMCID: PMC9348772 DOI: 10.1093/rheumatology/keab910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Paternal preconception health is recognized as an important contributor to pregnancy outcomes. Nonetheless, pregnancy outcomes of partners of men with inflammatory arthritis (IA) have never been studied. Our objective was to describe the pregnancy outcomes of partners of men diagnosed with IA. Methods We performed a multicentre cross-sectional retrospective study conducted in the Netherlands. Men with IA who were over 40 years old that reported at least one positive pregnancy test were included. To analyse the impact of IA on pregnancy outcomes, pregnancies were classified into two groups: pregnancies conceived after the diagnosis of IA and before the diagnosis of IA. Results In total, 408 male participants diagnosed with IA reported 897 singleton pregnancies that resulted in 794 live births. Pregnancies conceived after the diagnosis of IA had higher rate of miscarriage (12.27 vs 7.53%, P = <0.05). This increased risk was still present after adjusting for confounders [OR 2.03 (95% CI 1.12, 3.69) P = 0.015]. Conclusions This is the largest study to describe the pregnancy outcomes of partners of men diagnosed with IA and the first to demonstrate that paternal IA is associated with a higher risk of miscarriage. Notwithstanding, the overall rate of miscarriage reported in our study could be comparable to previously reported population estimates.
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Affiliation(s)
- Luis F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Esther Röder
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Hieronymus T W Smeele
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Robbert Goekoop
- Department of Rheumatology, Haga Hospital, The Hague, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Annette van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos van der Kaap
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam.,Department of Rheumatology, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Petra Kok
- Department of Rheumatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Bouwe P Krijthe P
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam.,Department of Rheumatology, Sint Franciscus Vlietland Group, Rotterdam, Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
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8
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Perez-Garcia LF, Röder E, Goekoop RJ, Hazes JMW, Kok MR, Smeele HTW, Tchetverikov I, van der Helm-van Mil AHM, van der Kaap JH, Kok P, Krijthe BP, Dolhain RJEM. Impaired fertility in men diagnosed with inflammatory arthritis: results of a large multicentre study (iFAME-Fertility). Ann Rheum Dis 2021; 80:1545-1552. [PMID: 34373257 PMCID: PMC8600610 DOI: 10.1136/annrheumdis-2021-220709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The impact of inflammatory arthritis (IA) on male fertility remains unexplored. Our objective was to evaluate the impact of IA on several male fertility outcomes; fertility rate (number of biological children per man), family planning, childlessness and fertility problems. METHODS We performed a multicentre cross-sectional study (iFAME-Fertility). Men with IA 40 years or older who indicated that their family size was complete were invited to participate. Participants completed a questionnaire that included demographic, medical and fertility-related questions. To analyse the impact of IA on fertility rate, patients were divided into groups according to the age at the time of their diagnosis: ≤30 years (before the peak of reproductive age), between 31 and 40 years (during the peak) and ≥41 years (after the peak). RESULTS In total 628 participants diagnosed with IA were included. Men diagnosed ≤30 years had a lower mean number of children (1.32 (SD 1.14)) than men diagnosed between 31 and 40 years (1.60 (SD 1.35)) and men diagnosed ≥41 years (1.88 (SD 1.14)).This was statistically significant (p=0.0004).The percentages of men diagnosed ≤30 and 31-40 years who were involuntary childless (12.03% vs 10.34% vs 3.98%, p=0.001) and who reported having received medical evaluations for fertility problems (20.61%, 20.69% and 11.36%, p=0.027) were statistically significant higher than men diagnosed ≥41 years. CONCLUSIONS This is the first study that shows that IA can impair male fertility. Men diagnosed with IA before and during the peak of reproductive age had a lower fertility rate, higher childlessness rate and more fertility problems. Increased awareness and more research into the causes behind this association are urgently needed.
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Affiliation(s)
| | - Esther Röder
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Johanna M W Hazes
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marc R Kok
- Rheumatology and Clinical Immunology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Ilja Tchetverikov
- Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Annette H M van der Helm-van Mil
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos H van der Kaap
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Admiraal De Ruyter Hospital, Goes, The Netherlands
| | - Petra Kok
- Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Bouwe P Krijthe
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Sint Franciscus Vlietland Group, Rotterdam, The Netherlands
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9
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Luurssen-Masurel N, Weel AEAM, Koc GH, Hazes JMW, de Jong PHP. The number of risk factors for persistent disease determines the clinical course of early arthritis. Rheumatology (Oxford) 2021; 60:3617-3627. [PMID: 33484138 PMCID: PMC8328505 DOI: 10.1093/rheumatology/keaa820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/17/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives Management of early arthritis is based upon early recognition of individuals at high risk of developing persistent arthritis. Therefore, this study investigates whether the number of risk factors for persistent disease or treatment determines the clinical course of early arthritis by comparing the chance at (sustained) DMARD-free remission ((S)DFR) after 2 years follow-up. Methods Data from the tREACH trial, a stratified single-blinded multicentre strategy trial with a treat-to-target approach were used. We selected all patients with ≥1 swollen joint who did not fulfil 1987 and/or 2010 criteria for RA. The number of risk factors present; autoantibody-positivity, polyarthritis (>4), erosive disease and elevated acute phase reactants, determined risk group stratification. Multivariate logistic regression analyses were performed with (S)DFR as dependent variables and baseline disease activity score (DAS), treatment, symptom duration and number of risk factors present as independent variables. Results In total, 130 early arthritis patients were included and respectively 31, 66 and 33 had 0, 1 and ≥2 risk factors present. DFR rates were respectively 74%, 48% and 45% for early arthritis patients with 0, 1 and ≥2 risk factors present. In accordance SDFR rates were 61%, 32% and 30%. In our logistic model (S)DFR was not influenced by the initial treatment strategies when stratified for risk groups. Conclusion The chance at (S)DFR in early arthritis diminishes when more risk factors are present, which is irrespective of the given initial treatment. Our data point out to a stratified management approach in early arthritis based on their risk profile, but validation is needed. Trial registration ISRCTN registry: ISRCTN26791028 (http://www.isrctn.com/ISRCTN26791028).
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Affiliation(s)
| | - A E A M Weel
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - G H Koc
- Department of Internal Medicine, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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10
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Kasiem FR, Kok MR, Luime JJ, Tchetverikov I, Wervers K, Korswagen LA, Denissen NHAM, Goekoop-Ruiterman YPM, van Oosterhout M, Fodili F, Hazes JMW, Vis M. The burden of psoriasis in patients with early psoriatic arthritis. Rheumatology (Oxford) 2021; 61:1570-1578. [PMID: 34302456 PMCID: PMC8996789 DOI: 10.1093/rheumatology/keab606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/05/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives Psoriasis impacts health-related quality of life (HRQoL) in PsA patients. However, this is not adequately measured with a general HRQoL questionnaire. The aim of this study was to quantify the degree of psoriasis evolution in PsA patients over the first year of follow-up and to evaluate whether the impact of psoriasis on HRQoL can be adequately measured with a dermatology-specific HRQoL questionnaire. Methods Data were used from PsA patients in the Dutch south west Early Psoriatic Arthritis cohort. Psoriasis severity was measured with the Psoriasis Area and Severity Index (PASI). Dermatology-specific HRQoL was assessed with the Skindex-17 questionnaire. We used a Sankey diagram to illustrate the evolution of psoriasis severity during the first year of follow-up. To assess the association between psoriasis severity and the symptoms and psychosocial subscale of the Skindex-17, a linear regression analysis with hierarchical variable selection and zero-inflated negative binominal regression analysis were performed, respectively. Results We included 644 patients; 109 (17%) patients had no psoriasis (PASI = 0), 456 (71%) had mild psoriasis (PASI < 7), 56 (9%) had moderate psoriasis (PASI 7–12) and 23 (4%) had severe psoriasis (PASI > 12). Psoriasis severity did not fluctuate much during the first year. PASI was significantly associated with both subscales of the Skindex-17 at baseline and 12 months. Conclusion Psoriasis severity in PsA patients is mostly mild but impacts HRQoL when measured using a dermatology-specific HRQoL questionnaire. For optimal management of PsA patients, we recommend rheumatologists acquire information on skin burden by using a dermatology-specific HRQoL questionnaire.
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Affiliation(s)
| | - Marc R Kok
- Maasstad Hospital, Rotterdam, Netherlands
| | | | | | - Kim Wervers
- Erasmus Medical Center, Rotterdam, Netherlands
| | | | | | | | | | | | | | - Marijn Vis
- Erasmus Medical Center, Rotterdam, Netherlands
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11
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den Braanker H, Wervers K, Mus AMC, Bangoer PS, Davelaar N, Luime J, Tchetverikov I, Hazes JMW, Vis M, Lubberts E, Kok MR. Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis. RMD Open 2021; 6:rmdopen-2020-001175. [PMID: 32669451 PMCID: PMC7425114 DOI: 10.1136/rmdopen-2020-001175] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 01/14/2023] Open
Abstract
Objectives Methotrexate (MTX) is currently the recommended first-line therapy for treating psoriatic arthritis (PsA), despite lacking clear evidence. No estimates of efficacy of MTX in usual care and no clear MTX responsive clinical or laboratory variables are currently available. This study describes the response to MTX monotherapy in newly diagnosed patients with PsA in usual care. Second, we compared clinical variables and cytokine profiles in patients responding and not responding to MTX monotherapy. Methods We used data collected in the Dutch southwest Early Psoriatic Arthritis cohoRt study to select patients with PsA with oligoarthritis or polyarthritis, and at least 1 year follow-up. We analysed disease activity at 6 months of patients who started MTX monotherapy and still used MTX monotherapy 1 year after diagnosis. Cytokine profiles were determined at baseline and after 3 and 6 months with a bead-based multi-immunoassay. Results We identified 219 patients of which 183 (84%) patients started MTX monotherapy within 6 months after diagnosis. 90 patients used MTX monotherapy throughout the first year of which 44 patients (24%) reached minimal disease activity(MDA) at 6 months, decreasing to 33 patients (18%) after 1 year. Non-responders had significantly higher concentrations of interleukin (IL) 23 and IL-10 before and during MTX therapy. Conclusions Our results showed that only 18% of patients with PsA are in sustained MDA after 1 year of MTX monotherapy and non-responders more often had IL-23-driven disease. Our results indicate the need for more treat-to-target and personalised therapy strategies in PsA.
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Affiliation(s)
- Hannah den Braanker
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, Netherlands.,Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Kim Wervers
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Adriana M C Mus
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Priyanka S Bangoer
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Nadine Davelaar
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Jolanda Luime
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Marijn Vis
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Erik Lubberts
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, Netherlands
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12
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Perez-Garcia LF, Dolhain RJEM, Vorstenbosch S, Bramer W, van Puijenbroek E, Hazes JMW, Te Winkel B. The effect of paternal exposure to immunosuppressive drugs on sexual function, reproductive hormones, fertility, pregnancy and offspring outcomes: a systematic review. Hum Reprod Update 2021; 26:961-1001. [PMID: 32743663 PMCID: PMC7600290 DOI: 10.1093/humupd/dmaa022] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/17/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information regarding the possible influence of immunosuppressive drugs on male sexual function and reproductive outcomes is scarce. Men diagnosed with immune-mediated diseases and a wish to become a father represent an important neglected population since they lack vital information to make balanced decisions about their treatment. OBJECTIVE AND RATIONALE The aim of this research was to systematically review the literature for the influence of paternal immunosuppressive drug use on many aspects of male sexual health, such as sexual function, fertility, pregnancy outcomes and offspring health outcomes. SEARCH METHODS A systematic literature search was performed in the bibliographic databases: Embase (via Elsevier embase.com), MEDLINE ALL via Ovid, Cochrane Central Register of Trials (via Wiley) and Web of Science Core Collection. Additionally, Google Scholar and the Clinical trial registries of Europe and the USA were searched. The databases were searched from inception until 31 August 2019. The searches combined keywords regarding male sexual function and fertility, pregnancy outcomes and offspring health with a list of immunosuppressive drugs. Studies were included if they were published in English and if they included original data on male human exposure to immunosuppressive drugs. A meta-analysis was not possible to perform due to the heterogeneity of the data. OUTCOMES A total of 5867 references were identified, amongst which we identified 161 articles fulfilling the eligibility criteria. Amongst these articles, 50 included pregnancy and offspring outcomes and 130 included sexual health outcomes. Except for large Scandinavian cohorts, most of the identified articles included a small number of participants. While a clear negative effect on sperm quality was evident for sulfasalazine and cyclophosphamide, a dubious effect was identified for colchicine, methotrexate and sirolimus. In three articles, exposure to tumour necrosis factor-α inhibitors in patients diagnosed with ankylosing spondylitis resulted in improved sperm quality. The information regarding pregnancy and offspring outcomes was scant but no large negative effect associated with paternal immunosuppressive drug exposure was reported. WIDER IMPLICATIONS Evidence regarding the safety of immunosuppressive drugs in men with a wish to become a father is inconclusive. The lack of standardisation on how to evaluate and report male sexual function, fertility and reproduction as study outcomes in men exposed to immunosuppressive drugs is an important contributor to this result. Future research on this topic is needed and should be preferably done using standardised methods.
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Affiliation(s)
- L F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - S Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
| | - W Bramer
- Medical Library, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - E van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands.,Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, 9712 CP Groningen, The Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - B Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
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13
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Smeele HTW, de Man YA, Röder E, Wintjes H, Hazes JMW, Dolhain RJEM. Parenting problems postpartum can be detected early in pregnancy in patients with rheumatoid arthritis. RMD Open 2021; 6:rmdopen-2020-001276. [PMID: 32646954 PMCID: PMC7425188 DOI: 10.1136/rmdopen-2020-001276] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/03/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To describe parenting disability postpartum in patients with rheumatoid arthritis (RA) using the Parenting Disability Index and to determine early in pregnancy which patients will face parenting problems postpartum. Methods Data were collected from a prospective study on pregnancy and RA (Pregnancy induced Amelioration of Rheumatoid Arthritis study). Postpartum visits were performed at 6, 12 and 26 weeks after delivery. Domains causing parenting difficulties were identified. A multivariate logistic regression model to identify which patients develop parenting disabilities postpartum with patient characteristics in the first trimester as covariates was performed. Results 148 patients were eligible for this study. The domains carrying, hygiene, feeding, getting up and down, and household/shopping were frequently scored as difficult. Maintaining discipline, taking care of the children when sick, listening and having other children over caused the least problems. 30.1% of patients with RA report low parenting disability, 30.9% reports intermediate disability and 39.0% reports high disability. Patients with a low Health Assessment Questionnaire (HAQ)-score in the first trimester (OR 9.2, 95% CI 3.0 to 27.7, p<0.001) and low disease activity in the first trimester (Disease Activity Score 28-joint count C reactive protein<3.2) (OR 4.8, 95% CI 1.8 to 12.9, p=0.002) were likely to report low parenting disability postpartum. Patients with a longer disease duration (OR 0.87, 95% CI 0.79 to 0.95, p=0.003) were less likely to report low parenting disability postpartum. A high HAQ-score in the first trimester (OR 4.54, 95% CI 1.99 to 10.34, p<0.001) and erosive disease (OR 2.32, 95% CI 1.00 to 5.35, p=0.049) increased the risk of high parenting disability postpartum. Conclusion Physical domains of parenting postpartum are most commonly affected in patients with RA. When counselling patients with RA, a HAQ-score in the first trimester is the most reliable marker to identify patients that develop parenting disability after delivery.
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Affiliation(s)
| | | | - Esther Röder
- Rheumatology, Erasmus MC, Rotterdam, Netherlands
| | | | - J M W Hazes
- Rheumatology, Erasmus MC, Rotterdam, Netherlands
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14
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Gosselt HR, Verhoeven MMA, Bulatović-Ćalasan M, Welsing PM, de Rotte MCFJ, Hazes JMW, Lafeber FPJG, Hoogendoorn M, de Jonge R. Complex Machine-Learning Algorithms and Multivariable Logistic Regression on Par in the Prediction of Insufficient Clinical Response to Methotrexate in Rheumatoid Arthritis. J Pers Med 2021; 11:jpm11010044. [PMID: 33466633 PMCID: PMC7828730 DOI: 10.3390/jpm11010044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/30/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
The goals of this study were to examine whether machine-learning algorithms outperform multivariable logistic regression in the prediction of insufficient response to methotrexate (MTX); secondly, to examine which features are essential for correct prediction; and finally, to investigate whether the best performing model specifically identifies insufficient responders to MTX (combination) therapy. The prediction of insufficient response (3-month Disease Activity Score 28-Erythrocyte-sedimentation rate (DAS28-ESR) > 3.2) was assessed using logistic regression, least absolute shrinkage and selection operator (LASSO), random forest, and extreme gradient boosting (XGBoost). The baseline features of 355 rheumatoid arthritis (RA) patients from the “treatment in the Rotterdam Early Arthritis CoHort” (tREACH) and the U-Act-Early trial were combined for analyses. The model performances were compared using area under the curve (AUC) of receiver operating characteristic (ROC) curves, 95% confidence intervals (95% CI), and sensitivity and specificity. Finally, the best performing model following feature selection was tested on 101 RA patients starting tocilizumab (TCZ)-monotherapy. Logistic regression (AUC = 0.77 95% CI: 0.68–0.86) performed as well as LASSO (AUC = 0.76, 95% CI: 0.67–0.85), random forest (AUC = 0.71, 95% CI: 0.61 = 0.81), and XGBoost (AUC = 0.70, 95% CI: 0.61–0.81), yet logistic regression reached the highest sensitivity (81%). The most important features were baseline DAS28 (components). For all algorithms, models with six features performed similarly to those with 16. When applied to the TCZ-monotherapy group, logistic regression’s sensitivity significantly dropped from 83% to 69% (p = 0.03). In the current dataset, logistic regression performed equally well compared to machine-learning algorithms in the prediction of insufficient response to MTX. Models could be reduced to six features, which are more conducive for clinical implementation. Interestingly, the prediction model was specific to MTX (combination) therapy response.
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Affiliation(s)
- Helen R. Gosselt
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands;
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-4443029
| | - Maxime M. A. Verhoeven
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
| | - Maja Bulatović-Ćalasan
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
- Department of Internal Medicine, UMC Utrecht, 3508 GA Utrecht, The Netherlands
| | - Paco M. Welsing
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
| | - Maurits C. F. J. de Rotte
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Univ of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Johanna M. W. Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Floris P. J. G. Lafeber
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, 3508 GA Utrecht, The Netherlands; (M.M.A.V.); (M.B.-Ć.); (P.M.W.); (F.P.J.G.L.)
| | - Mark Hoogendoorn
- Department of Computer Science, Quantitative Data Analytics Group, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands;
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15
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van Mulligen E, Ahmed S, Weel AEAM, Hazes JMW, van der Helm-van Mil AHM, de Jong PHP. Factors that influence biological survival in rheumatoid arthritis: results of a real-world academic cohort from the Netherlands. Clin Rheumatol 2021; 40:2177-2183. [PMID: 33415451 PMCID: PMC8121743 DOI: 10.1007/s10067-020-05567-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
We aim to explore real-world biological survival stratified for discontinuation reason and determine its influenceability in rheumatoid arthritis (RA) patients. Data from the local pharmacy database and patient records of a university hospital in the Netherlands were used. RA patients who started a biological between 2000 and 2020 were included. Data on age, anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) status, presence of erosions, gender, body mass index, time to first biological, biological survival time, use of csDMARDs, and discontinuation reasons were collected. Of the included 318 patients, 12% started their first biological within 6 months after diagnosis. The median time to first biological was 3.6 years (95% CI, 1.0–7.2). The median survival of the first- and second-line biological was respectively 1.7 years (95% CI, 1.3–2.2) and 0.8 years (95% CI, 0.5–1.0) (p = 0.0001). Discontinuation reasons for the first-line biological were ineffectiveness (47%), adverse events (17%), remission (16%), pregnancy (30%), or patient preference (10%). Multivariable Cox regression analyses for discontinuation due to inefficacy or adverse events showed that concomitant use of csDMARDs (HR = 1.32, p < 0.001) positively while RF positivity negatively (HR = 0.82, p = 0.03) influenced biological survival. ACPA positivity was associated with the inability to discontinue biologicals after achieving remission (HR = 1.43, p = 0.023). Second-line TNF inhibitor survival was similar between patients with a primary and secondary non-response on the first-line TNF inhibitor (HR = 1.28, p = 0.34). Biological survival diminishes with the number of biologicals used. Biological survival is prolonged if patients use csDMARDs. RF was negatively associated with biological survival. ACPA was negatively associated with the inability to discontinue biologicals after achieving remission. Therefore, tailoring treatment based upon autoantibody status might be the first step towards personalized medicine in RA.Key Points • Prolonged biological survival is a surrogate for treatment effectiveness; however, an increasing amount of patients will taper treatment due to remission, and factors influencing biological survival based on separate reasons for discontinuation have not been explored. • We found that combining a biological DMARD with a conventional synthetic DMARD increases biological DMARD survival. Rheumatoid factor is negatively associated with biological survival. Anti-citrullinated protein antibody is negatively associated with the inability to discontinue the biological when remission was reached. • The first step towards personalized medicine might be tailoring of treatment based upon autoantibody status. |
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Affiliation(s)
- Elise van Mulligen
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Saad Ahmed
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Angelique E A M Weel
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands.,Erasmus School of Health Policy & Management, Rotterdam, the Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Rheumatology, LUMC, Leiden, the Netherlands
| | - Pascal H P de Jong
- Department of Rheumatology, Erasmus MC, Room Na-523, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
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16
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Gosselt HR, Muller IB, Jansen G, van Weeghel M, Vaz FM, Hazes JMW, Heil SG, de Jonge R. Identification of Metabolic Biomarkers in Relation to Methotrexate Response in Early Rheumatoid Arthritis. J Pers Med 2020; 10:jpm10040271. [PMID: 33321888 PMCID: PMC7768454 DOI: 10.3390/jpm10040271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
This study aimed to identify baseline metabolic biomarkers for response to methotrexate (MTX) therapy in rheumatoid arthritis (RA) using an untargeted method. In total, 82 baseline plasma samples (41 insufficient responders and 41 sufficient responders to MTX) were selected from the Treatment in the Rotterdam Early Arthritis Cohort (tREACH, trial number: ISRCTN26791028) based on patients' EULAR response at 3 months. Metabolites were assessed using high-performance liquid chromatography-quadrupole time of flight mass spectrometry. Differences in metabolite concentrations between insufficient and sufficient responders were assessed using partial least square regression discriminant analysis (PLS-DA) and Welch's t-test. The predictive performance of the most significant findings was assessed in a receiver operating characteristic plot with area under the curve (AUC), sensitivity and specificity. Finally, overrepresentation analysis was performed to assess if the best discriminating metabolites were enriched in specific metabolic events. Baseline concentrations of homocystine, taurine, adenosine triphosphate, guanosine diphosphate and uric acid were significantly lower in plasma of insufficient responders versus sufficient responders, while glycolytic intermediates 1,3-/2,3-diphosphoglyceric acid, glycerol-3-phosphate and phosphoenolpyruvate were significantly higher in insufficient responders. Homocystine, glycerol-3-phosphate and 1,3-/2,3-diphosphoglyceric acid were independent predictors and together showed a high AUC of 0.81 (95% CI: 0.72-0.91) for the prediction of insufficient response, with corresponding sensitivity of 0.78 and specificity of 0.76. The Warburg effect, glycolysis and amino acid metabolism were identified as underlying metabolic events playing a role in clinical response to MTX in early RA. New metabolites and potential underlying metabolic events correlating with MTX response in early RA were identified, which warrant validation in external cohorts.
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Affiliation(s)
- Helen R. Gosselt
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands; (I.B.M.); (R.d.J.)
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Correspondence: ; Tel.: +31-20-4443029
| | - Ittai B. Muller
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands; (I.B.M.); (R.d.J.)
| | - Gerrit Jansen
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands;
| | - Michel van Weeghel
- Amsterdam Gastroenterology Endocrinology Metabolism, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.v.W.); (F.M.V.)
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Frédéric M. Vaz
- Amsterdam Gastroenterology Endocrinology Metabolism, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.v.W.); (F.M.V.)
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Johanna M. W. Hazes
- Department of Rheumatology, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Academic Center of Excellence−Inflammunity, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Sandra G. Heil
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Academic Center of Excellence−Inflammunity, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Robert de Jonge
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, VUmc, 1081 HV Amsterdam, The Netherlands; (I.B.M.); (R.d.J.)
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17
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Gosselt HR, Verhoeven MMA, de Rotte MCFJ, Pluijm SMF, Muller IB, Jansen G, Tekstra J, Bulatović-Ćalasan M, Heil SG, Lafeber FPJG, Hazes JMW, de Jonge R. Validation of a Prognostic Multivariable Prediction Model for Insufficient Clinical Response to Methotrexate in Early Rheumatoid Arthritis and Its Clinical Application in Evidencio. Rheumatol Ther 2020; 7:837-850. [PMID: 32926395 PMCID: PMC7695780 DOI: 10.1007/s40744-020-00230-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Methotrexate (MTX) constitutes the first-line therapy in rheumatoid arthritis (RA), yet approximately 30% of the patients do not benefit from MTX. Recently, we reported a prognostic multivariable prediction model for insufficient clinical response to MTX at 3 months of treatment in the treatment in the Rotterdam Early Arthritis Cohort (tREACH), including baseline predictors: Disease activity score 28 (DAS28), Health Assessment Questionnaire (HAQ), erythrocyte folate, single-nucleotide polymorphisms (SNPs; ABCB1, ABCC3), smoking, and BMI. The purpose of the current study was (1) to externally validate the model and (2) to enhance the model's clinical applicability. METHODS Erythrocyte folate and SNPs were assessed in 91 early disease-modifying antirheumatic drug (DMARD)-naïve RA patients starting MTX in the external validation cohort (U-Act-Early). Insufficient response (DAS28 > 3.2) was determined after 3 months and non-response after 6 months of therapy. The previously developed prediction model was considered successfully validated in the U-Act-Early (validation cohort) if the area under the curve (AUC) of the receiver operating characteristic (ROC) was not significantly lower than in the tREACH (derivation cohort). RESULTS The AUCs in U-Act-Early at three and 6 months were 0.75 (95% CI 0.64-0.85) and 0.71 (95% CI 0.60-0.82) respectively, similar to the tREACH. Baseline DAS28 > 5.1 and HAQ > 0.6 were the strongest predictors. The model was simplified by excluding the SNPs, while still classifying 73% correctly. Furthermore, interaction terms between BMI and HAQ and BMI and erythrocyte folate significantly improved the model increasing correct classification to 75%. Results were successfully implemented in Evidencio online platform assisting clinicians in shared decision-making to intensify treatment when appropriate. CONCLUSIONS We successfully externally validated our recently reported prediction model for MTX non-response and enhanced its clinical application thus enabling its evaluation in a clinical trial. TRIAL REGISTRATION The U-Act-Early is registered at ClinicalTrials.gov. number: NCT01034137. tREACH is registered retrospectively at ISRCTN registry, number: ISRCTN26791028 at 23 August 2007.
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Affiliation(s)
- Helen R Gosselt
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Maxime M A Verhoeven
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Maurits C F J de Rotte
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia M F Pluijm
- Department of Paediatric Oncology, Prinses Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Ittai B Muller
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerrit Jansen
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Janneke Tekstra
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert de Jonge
- Amsterdam Gastroenterology and Metabolism, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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18
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Ghalandari N, Dolhain RJEM, Hazes JMW, van Puijenbroek EP, Kapur M, Crijns HJMJ. Intrauterine Exposure to Biologics in Inflammatory Autoimmune Diseases: A Systematic Review. Drugs 2020; 80:1699-1722. [PMID: 32852745 PMCID: PMC7568712 DOI: 10.1007/s40265-020-01376-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory autoimmune diseases are chronic diseases that often affect women of childbearing age. Therefore, detailed knowledge of the safety profile of medications used for management of inflammatory autoimmune diseases during pregnancy is important. However, in many cases the potential harmful effects of medications (especially biologics) during pregnancy (and lactation) on mother and child have not been fully identified. OBJECTIVE Our aim was to update the data on the occurrence of miscarriages and (major) congenital malformations when using biologics during pregnancy based on newly published articles. Additionally, we selected several different secondary outcomes that may be of interest for clinicians, especially information on adverse events in the use of a specific biologic during pregnancy. MATERIAL AND METHODS A search was conducted from 1 January 2015 until 4 July 2019 in Embase.com, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar with specific search terms for each database. Selection of publications was based on title/abstract and followed by full text (double blinded, two researchers). An overview was made based on outcomes of interest. References of the included publications were reviewed to include and minimize the missing publications. RESULTS A total of 143 publications were included. The total number of cases ranged from nine for canakinumab to 4276 for infliximab. The rates of miscarriages and major congenital malformations did not show relevant differences from those rates in the general population. CONCLUSION Despite limitations to our study, no major safety issues were reported and no trend could be identified in the reported malformations.
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Affiliation(s)
- N Ghalandari
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Medicines Evaluation Board (MEB), Graadt van Roggenweg 500, 3531 AH, Utrecht, The Netherlands.
- Academic Center of Inflammunity, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center of Inflammunity, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Medicines Evaluation Board (MEB), Graadt van Roggenweg 500, 3531 AH, Utrecht, The Netherlands
- Academic Center of Inflammunity, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 's Hertogenbosch, The Netherlands
| | - M Kapur
- Utrecht University of Medical Sciences, Utrecht, The Netherlands
| | - H J M J Crijns
- Medicines Evaluation Board (MEB), Graadt van Roggenweg 500, 3531 AH, Utrecht, The Netherlands
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19
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Brouwer J, Dolhain RJEM, Hazes JMW, Erler NS, Visser JA, Laven JSE. Decline of ovarian function in patients with rheumatoid arthritis: serum anti-Müllerian hormone levels in a longitudinal cohort. RMD Open 2020; 6:rmdopen-2020-001307. [PMID: 33040022 PMCID: PMC7722280 DOI: 10.1136/rmdopen-2020-001307] [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: 05/05/2020] [Revised: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) often affects women in their fertile age, and is known to compromise female fertility. Serum anti-Müllerian hormone (AMH) levels are a proxy for the total number of primordial follicles, and a reliable predictor of the age at menopause. Our objective was to study the longitudinal intra-individual decline of serum AMH levels in female RA patients. METHODS Female RA patients from a nationwide prospective cohort (2002-2008) were re-assessed in 2015-2016. Serum AMH levels were measured using the picoAMH assay and compared with healthy controls. A linear mixed model (LMM) was built to assess the effect of RA-related clinical factors on the decline of AMH levels. RESULTS A group of 128 women were re-assessed at an age of 42.6±4.4 years, with a median disease duration of 15.8 (IQR 12.7-21.5) years. The time between first and last AMH assessments was 10.7±1.8 (range 6.4-13.7) years. Participants represented a more fertile selection of the original cohort. At follow-up, 39% of patients had AMH levels below the 10th percentile of controls (95% CI 31% to 48%), compared with 16% (95% CI 9.3% to 22%) at baseline. The LMM showed a significant decline of AMH with increasing age, but no significant effect of RA-related factors on AMH. CONCLUSION AMH levels in RA patients showed a more pronounced decline over time than expected, supporting the idea that in chronic inflammatory conditions, reproductive function is compromised, resulting in a faster decline of ovarian function over time and probably an earlier age at menopause.
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Affiliation(s)
- Jenny Brouwer
- Rheumatology, Erasmus MC, Rotterdam, Netherlands.,Obstetrics and Gynaecology - Division of Reproductive Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | | | | | | | - Joop S E Laven
- Obstetrics and Gynaecology - Division of Reproductive Medicine, Erasmus MC, Rotterdam, Netherlands
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20
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Xu X, Davelaar N, Mus AM, Asmawidjaja PS, Hazes JMW, Baeten DLP, Vis M, Bisoendial RJ, Prens EP, Lubberts E. Interleukin-17A Is Produced by CD4+ but Not CD8+ T Cells in Synovial Fluid Following T Cell Receptor Activation and Regulates Different Inflammatory Mediators Compared to Tumor Necrosis Factor in a Model of Psoriatic Arthritis Synovitis. Arthritis Rheumatol 2020; 72:1303-1313. [PMID: 32243724 PMCID: PMC7497075 DOI: 10.1002/art.41271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 03/24/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Interleukin-17A (IL-17A) and tumor necrosis factor (TNF) contribute to the pathogenesis of psoriatic arthritis (PsA). However, their functional relationship in PsA synovitis has not been fully elucidated. Additionally, although CD8+ T cells in PsA have been recognized via flow cytometry as a source of IL-17A production, it is not clear whether CD8+ T cells secrete IL-17A under more physiologically relevant conditions in the context from PsA synovitis. This study was undertaken to clarify the roles of IL-17A and TNF in the synovial fluid (SF) from patients with PsA and investigate the impact of CD8+ T cells on IL-17A production. METHODS IL-17A+ T cells were identified by flow cytometry in SF samples from 20 patients with active PsA, blood samples from 22 treatment-naive patients with PsA, and blood samples from 22 healthy donors. IL-17A+ T cells were sorted from 12 PsA SF samples and stimulated using anti-CD3/anti-CD28 or phorbol myristate acetate (PMA) and ionomycin ex vivo, alone (n = 3) or together with autologous monocytes (n = 3) or PsA fibroblast-like synoviocytes (FLS) (n = 5-6). To evaluate the differential allogeneic effects of neutralizing IL-17A and TNF, SF CD4+ T cells and PsA FLS cocultures were also used (n = 5-6). RESULTS Flow cytometry analyses of SF samples from patients with PsA showed IL-17A positivity for CD4+ and CD8+ T cells (IL-17A, median 0.71% [interquartile range 0.35-1.50%] in CD4+ cells; median 0.44% [interquartile range 0.17-1.86%] in CD8+ T cells). However, only CD4+ T cells secreted IL-17A after anti-CD3/anti-CD28 activation, when cultured alone and in cocultures with PsA monocytes or PsA FLS (each P < 0.05). Remarkably, CD8+ T cells only secreted IL-17A after 4- or 72-hour stimulation with PMA/ionomycin. Anti-IL-17A and anti-TNF treatments both inhibited PsA synovitis ex vivo. Neutralizing IL-17A strongly inhibited IL-6 (P < 0.05) and IL-1β (P < 0.01), while anti-TNF treatment was more potent in reducing matrix metalloproteinase 3 (MMP-3) (P < 0.05) and MMP-13. CONCLUSION CD8+ T cells, in contrast to CD4+ T cells, in SF specimens obtained from PsA patients did not secrete IL-17A following T cell receptor activation. Overlapping, but distinct, effects at the level of inflammatory cytokines and MMPs were found after neutralizing IL-17A or TNF ex vivo in a human model of PsA synovitis.
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Affiliation(s)
- Xiaofei Xu
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | - Marijn Vis
- Erasmus Medical Center, Rotterdam, The Netherlands
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21
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van Mulligen E, Hazes JMW, Weel AEAM, de Jong PHP. Response to: ‘TARA Study: a new perspective on tapering drugs in RA’ by Mishra et al. Ann Rheum Dis 2020; 79:e80. [PMID: 31110029 PMCID: PMC7307212 DOI: 10.1136/annrheumdis-2019-215641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Angelique E A M Weel
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
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Wervers K, Luime JJ, Tchetverikov I, Gerards AH, Kok MR, Appels CWY, van der Graaff WL, van Groenendael JHLM, Korswagen LA, Veris-van Dieren JJ, Hazes JMW, Vis M. Comparison of disease activity measures in early psoriatic arthritis in usual care. Rheumatology (Oxford) 2020; 58:2251-2259. [PMID: 31211399 PMCID: PMC7032073 DOI: 10.1093/rheumatology/kez215] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/23/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To compare responsiveness and longitudinal validity of Disease Activity Score 28 (DAS28), Disease Activity index for PSoriatic Arthritis (DAPSA), Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic ArthritiS Disease Activity Score (PASDAS), GRAppa Composite scorE (GRACE) and Minimal Disease Activity (MDA) in usual care PsA patients, within 1 year after diagnosis. Methods Data collected in the Dutch southwest early PsA cohort (DEPAR) were used. Responsiveness was assessed using effect size (ES), standardized response mean (SRM), and discrimination between different general health states. Longitudinal validity was tested using mixed models with outcomes health-related quality of life (HRQOL), productivity and disability. Results Responsiveness was highest for PASDAS, with ES 1.00 and SRM 0.95, lowest for DAPSA, with ES 0.73 and SRM 0.71, and in between for DAS28, CPDAI and GRACE. Differences in general health were best discriminated with PASDAS and GRACE. Patients reporting stable or worsening general health could not be distinguished by DAS28 or CPDAI. Discrimination was better using DAPSA, but worse than when using PASDAS and GRACE. Longitudinal evolvement of HRQOL and productivity had the highest association with low disease activity according to GRACE, followed by PASDAS, MDA, DAPSA, DAS28, with the lowest association for CPDAI. Conclusion PASDAS and GRACE were superior with respect to responsiveness, and together with MDA best related to longitudinal evolvement of HRQOL, productivity and disability. Responsiveness and longitudinal validity of most outcomes were inferior for DAS28, DAPSA and CPDAI. As alternatives to the continuous measure DAPSA, use of PASDAS or GRACE should be considered.
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Affiliation(s)
- Kim Wervers
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Andreas H Gerards
- Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
| | - Marc R Kok
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | - Lindy-Anne Korswagen
- Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Johanna M W Hazes
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marijn Vis
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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van Mulligen E, Weel AEAM, Kuijper TM, Hazes JMW, van der Helm-van Mil AHM, de Jong PHP. The impact of a disease flare during tapering of DMARDs on the lives of rheumatoid arthritis patients. Semin Arthritis Rheum 2020; 50:423-431. [PMID: 32224045 DOI: 10.1016/j.semarthrit.2020.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/28/2020] [Accepted: 02/21/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To determine the impact of a disease flare on patient reported outcome measures (PROMs) in rheumatoid arthritis (RA) patients, who are tapering treatment. METHODS Data were used from the TARA trial; a multicenter, randomized controlled trial in which RA patients, with a well-controlled disease (DAS≤2.4 and SJC≤1) for at least 6 months, gradually tapered their DMARDs. PROMs of patients with a flare (DAS>2.4 and/or SJC>1) were compared every three months before and after a flare with their own norm values. Linear Mixed Models were used to investigate whether a disease flare influenced functional ability (HAQ-DI), fatigue (BRAF-MDQ), quality of life (EQ-5D and SF36), anxiety and depression (HADS), morning stiffness, general health (GH) and worker productivity, and if so, the duration was determined. For unemployment and sick leave we used descriptive statistics. RESULTS A flare negatively influenced GH, morning stiffness, HAQ-DI, EQ-5D, BRAF-MDQ, and the SF36 physical component scale and this effect lasted >3 months. Except for the HAQ-DI, effect sizes exceeded the minimum clinically important differences (MCIDs). For the physical outcomes effects lasted >6 months. Worker productivity was not significantly affected by a flare. CONCLUSION A disease flare influenced patients' lives, the largest effect was seen in the physical outcomes, and lasted 6 months. Although on a group level effect sizes for the separate PROMs were not always significant or larger than specific MCIDs, a disease flare can still be of great importance for individual patients.
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Affiliation(s)
- E van Mulligen
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands.
| | - A E A M Weel
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands; Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - T M Kuijper
- Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands; Department of Rheumatology, LUMC, Leiden, the Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
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Perez-Garcia LF, Te Winkel B, Carrizales JP, Bramer W, Vorstenbosch S, van Puijenbroek E, Hazes JMW, Dolhain RJEM. Sexual function and reproduction can be impaired in men with rheumatic diseases: A systematic review. Semin Arthritis Rheum 2020; 50:557-573. [PMID: 32165034 DOI: 10.1016/j.semarthrit.2020.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 07/19/2019] [Revised: 01/14/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information about the possible effect of rheumatic diseases on male sexual function and reproduction (sexual health) is scarce and difficult to summarize. Factors known to impair sexual health, such as inflammation, medication use and hypogonadism can be present in a significant proportion of male patients with rheumatic diseases. OBJECTIVES The objective of our study was to systematically review the literature for the influence of paternal rheumatic disease on sexual health, such as sexual function, reproductive hormones, male fertility, pregnancy and offspring outcomes. DATA SOURCES English language articles identified through Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar and the Clinical trial registries of Europe and the USA published until February 2019. STUDY APPRAISAL AND SYNTHESIS METHODS Literature was synthesized in narrative form and in summary tables. Outcomes were categorized as: sexual function, reproductive hormones, fertility and pregnancy and offspring outcomes. Results are presented per category and per disease. RESULTS 9735 articles were identified with our search strategy. After removal of duplicates, excluding articles by screening titles and abstracts and assessing eligibility by reading 289 fulltext articles, 87 articles fulfilled the eligibility criteria. All included studies enrolled patients diagnosed with a rheumatic disease and had results at least on one of the outcome categories. Sexual function was the most common category, followed by reproductive hormones, fertility and pregnancy and offspring outcomes. Sexual function is impaired in a high proportion of patients with rheumatic diseases. This was statistically significant in most of the studies where a control group was available. Clinically relevant abnormalities in reproductive hormones were mainly identified in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and a positive correlation with disease activity were reported. Semen quality in men with rheumatic diseases can be impaired in patients with SLE, SpA, sarcoidosis, BD and MWS. Sperm count and motility were the most common semen quality parameters affected. No negative effect of paternal RA and vasculitis on pregnancy outcomes were reported in 3 studies. No studies reporting the effect of paternal disease on offspring outcomes were identified. LIMITATIONS Most of the studies included in this review suffer from an inconsistent methodological quality, definitions of outcomes varied in several studies, a wide variety of screening questionnaires and/or diagnostic tools were used and results might only apply to the specific populations that were studied. CONCLUSIONS This systematic review suggests that sexual health is impaired in men with rheumatic diseases. The degree and extent of sexual health impairment vary per disease. More research is needed to fully understand the link between rheumatic diseases and impaired male sexual health. Meanwhile, rheumatologists should be aware of this association and discuss it with their patients. IMPLICATIONS OF KEY FINDINGS Sexual health of men with rheumatic diseases can be impaired by the disease itself. Especially in men trying to conceive, information on sexual function, reproductive hormones and sperm quality are needed to identify these problems. Treatment resulting in lower disease activity can improve overall sexual health in man with rheumatic diseases and facilitate their journey to fatherhood. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2018 CRD42018099845.
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Affiliation(s)
- L F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - B Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands
| | - J P Carrizales
- Servicio de Reumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Monterrey, Mexico
| | - W Bramer
- Medical Library, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands
| | - E van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands; PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen Research Institute of Pharmacy, Broerstraat 4, 9712 CP, Groningen, the Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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25
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Jamal M, Korver AM, Kuijper M, Lopes Barreto D, Appels CWY, Spoorenberg APL, Koes BW, Hazes JMW, van Hoeven L, Weel AEAM. The IMPACT study: A clustered randomized controlled trial to assess the effect of a referral algorithm for axial spondyloarthritis. PLoS One 2020; 15:e0227025. [PMID: 31990912 PMCID: PMC6986702 DOI: 10.1371/journal.pone.0227025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A substantial number of patients with chronic low back pain (CLBP) have axial spondyloarthritis (axSpA), but early recognition of these patients is difficult for general practitioners (GPs). The Case Finding Axial Spondyloarthritis (CaFaSpA) referral strategy has shown to be able to identify patients with CLBP at risk for axSpA, but its impact on clinical daily practice is yet unknown. OBJECTIVE To assess the effect of the CaFaSpA referral strategy on pain caused by disability in primary care patients with CLBP. METHODS Within this clustered randomized controlled trial 93 general practices were randomized to either the CaFaSpA referral model (intervention) or usual primary care (control). In each group primary care patients between 18 and 45 years with CLBP were included. The primary outcome was disability caused by CLBP, measured with the Roland Morris Disability Questionnaire (RMDQ) at baseline and four months. Secondary outcome was the frequency of new axSpA diagnosis. Descriptive analyses were performed, and a linear mixed-effects model was used. RESULTS In total 679 CLBP patients were included of which 333 patients were allocated to the intervention group and 346 to the control group. Sixty-four percent were female and mean age was 36.2 years. The mean RMDQ score at baseline was 8.39 in the intervention group and 8.61 in the control group. At four months mean RMDQ score was 7.65 in the intervention group and 8.15 in the control group. This difference was not statistically significant (p = 0.50). Six (8%) out of the 75 finally referred patients, were diagnosed with axSpA by their rheumatologist. CONCLUSIONS The CaFaSpA referral strategy for axSpA did not have an effect on disability after four months caused by CLBP. However, the strategy is able to detect the axSpA patient within the large CLBP population sufficiently. Trial registration number: NCT01944163, Clinicaltrials.gov.
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Affiliation(s)
- Maha Jamal
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- * E-mail:
| | - Amber M. Korver
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Martijn Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Deirisa Lopes Barreto
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Anneke P. L. Spoorenberg
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bart W. Koes
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Johanna M. W. Hazes
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Lonneke van Hoeven
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Angelique E. A. M. Weel
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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26
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Ince-Askan H, Mandaviya PR, Felix JF, Duijts L, van Meurs JB, Hazes JMW, Dolhain RJEM. Altered DNA methylation in children born to mothers with rheumatoid arthritis during pregnancy. Ann Rheum Dis 2019; 78:1198-1204. [PMID: 31142478 PMCID: PMC6788924 DOI: 10.1136/annrheumdis-2018-214930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/17/2019] [Accepted: 05/07/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The main objective of this study was to determine whether the DNA methylation profile of children born to mothers with rheumatoid arthritis (RA) is different from that of children born to mothers from the general population. In addition, we aimed to determine whether any differences in methylation are associated with maternal RA disease activity or medication use during pregnancy. METHODS For this study, genome-wide DNA methylation was measured at cytosine-phosphate-guanine (CpG) sites, using the Infinium Illumina HumanMethylation 450K BeadChip, in 80 blood samples from children (mean age=6.8 years) born to mothers with RA. As controls, blood samples from 354 children (mean age=6.0 years) from the population-based Generation R Study were used. Linear mixed models were performed to investigate differential methylation between the groups, corrected for relevant confounders. RESULTS A total of 147 CpGs were differentially methylated between blood samples of children born to mothers with RA and the control blood samples. The five most significantly associated CpGs were cg06642177, cg08867893, cg06778273, cg07786668 and cg20116574. The differences in methylation were not associated with maternal RA disease activity or medication use during pregnancy. CONCLUSIONS DNA methylation at 147 CpGs differed between children born to mothers with RA and children born to mothers from the general population. It remains unknown whether the identified associations are causal, and if so whether they are caused by the disease or treatment. More research, including replication of these results, is necessary in order to strengthen the relevance of our findings for the later-life health of children born to mothers with RA.
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Affiliation(s)
- Hilal Ince-Askan
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pooja R Mandaviya
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joyce B van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Saltzherr MS, Muradin GSR, Haugen IK, Selles RW, van Neck JW, Coert JH, Hazes JMW, Luime JJ. Cartilage evaluation in finger joints in healthy controls and early hand osteoarthritis patients using high-resolution MRI. Osteoarthritis Cartilage 2019; 27:1148-1151. [PMID: 31108225 DOI: 10.1016/j.joca.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 04/14/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare direct evaluation of cartilage with high resolution MRI (hrMRI) to indirect cartilage evaluation using MRI inter-bone distance in hand OA patients and healthy controls. DESIGN 41 hand OA patients and 18 healthy controls underwent hrMRI of the 2nd and 3rd metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The images were read by two independent readers using OMERACT hand OA MRI inter-bone distance score (0-3 scale) and a new hrMRI cartilage score with direct evaluation of the cartilage (0-3 scale). Inter-reader and intra-reader reliability was calculated using exact and close agreement and kappa values. The prevalence of abnormal scores and agreement between methods was assessed in both hand OA patients and healthy controls. RESULTS The intra- and inter-reader reliability of both scores was comparable, with exact agreement in 73-83% and close agreement in 95-100%. In hand OA patients 27% of 161 joints had both cartilage damage and loss of inter-bone distance, cartilage damage by hrMRI only was present in 20% of joints and reduced inter-bone distance only in 4% of joints. In the healthy controls, 1 of 71 joints were scored as abnormal by both hrMRI and inter bone distance scoring, 1 joint was scored as abnormal using the hrMRI cartilage score only, whereas 15% of joints had only reduced inter bone distance. CONCLUSIONS Direct cartilage evaluation of MCP and PIP joints using hrMRI has a good reliability, and the higher prevalence of hrMRI cartilage damage in hand OA patients and the lower prevalence in healthy controls in comparison to evaluation of inter-bone distance suggests a better validity.
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Affiliation(s)
- M S Saltzherr
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - G S R Muradin
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - R W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J W van Neck
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J H Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J J Luime
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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28
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Wervers K, Vis M, Tchetveriko I, Gerards AH, Kok MR, Appels CWY, van der Graaff WL, van Groenendael JHLM, Korswagen LA, Veris-van Dieren JJ, Hazes JMW, Luime JJ. Burden of Psoriatic Arthritis According to Different Definitions of Disease Activity: Comparing Minimal Disease Activity and the Disease Activity Index for Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2019; 70:1764-1770. [PMID: 29609220 PMCID: PMC6587485 DOI: 10.1002/acr.23571] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/27/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Treat-to-target strategies have improved outcomes in rheumatic diseases. In psoriatic arthritis (PsA), the proposed targets are the multidimensional target minimal disease activity (MDA) and the articular target Disease Activity index for PsA (DAPSA). The aim of this study was to compare the disease burden of PsA in patients with low disease activity according to the 2 definitions, MDA and DAPSA low disease activity (DAPSA-LDA), 1 year after diagnosis. METHODS We obtained data on MDA, DAPSA-LDA and disease burden 1 year after diagnosis for patients included in the Dutch southwest early PsA cohort. Disease burden was assessed in 2 domains: "Body functions," including the Short Form 36 bodily pain (SF-36 BP) measure, and "Activity," including the Health Assessment Questionnaire (HAQ). RESULTS Among the 292 patients included, 48% achieved MDA and 74% achieved DAPSA-LDA. Average scores for Body functions and Activity were better in patients who achieved MDA and those who achieved DAPSA-LDA. The scores were significantly better in the 46% of patients who achieved both MDA and DAPSA-LDA than in the 29% of patients who achieved only DAPSA-LDA. The average SF-36 BP score was higher in patients achieving both targets (73.8; 95% confidence interval [95% CI] 71.1-76.5) than in patients achieving only DAPSA-LDA (57.6; 95% CI 54.5-60.8). Similarly, mean HAQ scores measuring Activity were 0.21 (95% CI 0.15-0.26) and 0.63 (95% CI 0.53-0.72), respectively. CONCLUSION Among patients with newly diagnosed PsA, 48% achieved MDA and 74% achieved DAPSA-LDA after 1 year of receiving usual care. The average disease burden was better in patients who achieved MDA and those who achieved DAPSA-LDA. Also, patients who achieved only DAPSA-LDA reported worse outcomes than those who also achieved MDA.
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Affiliation(s)
- Kim Wervers
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marijn Vis
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Marc R Kok
- Maasstad Hospital, Rotterdam, The Netherlands
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29
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Brouwer J, Dolhain RJEM, Hazes JMW, Visser JA, Laven JSE. Reduced Ovarian Function in Female Rheumatoid Arthritis Patients Trying to Conceive. ACR Open Rheumatol 2019; 1:327-335. [PMID: 31777809 PMCID: PMC6857972 DOI: 10.1002/acr2.11043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Subfertility, a time to pregnancy (TTP) longer than 12 months, is present in 40% of female patients with rheumatoid arthritis (RA) who are actively trying to conceive. Because patients with RA appear to reach menopause at a younger age, diminished ovarian function may explain the reduced fertility. Serum anti-Müllerian hormone (AMH) levels are the best proxy to measure ovarian function. Our objectives were to study AMH levels in female patients with RA and determine the association of preconception serum AMH levels with TTP. METHODS A post hoc analysis was performed before conception in patients of the Pregnancy-Induced Amelioration of Rheumatoid Arthritis (PARA) cohort. Serum AMH levels were compared with those in an existing cohort of healthy controls using analysis of covariance. Associations between AMH and TTP were studied using the Cox proportional hazard analysis. RESULTS Preconception serum was available in 209 women of the PARA cohort (aged 32.1 ± 3.9 years), of whom 45% were subfertile in the current episode. The median AMH level was 2.5 μg/l (interquartile range: 1.5-4.6). AMH levels were significantly lower compared with those in healthy controls (P < 0.001), with 17% of patients having levels below the age-specific 10th percentile. A multivariable analysis showed a negative association of AMH with the presence of anticitrullinated protein antibodies (ACPAs) (P = 0.009). AMH levels showed no significant association with TTP (P = 0.26). CONCLUSION Women with RA have lower AMH levels than healthy controls, and AMH levels were lower in ACPA-positive patients. However, because preconception AMH levels were not associated with TTP, the reduced AMH levels do not explain the reduced fertility in patients with RA.
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Affiliation(s)
- Jenny Brouwer
- Erasmus University Medical Center RotterdamRotterdamThe Netherlands
| | | | | | - Jenny A. Visser
- Erasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Joop S. E. Laven
- Erasmus University Medical Center RotterdamRotterdamThe Netherlands
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30
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Gosselt HR, van Zelst BD, de Rotte MCFJ, Hazes JMW, de Jonge R, Heil SG. Higher baseline global leukocyte DNA methylation is associated with MTX non-response in early RA patients. Arthritis Res Ther 2019; 21:157. [PMID: 31242943 PMCID: PMC6595617 DOI: 10.1186/s13075-019-1936-5] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-dose methotrexate (MTX) is the first-line therapy in early rheumatoid arthritis (eRA). Up to 40% of eRA patients do not benefit from MTX therapy. MTX has been shown to inhibit one-carbon metabolism, which is involved in the donation of methyl groups. In this study, we investigate baseline global DNA methylation and changes in DNA methylation during treatment in relation to clinical non-response after 3 months of MTX treatment. METHODS Two hundred ninety-four blood samples were collected from the Treatment in the Rotterdam Early Arthritis Cohort (tREACH, ISRCTN26791028), a multicenter, stratified single-blind clinical trial of eRA patients. Global DNA (hydroxy)methylation was quantified using liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) and validated with a global DNA LINE-1 methylation technique. MTX response was determined as ΔDAS28. Additionally, patients were stratified into two response groups according to the European League Against Rheumatism (EULAR) response criteria. Associations between global DNA methylation and response were examined using univariate regression models adjusted for baseline DAS28, baseline erythrocyte folate levels, and body mass index (BMI). RESULTS Higher baseline global DNA methylation was associated with less decrease of DAS28 (β = 0.15, p = 0.013) and with MTX non-response (OR = 0.010, 95% CI = 0.001-0.188). This result was validated in LINE-1 elements (β = 0.22, p = 0.026). Changes in global DNA (hydroxy)methylation were not associated with MTX response over 3 months. CONCLUSIONS These results show that higher baseline global DNA methylation in treatment naïve eRA patients is associated with decreased clinical response after 3 months of treatment of eRA patients and can be further evaluated as a predictor for MTX therapy non-response. TRIAL REGISTRATION ISRCTN, ISRCTN26791028 , registered 23 August 2007-retrospectively registered.
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Affiliation(s)
- Helen R Gosselt
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bertrand D van Zelst
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maurits C F J de Rotte
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Academic Center of Excellence - Inflammunity, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Academic Center of Excellence - Inflammunity, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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31
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van Mulligen E, de Jong PHP, Kuijper TM, van der Ven M, Appels C, Bijkerk C, Harbers JB, de Man Y, Molenaar THE, Tchetverikov I, Goekoop-Ruiterman YPM, van Zeben J, Hazes JMW, Weel AEAM, Luime JJ. Gradual tapering TNF inhibitors versus conventional synthetic DMARDs after achieving controlled disease in patients with rheumatoid arthritis: first-year results of the randomised controlled TARA study. Ann Rheum Dis 2019; 78:746-753. [DOI: 10.1136/annrheumdis-2018-214970] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesThe aim of this study is to evaluate the effectiveness of two tapering strategies after achieving controlled disease in patients with rheumatoid arthritis (RA), during 1 year of follow-up.MethodsIn this multicentre single-blinded (research nurses) randomised controlled trial, patients with RA were included who achieved controlled disease, defined as a Disease Activity Score (DAS) ≤ 2.4 and a Swollen Joint Count (SJC) ≤ 1, treated with both a conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and a TNF inhibitor. Eligible patients were randomised into gradual tapering csDMARDs or TNF inhibitors. Medication was tapered if the RA was still under control, by cutting the dosage into half, a quarter and thereafter it was stopped. Primary outcome was proportion of patients with a disease flare, defined as DAS > 2.4 and/or SJC > 1. Secondary outcomes were DAS, European Quality of Life-5 Dimensions (EQ5D) and functional ability (Health Assessment Questionnaire Disability Index [HAQ-DI]) after 1 year and over time.ResultsA total of 189 patients were randomly assigned to tapering csDMARDs (n = 94) or tapering anti-TNF (n = 95). The cumulative flare rates in the csDMARD and anti-TNF tapering group were, respectively, 33 % (95% CI,24% to 43 %) and 43 % (95% CI, 33% to 53 % (p = 0.17). Mean DAS, HAQ-DI and EQ-5D did not differ between tapering groups after 1 year and over time.ConclusionUp to 9 months, flare rates of tapering csDMARDs or TNF inhibitors were similar. After 1 year, a non-significant difference was found of 10 % favouring csDMARD tapering. Tapering TNF inhibitors was, therefore, not superior to tapering csDMARDs. From a societal perspective, it would be sensible to taper the TNF inhibitor first, because of possible cost reductions and less long-term side effects.Trial registration numberNTR2754
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Mahmood S, Hazes JMW, Veldt P, van Riel P, Landewé R, Bernelot Moens H, Pasma A. The Development and Evaluation of Personalized Training in Shared Decision-making Skills for Rheumatologists. J Rheumatol 2019; 47:290-297. [PMID: 30936289 DOI: 10.3899/jrheum.180780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Many factors influence a patient's preference in engaging in shared decision making (SDM). Several training programs have been developed for teaching SDM to physicians, but none of them focused on the patients' preferences. We developed an SDM training program for rheumatologists with a specific focus on patients' preferences and assessed its effects. METHODS A training program was developed, pilot tested, and given to 30 rheumatologists. Immediately after the training and 10 weeks later, rheumatologists were asked to complete a questionnaire to evaluate the training. Patients were asked before and after the training to complete a questionnaire on patient satisfaction. RESULTS Ten weeks after the training, 57% of the rheumatologists felt they were capable of estimating the need of patients to engage in SDM, 62% felt their communication skills had improved, and 33% reported they engaged more in SDM. Up to 268 patients were included. Overall, patient satisfaction was high, but there were no statistically significant differences in patient satisfaction before and after the training. CONCLUSION The training was received well by the participating rheumatologists. Even in a population of rheumatologists that communicates well, 62% reported improvement. The training program increased awareness about the principles of SDM in patients and physicians, and improved physicians' communicative skills, but did not lead to further improvement in patients' satisfaction, which was already high.
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Affiliation(s)
- Sehrash Mahmood
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands. .,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology.
| | - Johanna M W Hazes
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Petra Veldt
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Piet van Riel
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Robert Landewé
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Hein Bernelot Moens
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Annelieke Pasma
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
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Wervers K, Herrings I, Luime JJ, Tchetverikov I, Gerards AH, Hazes JMW, Vis M. Association of Physical Activity and Medication with Enthesitis on Ultrasound in Psoriatic Arthritis. J Rheumatol 2019; 46:1290-1294. [PMID: 30824661 DOI: 10.3899/jrheum.180782] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Enthesitis is a manifestation of psoriatic arthritis (PsA), but its symptoms are difficult to interpret clinically. We investigated the associations of ultrasonographic changes in entheses with clinical characteristics in patients with PsA, and compared enthesis changes of patients aged 35 to 60 years with healthy volunteers of that age. METHODS Consecutive patients with PsA participated in this cross-sectional study, irrespective of enthesitis complaints and age. We collected data about complaints, physical activity and activity avoidance, medication, and clinical enthesitis. Inflammatory and structural enthesis changes were scored with the modified MAdrid Sonographic Enthesitis Index (MASEI). Among all patients, associations between ultrasound (US) scores and clinical characteristics were investigated using linear regression. We compared US scores of healthy volunteers and patients with PsA aged 35-60 years using Wilcoxon rank-sum tests. RESULTS Eighty-four patients with PsA and 25 healthy volunteers participated. In patients with PsA, we found a small association between higher inflammatory-modified MASEI score and older age (β 0.07, 95% CI 0-0.13) and current use of biologics (β 1.56, 95% CI 0.16-2.95). Patients who reported avoiding activities had significantly lower inflammatory-modified MASEI scores (β -1.71, 95% CI -3.1 to -0.32) than those who did not. The patients with PsA aged 35-60 years (n = 50) had similar inflammatory scores as healthy volunteers but higher structural scores (median 6 vs 2; p = 0.01). CONCLUSION Within patients with PsA, avoiding physical activity, younger age, and not using biologics were associated with less enthesis inflammation. Patients with PsA and healthy volunteers aged 35 to 60 years displayed similar levels of inflammatory changes of the entheses, but patients had more structural damage.
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Affiliation(s)
- Kim Wervers
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Irene Herrings
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Jolanda J Luime
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Ilja Tchetverikov
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Andreas H Gerards
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Johanna M W Hazes
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Marijn Vis
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands. .,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam.
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Ince-Askan H, van den Akker ELT, de Rijke YB, van Rossum EFC, Hazes JMW, Dolhain RJEM. Associations between antenatal prednisone exposure and long-term cortisol and cortisone concentrations in children born to women with rheumatoid arthritis: results from a nationwide prospective cohort study. RMD Open 2019; 5:e000852. [PMID: 30815278 PMCID: PMC6361363 DOI: 10.1136/rmdopen-2018-000852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/07/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives To identify whether children with antenatal prednisone exposure have chronically elevated cortisol and cortisone concentrations, an altered body composition or higher blood pressure. In addition, to identify whether maternal rheumatoid arthritis disease (RA) activity is associated with these alterations. Methods In this prospective study, 56 children (mean age=10.0 years) with and 61 children (mean age=9.6 years) without antenatal prednisone exposure, born to women with RA, were included. Hair cortisol and cortisone were analysed using liquid chromatography-tandem mass spectrometry. Linear regression models were built to analyse differences between the two groups, corrected for relevant covariates. Hair cortisol concentrations were also compared between the study population and an age-matched healthy reference group(n=150 children, mean age=9.8 years). Results Hair cortisol and cortisone concentrations were similar in children with and without antenatal prednisone exposure (median cortisol 1.14 pg/mg (IQR 0.67-1.75) and 1.15 pg/mg (IQR 0.65-2.21) and median cortisone 6.76 pg/mg (IQR 5.42-8.86) and 7.40 pg/mg (IQR 5.39-10.73), respectively). Antenatal prednisone exposure and maternal RA disease activity were also not associated with body composition or blood pressure. Hair cortisol concentrations were not different in children born to mothers with RA compared with children from the reference group. Conclusion This, in its kind, large and unique long-term prospective study demonstrates that low-dose antenatal prednisone exposure and maternal RA disease activity are not associated with negative consequences in prepubertal childhood. The findings of this study are reassuring and support the assumption that low-dose maternal prednisone use during pregnancy is safe for the offspring, at least until the age of approximately 10 years.
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Affiliation(s)
- Hilal Ince-Askan
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Erica L T van den Akker
- Department of Pediatric Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Wervers K, Luime JJ, Tchetverikov I, Gerards AH, Kok MR, Appels CWY, van der Graaff WL, van Groenendael JHLM, Korswagen LA, Veris-van Dieren JJ, Hazes JMW, Vis M. Time to minimal disease activity in relation to quality of life, productivity, and radiographic damage 1 year after diagnosis in psoriatic arthritis. Arthritis Res Ther 2019; 21:25. [PMID: 30651121 PMCID: PMC6335829 DOI: 10.1186/s13075-019-1811-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background In a cohort of patients with newly diagnosed psoriatic arthritis (PsA) who received usual care, we investigated the impact of time elapsed to minimal disease activity (MDA) on health-related quality of life (HRQoL), work productivity, and radiographic damage throughout the first year after diagnosis. Methods Data collected in the Dutch southwest early PsA cohort (DEPAR) study were analyzed. These three-monthly data encompassed disease activity, HRQOL was measured with the Short Form 36 (SF36) Physical Component Scale (SF36-PCS) and Mental Component Scale, and productivity was measured with the Productivity Cost Questionnaire. Radiographic damage was scored at baseline and at 12 months with the PsA-modified Sharp/van der Heijde score. Patients were classified by time to MDA as in early (within 3 months), late (at 6–12 months), and never MDA in the first year. Results We included 296 patients who had had their 1-year outpatient visit (mean age 51 years, 53% male). Ninety-six (32%) were classified as early MDA, 78 (26%) as late MDA, and 98 (33%) as never MDA. Data of 24 patients (8%) were missing. SF36-PCS and productivity scores improved after gaining MDA, but remained low in never MDA patients. At 1 year, SF36-PCS and productivity scores were similar in early and late MDA patients. Radiographic progression rate was low and similar in all groups. Conclusion Gaining MDA was associated with considerable improvement in HRQoL and functioning, irrespective of time to first MDA. In the one third of patients not in MDA in the first year, the disease had a substantial health impact.
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Affiliation(s)
- Kim Wervers
- Department of Rheumatology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Department of Rheumatology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Andreas H Gerards
- Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
| | - Marc R Kok
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | - Lindy-Anne Korswagen
- Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Johanna M W Hazes
- Department of Rheumatology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Marijn Vis
- Department of Rheumatology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
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Reiding KR, Bondt A, Hennig R, Gardner RA, O'Flaherty R, Trbojević-Akmačić I, Shubhakar A, Hazes JMW, Reichl U, Fernandes DL, Pučić-Baković M, Rapp E, Spencer DIR, Dolhain RJEM, Rudd PM, Lauc G, Wuhrer M. High-throughput Serum N-Glycomics: Method Comparison and Application to Study Rheumatoid Arthritis and Pregnancy-associated Changes. Mol Cell Proteomics 2019; 18:3-15. [PMID: 30242110 PMCID: PMC6317482 DOI: 10.1074/mcp.ra117.000454] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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: 11/13/2017] [Revised: 05/14/2018] [Indexed: 11/06/2022] Open
Abstract
N-Glycosylation is a fundamentally important protein modification with a major impact on glycoprotein characteristics such as serum half-life and receptor interaction. More than half of the proteins in human serum are glycosylated, and the relative abundances of protein glycoforms often reflect alterations in health and disease. Several analytical methods are currently capable of analyzing the total serum N-glycosylation in a high-throughput manner.Here we evaluate and compare the performance of three high-throughput released N-glycome analysis methods. Included were hydrophilic-interaction ultra-high-performance liquid chromatography with fluorescence detection (HILIC-UHPLC-FLD) with 2-aminobenzamide labeling of the glycans, multiplexed capillary gel electrophoresis with laser-induced fluorescence detection (xCGE-LIF) with 8-aminopyrene-1,3,6-trisulfonic acid labeling, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) with linkage-specific sialic acid esterification. All methods assessed the same panel of serum samples, which were obtained at multiple time points during the pregnancies and postpartum periods of healthy women and patients with rheumatoid arthritis (RA). We compared the analytical methods on their technical performance as well as on their ability to describe serum protein N-glycosylation changes throughout pregnancy, with RA, and with RA disease activity.Overall, the methods proved to be similar in their detection and relative quantification of serum protein N-glycosylation. However, the non-MS methods showed superior repeatability over MALDI-TOF-MS and allowed the best structural separation of low-complexity N-glycans. MALDI-TOF-MS achieved the highest throughput and provided compositional information on higher-complexity N-glycans. Consequentially, MALDI-TOF-MS could establish the linkage-specific sialylation differences within pregnancy and RA, whereas HILIC-UHPLC-FLD and xCGE-LIF demonstrated differences in α1,3- and α1,6-branch galactosylation. While the combination of methods proved to be the most beneficial for the analysis of total serum protein N-glycosylation, informed method choices can be made for the glycosylation analysis of single proteins or samples of varying complexity.
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Affiliation(s)
| | - Albert Bondt
- From the ‡Center for Proteomics and Metabolomics,; §Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - René Hennig
- ¶Max Planck Institute (MPI) for Dynamics of Complex Technical Systems, 39106 Magdeburg, Germany;; ‖glyXera GmbH., 39120 Magdeburg, Germany
| | - Richard A Gardner
- **Ludger, Ltd., Culham Science Centre, Abingdon, Oxfordshire, United Kingdom
| | - Roisin O'Flaherty
- ‡‡GlycoScience Group, National Institute for Bioprocessing Research and Training (NIBRT), Fosters Avenue, Blackrock, Co. Dublin, Ireland
| | | | - Archana Shubhakar
- **Ludger, Ltd., Culham Science Centre, Abingdon, Oxfordshire, United Kingdom
| | - Johanna M W Hazes
- ¶¶Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherland
| | - Udo Reichl
- ¶Max Planck Institute (MPI) for Dynamics of Complex Technical Systems, 39106 Magdeburg, Germany;; ‖‖Otto von Guericke University Magdeburg, Chair of Bioprocess Engineering, 39106 Magdeburg, Germany
| | - Daryl L Fernandes
- **Ludger, Ltd., Culham Science Centre, Abingdon, Oxfordshire, United Kingdom
| | | | - Erdmann Rapp
- ¶Max Planck Institute (MPI) for Dynamics of Complex Technical Systems, 39106 Magdeburg, Germany;; ‖glyXera GmbH., 39120 Magdeburg, Germany
| | - Daniel I R Spencer
- **Ludger, Ltd., Culham Science Centre, Abingdon, Oxfordshire, United Kingdom
| | - Radboud J E M Dolhain
- ¶¶Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherland
| | - Pauline M Rudd
- ‡‡GlycoScience Group, National Institute for Bioprocessing Research and Training (NIBRT), Fosters Avenue, Blackrock, Co. Dublin, Ireland
| | - Gordan Lauc
- §§Genos Glycoscience Research Laboratory, Zagreb, Croatia;; ***Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
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Dankers W, González-Leal C, Davelaar N, Asmawidjaja PS, Mus AMC, Hazes JMW, Colin EM, Lubberts E. 1,25(OH) 2D 3 and dexamethasone additively suppress synovial fibroblast activation by CCR6 + T helper memory cells and enhance the effect of tumor necrosis factor alpha blockade. Arthritis Res Ther 2018; 20:212. [PMID: 30236152 PMCID: PMC6148958 DOI: 10.1186/s13075-018-1706-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite recent improvements in the treatment of rheumatoid arthritis (RA), an insufficient treatment response and the development of treatment resistance in many patients illustrates the need for new therapeutic strategies. Chronic synovial inflammation could be suppressed by targeting RA synovial fibroblast (RASF) activation by, for example, interleukin (IL)-17A-producing CCR6+ T helper memory (memTh) cells. Here, we modulated this interaction by combining the active vitamin D metabolite 1,25(OH)2D3 with dexamethasone (DEX) and explored the potential therapeutic applications. METHODS CCR6+ memTh cells from peripheral blood mononuclear cells (PBMCs) of healthy donors or treatment-naive early RA patients were cultured alone or with RASF from established RA patients for 3 days and treated with or without 1,25(OH)2D3, DEX, or etanercept. Treatment effects were assessed using enzyme-linked immunosorbent assay (ELISA) and flow cytometry. RESULTS 1,25(OH)2D3, and to lesser extent DEX, reduced production of the pro-inflammatory cytokines IL-17A, IL-22, and interferon (IFN)γ in CCR6+ memTh cells. Tumor necrosis factor (TNF)α was only inhibited by the combination of 1,25(OH)2D3 and DEX. In contrast, DEX was the strongest inhibitor of IL-6, IL-8, and tissue-destructive enzymes in RASF. As a result, 1,25(OH)2D3 and DEX additively inhibited inflammatory mediators in CCR6+ memTh-RASF cocultures. Interestingly, low doses of mainly DEX, but also 1,25(OH)2D3, combined with etanercept better suppressed synovial inflammation in this coculture model compared with etanercept alone. CONCLUSION This study suggests that 1,25(OH)2D3 and DEX additively inhibit synovial inflammation through targeting predominantly CCR6+ memTh cells and RASF, respectively. Furthermore, low doses of DEX and 1,25(OH)2D3 enhance the effect of TNFα blockade in inhibiting RASF activation, thus providing a basis to improve RA treatment.
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Affiliation(s)
- Wendy Dankers
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - Claudia González-Leal
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - Nadine Davelaar
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - Patrick S. Asmawidjaja
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - Adriana M. C. Mus
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Edgar M. Colin
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Erik Lubberts
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
- Erasmus MC University Medical Center, Wytemaweg 80, 3015CN Rotterdam, The Netherlands
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38
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Teitsma XM, Jacobs JWG, de Jong PHP, Hazes JMW, Weel AEAM, Welsing PMJ, Pethö-Schramm A, Borm MEA, van Laar JM, Bijlsma JWJ, Lafeber FPJG. Adding baseline protein biomarkers to clinical predictors does not enhance prediction of treatment response to a methotrexate strategy in early rheumatoid arthritis. Ann Rheum Dis 2018; 78:142-144. [DOI: 10.1136/annrheumdis-2018-213767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/20/2018] [Accepted: 08/08/2018] [Indexed: 11/03/2022]
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Tran-Duy A, Ghiti Moghadam M, Oude Voshaar MAH, Vonkeman HE, Boonen A, Clarke P, McColl G, Ten Klooster PM, Zijlstra TR, Lems WF, Riyazi N, Griep EN, Hazes JMW, Landewé R, Bernelot Moens HJ, van Riel PLCM, van de Laar MAFJ, Jansen TL. An Economic Evaluation of Stopping Versus Continuing Tumor Necrosis Factor Inhibitor Treatment in Rheumatoid Arthritis Patients With Disease Remission or Low Disease Activity: Results From a Pragmatic Open-Label Trial. Arthritis Rheumatol 2018; 70:1557-1564. [PMID: 29745059 DOI: 10.1002/art.40546] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/24/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate, from a societal perspective, the incremental cost-effectiveness of withdrawing tumor necrosis factor inhibitor (TNFi) treatment compared to continuation of these drugs within a 1-year, randomized trial among rheumatoid arthritis patients with longstanding, stable disease activity or remission. METHODS Data were collected from a pragmatic, open-label trial. Cost-utility analysis was performed using the nonparametric bootstrapping method, and a cost-effectiveness acceptability curve was constructed using the net-monetary benefit framework, where a willingness-to-accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality-adjusted life year (QALY) lost. RESULTS A total of 531 patients were randomized to the stop group and 286 patients to the continuation group. Withdrawal of TNFi treatment resulted in a >60% reduction of the total drug cost, but led to an increase of ∼30% in other health care expenditures. Compared to continuation, stopping TNFi resulted in a mean yearly cost saving of €7,133 (95% confidence interval [95% CI] €6,071, €8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI 0.002, 0.040). Mean saved cost per QALY lost and per extra flare incurred in the stop group compared to the continuation group was €368,269 (95% CI €155,132, €1,675,909) and €17,670 (95% CI €13,650, €22,721), respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNFi treatment is cost-effective was 100%. CONCLUSION Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on willingness to pay.
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Affiliation(s)
- An Tran-Duy
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Marjan Ghiti Moghadam
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Martijn A H Oude Voshaar
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Annelies Boonen
- Maastricht University Medical Center and Maastricht University, Maastricht, The Netherlands
| | - Philip Clarke
- University of Melbourne, Melbourne, Victoria, Australia
| | - Geoff McColl
- University of Melbourne, Melbourne, Victoria, Australia
| | - Peter M Ten Klooster
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | | | - Willem F Lems
- VU University Medical Center and Reade Medical Center, Amsterdam, The Netherlands
| | - N Riyazi
- Haga Medical Center, The Hague, The Netherlands
| | - E N Griep
- Antonius Medical Center, Sneek, The Netherlands
| | - J M W Hazes
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Mart A F J van de Laar
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - T L Jansen
- Viecurie Medical Center, Venlo, The Netherlands
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40
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Walter MJM, Kuijper TM, Hazes JMW, Weel AE, Luime JJ. Fatigue in early, intensively treated and tight-controlled rheumatoid arthritis patients is frequent and persistent: a prospective study. Rheumatol Int 2018; 38:1643-1650. [PMID: 30014260 PMCID: PMC6105154 DOI: 10.1007/s00296-018-4102-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/10/2018] [Accepted: 07/13/2018] [Indexed: 01/11/2023]
Abstract
Fatigue has a large impact on quality of life and is still unmanageable for many patients. Study aims were describe (1) the prevalence and pattern of fatigue over time in patients with early rheumatoid arthritis under a treat-to-target strategy and (2) identify predictive factors for worsening and recovering of fatigue over time. Data from the tREACH study were used, comparing different treatment strategies with fatigue as secondary objective. Patient outcomes on fatigue, quality of life, depression, and coping were obtained every 6 months and clinically assessed every 3 months. Prediction of fatigue at 12 months was investigated with an ROC curve. Analysis was stratified into non-fatigue and fatigue at baseline. Logistic regression was used for the evolution of fatigue in relation with the covariates over time. Almost half of all patients (n = 246) had high fatigue levels at baseline, decreasing slightly over time. At 12 months, 43% of patients were fatigued; while 23% of the initially fatigued patients showed lower levels of fatigue, the fatigue level had increased in 15% of the initially non-fatigued patients. The strongest predictor of fatigue was the previous fatigue levels (AUC 0.89). Higher score on the depression scale and coping with limitations was associated with developing fatigue over time in the initially non-fatigued group. Despite a strict treat-to-target strategy, fatigue remained an overall problem during the first year of treatment, and was mainly predicted by its baseline status. In subgroups, a small additional effect of depression was seen. Monitoring fatigue and depression may be important in managing fatigue.
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Affiliation(s)
- Margot J M Walter
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - T M Kuijper
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A E Weel
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - J J Luime
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal box 2040, 3000 CA, Rotterdam, The Netherlands
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Wervers K, Luime JJ, Tchetverikov I, Gerards AH, Kok MR, Appels CWY, van der Graaff WL, van Groenendael JHLM, Korswagen LA, Veris-van Dieren JJ, Hazes JMW, Vis M. Influence of Disease Manifestations on Health-related Quality of Life in Early Psoriatic Arthritis. J Rheumatol 2018; 45:1526-1531. [PMID: 29961685 DOI: 10.3899/jrheum.171406] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) is a multifaceted disease. Affecting joints, skin, entheses, and dactylitis, its effect on health-related quality of life (HRQOL) could be substantial. We aim to assess HRQOL in patients newly diagnosed with PsA and analyze its associations with disease manifestations. METHODS Data collected at time of diagnosis from patients with PsA included in the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR) study were used. HRQOL was assessed using 8 domains of the Medical Outcomes Study Short Form-36 (SF-36) questionnaire. Patients were classified based on primary manifestation in arthritis subtypes (i.e., mono-, oligo-, or polyarthritis) and other subtypes (i.e., enthesitis, dactylitis, and axial disease). In all patients, presence of arthritis, enthesitis, dactylitis, psoriasis, and chronic inflammatory back pain was determined. Multivariable linear regression was used to determine associations of PsA manifestations with HRQOL. RESULTS Of 405 patients, primary manifestation was peripheral arthritis in 320 (78 monoarthritis, 151 oligoarthritis, and 91 polyarthritis), enthesitis in 37, axial disease in 9, and dactylitis in 39. Mean scores of SF-36 domains were lower than the Dutch reference population and similar across arthritis subtypes. A higher number of enthesitis locations and tender joints, and presence of chronic back pain, were independently associated with worse SF-36 scores. Psoriasis and dactylitis were not associated with worse scores. CONCLUSION HRQOL was diminished in PsA at time of diagnosis compared to the Dutch reference population, and tender joints, enthesitis at clinical examination, and back pain as indicators of pain affected HRQOL.
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Affiliation(s)
- Kim Wervers
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Jolanda J Luime
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Ilja Tchetverikov
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Andreas H Gerards
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Marc R Kok
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Cathelijne W Y Appels
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Wiebo L van der Graaff
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Johannes H L M van Groenendael
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Lindy-Anne Korswagen
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Josien J Veris-van Dieren
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Johanna M W Hazes
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands.,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center
| | - Marijn Vis
- From the Dutch south-west Early Psoriatic Arthritis cohort (DEPAR): Department of Rheumatology, Erasmus University Medical Center, and Maasstad Hospital, and Sint Franciscus Gasthuis, Rotterdam; Albert Schweitzer Hospital, Dordrecht; Vlietland Hospital, Schiedam; Amphia Hospital, Breda; Rivas Hospital, Gorinchem; Reumazorg Zuid West Nederland, Roosendaal, the Netherlands. .,K. Wervers, PhD Student, Department of Rheumatology, Erasmus University Medical Center; J.J. Luime, PhD, Department of Rheumatology, Erasmus University Medical Center; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital; M.R. Kok, MD, PhD, Department of Rheumatology, Maasstad Hospital; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; C.W. Appels, MD, Department of Rheumatology, Amphia Hospital; W.L. van der Graaff, MD, PhD, Department of Rheumatology, Rivas Hospital; J.H. van Groenendael, MD, Reumazorg Zuid West Nederland; L.A. Korswagen, MD, Department of Rheumatology, Sint Franciscus Gasthuis; J.J. Veris-van Dieren, MD, Reumazorg Zuid West Nederland; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus University Medical Center; M. Vis, MD, PhD, Department of Rheumatology, Erasmus University Medical Center.
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Teitsma XM, Jacobs JWG, Welsing PMJ, de Jong PHP, Hazes JMW, Weel AEAM, Pethö-Schramm A, Borm MEA, van Laar JM, Lafeber FPJG, Bijlsma JWJ. Inadequate response to treat-to-target methotrexate therapy in patients with new-onset rheumatoid arthritis: development and validation of clinical predictors. Ann Rheum Dis 2018; 77:1261-1267. [PMID: 29760159 DOI: 10.1136/annrheumdis-2018-213035] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify and validate clinical baseline predictors associated with inadequate response (IR) to methotrexate (MTX) therapy in newly diagnosed patients with rheumatoid arthritis (RA). METHODS In U-Act-Early, 108 disease-modifying antirheumatic drug (DMARD)-naive patients with RA were randomised to initiate MTX therapy and treated to target until sustained remission (disease activity score assessing 28 joints (DAS28) <2.6 with four or less swollen joints for ≥24 weeks) was achieved. If no remission, hydroxychloroquine was added to the treatment regimen (ie, 'MTX+') and replaced by tocilizumab if the target still was not reached thereafter. Regression analyses were performed to identify clinical predictors for IR, defined as needing addition of a biological DMARD, to 'MTX+'. Data from the treatment in the Rotterdam Early Arthritis Cohort were used for external validation of the prediction model. RESULTS Within 1 year, 56/108 (52%) patients in U-Act-Early showed IR to 'MTX+'. DAS28 (adjusted OR (ORadj) 2.1, 95% CI 1.4 to 3.2), current smoking (ORadj 3.02, 95% CI 1.1 to 8.0) and alcohol consumption (ORadj 0.4, 95% CI 0.1 to 0.9) were identified as baseline predictors. The area under the receiver operator characteristic curve (AUROC) of the prediction model was 0.75 (95% CI 0.66 to 0.84); the positive (PPV) and negative predictive value (NPV) were 65% and 80%, respectively. When applying the model to the validation cohort, the AUROC slightly decreased to 0.67 (95% CI 0.55 to 0.79) and the PPV and NPV to 54% and 80%, respectively. CONCLUSION Higher DAS28, current smoking and no alcohol consumption are predictive factors for IR to step-up 'MTX+' in DMARD-naive patients with new-onset RA. TRIAL REGISTRATION NCT01034137; Post-results, ISRCTN26791028; Post-results.
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Affiliation(s)
- Xavier M Teitsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pascal H P de Jong
- Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Angelique E A M Weel
- Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Bondt A, Hafkenscheid L, Falck D, Kuijper TM, Rombouts Y, Hazes JMW, Wuhrer M, Dolhain RJEM. ACPA IgG galactosylation associates with disease activity in pregnant patients with rheumatoid arthritis. Ann Rheum Dis 2018; 77:1130-1136. [PMID: 29615411 DOI: 10.1136/annrheumdis-2018-212946] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Patients with autoantibody-positive rheumatoid arthritis (RA) are less likely to experience pregnancy-induced improvement of RA disease activity (DAS28-C reactive protein (CRP)) compared with patients with autoantibody-negative RA. Anti-citrullinated protein antibodies (ACPAs) are the most specific autoantibodies for RA. We previously demonstrated that disease improvement is associated with changes in total IgG glycosylation, which regulate antibody effector function. Therefore, we sought to analyse the ACPA-IgG glycosylation profile during pregnancy with the aim to understand the lower change of pregnancy-induced improvement of the disease in patients with autoantibody-positive RA. METHODS ACPA-IgGs were purified from ACPA-positive patient sera (n=112) of the Pregnancy-induced Amelioration of Rheumatoid Arthritis cohort, a prospective study designed to investigate pregnancy-associated improvement of RA. The fragment crystallisable (Fc)glycosylation profile of ACPA-IgGs was characterised by mass spectrometry and compared with that of total IgG derived from the same patients or from ACPA-negative patients. RESULTS All ACPA-IgG subclasses display significant changes in the level of galactosylation and sialylation during pregnancy, although less pronounced than in total IgG. The pregnancy-induced increase in ACPA-IgG galactosylation, but not sialylation, associates with lower DAS28-CRP. In ACPA-positive patients, no such association was found with changes in the galactosylation of total IgG, whereas in ACPA-negative patients changes in disease activity correlated well with changes in the galactosylation of total IgG. CONCLUSIONS In ACPA-positive RA, the pregnancy-induced change in galactosylation of ACPA-IgG, and not that of total IgG, associates with changes in disease activity. These data may indicate that in ACPA-positive patients the galactosylation of ACPA-IgG is of more pathogenic relevance than that of total IgG.
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Affiliation(s)
- Albert Bondt
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lise Hafkenscheid
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - David Falck
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - T Martijn Kuijper
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yoann Rombouts
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Institut de Pharmacologie et Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Ten Cate DF, Jacobs JWG, Swen WAA, Hazes JMW, de Jager MH, Basoski NM, Haagsma CJ, Luime JJ, Gerards AH. Can baseline ultrasound results help to predict failure to achieve DAS28 remission after 1 year of tight control treatment in early RA patients? Arthritis Res Ther 2018; 20:15. [PMID: 29382379 PMCID: PMC5791342 DOI: 10.1186/s13075-018-1514-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/04/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022] Open
Abstract
Background At present, there are no prognostic parameters unequivocally predicting treatment failure in early rheumatoid arthritis (RA) patients. We investigated whether baseline ultrasonography (US) findings of joints, when added to baseline clinical, laboratory, and radiographical data, could improve prediction of failure to achieve Disease Activity Score assessing 28 joints (DAS28) remission (<2.6) at 1 year in newly diagnosed RA patients. Methods A multicentre cohort of newly diagnosed RA patients was followed prospectively for 1 year. US of the hands, wrists, and feet was performed at baseline. Clinical, laboratory, and radiographical parameters were recorded. Primary analysis was the prediction by logistic regression of the absence of DAS28 remission 12 months after diagnosis and start of therapy. Results Of 194 patients included, 174 were used for the analysis, with complete data available for 159. In a multivariate model with baseline DAS28 (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.2–2.2), the presence of rheumatoid factor (OR 2.3, 95% CI 1.1–5.1), and type of monitoring strategy (OR 0.2, 95% CI 0.05–0.85), the addition of baseline US results for joints (OR 0.96, 95% CI 0.89–1.04) did not significantly improve the prediction of failure to achieve DAS28 remission (likelihood ratio test, 1.04; p = 0.31). Conclusion In an early RA population, adding baseline ultrasonography of the hands, wrists, and feet to commonly available baseline characteristics did not improve prediction of failure to achieve DAS28 remission at 12 months. Trial registration Clinicaltrials.gov, NCT01752309. Registered on 19 December 2012. Electronic supplementary material The online version of this article (10.1186/s13075-018-1514-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D F Ten Cate
- Department of Rheumatology, Erasmus University Medical Center, Room Na-609; 0031-10-7038251, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - J W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W A A Swen
- Rheumatology, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus University Medical Center, Room Na-609; 0031-10-7038251, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - M H de Jager
- Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - N M Basoski
- Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - C J Haagsma
- Rheumatology, Hospital Group Twente, Almelo, The Netherlands
| | - J J Luime
- Department of Rheumatology, Erasmus University Medical Center, Room Na-609; 0031-10-7038251, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - A H Gerards
- Rheumatology, Vlietland Hospital Schiedam, Schiedam, The Netherlands
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Reiding KR, Vreeker GCM, Bondt A, Bladergroen MR, Hazes JMW, van der Burgt YEM, Wuhrer M, Dolhain RJEM. Serum Protein N-Glycosylation Changes with Rheumatoid Arthritis Disease Activity during and after Pregnancy. Front Med (Lausanne) 2018; 4:241. [PMID: 29359131 PMCID: PMC5766648 DOI: 10.3389/fmed.2017.00241] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 11/01/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022] Open
Abstract
Symptoms of rheumatoid arthritis (RA) improve during pregnancy, a phenomenon that was found to be associated with N-glycosylation changes of immunoglobulin G. Recent advances in high-throughput glycosylation analysis allow the assessment of the N-glycome of human sera as well. The aim of this study was to identify new protein N-glycosylation properties that associate with changes in RA disease activity during and after pregnancy. A longitudinal cohort of serum samples was collected during 285 pregnancies (32 control individuals and 253 RA patients). Per individual one sample was collected before conception, three during pregnancy, and three after delivery. Released serum protein N-glycans were measured by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) after employing chemical modification of the sialic acids to allow discrimination of sialic acid linkage isomers. Serum protein N-glycosylation showed strongly modified during pregnancy, with similar changes visible in control individuals and RA pregnancies. Namely, a decrease in bisection and an increase in galactosylation in diantennary glycans were found, as well as an increase in tri- and tetraantennary species and α2,3-linked sialylation thereof. The change in RA disease activity [DAS28(3)-CRP] proved negatively associated with the galactosylation of diantennary N-glycans, and positively with the sialylation of triantennary fucosylated species (A3FGS). While the protein source of the novel finding A3FGS is thus far unknown, its further study may improve our understanding of the etiology of RA disease severity.
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Affiliation(s)
- Karli R Reiding
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Gerda C M Vreeker
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Albert Bondt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands.,Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Marco R Bladergroen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands.,Department of Clinical Chemistry, Leiden University Medical Center, Leiden, Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
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van der Ven M, van der Veer-Meerkerk M, Ten Cate DF, Rasappu N, Kok MR, Csakvari D, Hazes JMW, Gerards AH, Luime JJ. Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis. Arthritis Res Ther 2017; 19:202. [PMID: 28915847 PMCID: PMC5602837 DOI: 10.1186/s13075-017-1405-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 04/18/2017] [Accepted: 08/15/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To decrease the burden of disease of rheumatoid arthritis (RA), patients at risk for RA need to be identified as early as possible, preferably when no clinically apparent synovitis can be detected. Up to now, it has been fairly difficult to identify those patients with arthralgia who develop inflammatory arthritis (IA), but recent studies using ultrasound (US) suggest that earlier detection is possible. We aimed to identify patients with arthralgia developing IA within 1 year using US to detect subclinical synovitis at first consultation. METHODS In a multi-centre cohort study, we followed patients with arthralgia with at least two painful joints of the hands, feet or shoulders without clinical synovitis over 1 year. Symptom duration was < 1 year, and symptoms were not explained by other conditions. At baseline and at 6 and 12 months, data were collected for physical examinations, laboratory values and diagnoses. At baseline, we examined 26 joints ultrasonographically (bilateral metacarpophalangeal joints 2-5, proximal interphalangeal joints 2-5, wrist and metatarsophalangeal joints 2-5). Scoring was done semi-quantitatively on greyscale (GS; 0-3) and power Doppler (PD; 0-3) images. US synovitis was defined as GS ≥ 2 and/or PD ≥ 1. IA was defined as clinical soft tissue swelling. Sensitivity and specificity were used to assess the diagnostic value of US for the development of IA. Univariate logistic regression was used to analyse the association between independent variables and the incidence of IA. For multivariate logistic regression, the strongest variables (p < 0.157) were selected. Missing values for independent variables were imputed. RESULTS A total of 196 patients were included, and 159 completed 12 months of follow-up. Thirty-one (16%) patients developed IA, of whom 59% showed US synovitis at baseline. The sensitivity and specificity of US synovitis were 59% and 68%, respectively. If no joints were positive on US, negative predictive value was 89%. In the multivariate logistic regression, age (OR 1.1), the presence of morning stiffness for > 30 minutes (OR 3.3) and PD signal (OR 3.4) were associated with incident IA. CONCLUSIONS The presence of PD signal, morning stiffness for > 30 minutes and age at baseline were independently associated with the development of IA. Regarding the value of US in the diagnostic workup of patients with early arthralgia at risk for IA, US did perform well in ruling out IA in patients who did not have US synovitis.
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Affiliation(s)
- Myrthe van der Ven
- Department of Rheumatology (Na609), Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - M van der Veer-Meerkerk
- Department of Rheumatology (Na609), Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - D F Ten Cate
- Department of Rheumatology (Na609), Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - N Rasappu
- Department of Rheumatology (Na609), Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M R Kok
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - D Csakvari
- Department of Rheumatology (Na609), Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J M W Hazes
- Department of Rheumatology (Na609), Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A H Gerards
- Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
| | - J J Luime
- Department of Rheumatology (Na609), Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ince-Askan H, Hazes JMW, Dolhain RJEM. Identifying Clinical Factors Associated With Low Disease Activity and Remission of Rheumatoid Arthritis During Pregnancy. Arthritis Care Res (Hoboken) 2017; 69:1297-1303. [PMID: 27813290 DOI: 10.1002/acr.23143] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify a combination of clinical factors associated with low disease activity and remission in the third trimester during pregnancy in women with rheumatoid arthritis (RA). METHODS This study is embedded in the Pregnancy-Induced Amelioration of Rheumatoid Arthritis study, a prospective cohort study. There were data available on 190 pregnancies from first trimester until delivery. Multivariate regression analyses were performed on the disease activity (Disease Activity Score in 28 joints [DAS28] using the C-reactive protein [CRP] level) in the third trimester. Independent covariates were the DAS28-CRP-3 in first trimester, prednisone and sulfasalazine use in the first trimester, parity, methotrexate use in the past, autoantibody status, the presence of erosions, and RA disease duration. RESULTS In multivariate regression models, the DAS28-CRP-3, use of prednisone in the first trimester, and the presence of autoantibodies were negatively associated with low disease activity (DAS28-CRP-3 <3.2) in the third trimester (P < 0.05), and the DAS28-CRP-3 and presence of autoantibodies were also associated with remission (DAS28-CRP-3 <2.6) (P < 0.001). Subgroup analysis revealed that the associations of prednisone use and presence of autoantibodies were only present in patients with moderate-to-high disease activity (DAS28-CRP-3 ≥3.2) in the first trimester. CONCLUSION RA patients who have a low DAS28-CRP-3 in the first trimester (irrespective of autoantibody status or prednisone use) are likely to have low disease activity or remission in the third trimester. Also, women with higher disease activity who are not taking prednisone and who express no autoantibodies still have a fair chance of low disease activity in the last trimester.
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Luime JJ, Buisman LR, Oppe M, Hazes JMW, Rutten-van Mölken MPMH. Cost-Effectiveness Model for Evaluating New Diagnostic Tests in the Evaluation of Patients With Inflammatory Arthritis at Risk of Having Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 68:927-35. [PMID: 26555013 DOI: 10.1002/acr.22776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE New opportunities have emerged for early diagnosis with the arrival of new technologies that assess the impact of genomics, proteomics, metabolomics, and cytomics on rheumatoid arthritis (RA) risk. This early health technology assessment study assesses the short-term cost effectiveness of 4 add-on diagnostic tests in early inflammatory arthritis patients at risk of RA. METHODS We modeled 4 diagnostic add-on tests to the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, covering the first year after diagnosis, using Rotterdam Early Arthritis Cohort data. Sensitivity, specificity, and costs were assigned to the magnetic resonance imaging of hands and feet (sensitivity 0.90, specificity 0.60, cost €756), interleukin-6 (IL-6) serum level test (sensitivity 0.70, specificity 0.53, cost €50), B cell-related gene expression (sensitivity 0.60, specificity 0.90, cost €150), and gene assay for RA (sensitivity 0.40, specificity 0.85, cost €750), based on literature and expert opinion. Outcomes were evaluated using the unweighted diagnostic net benefit (UDNB) and the incremental cost-effectiveness ratio (ICER) in all patients (n = 552), intermediate-risk patients (n = 263), and seronegative patients (n = 329). RESULTS The highest UDNB was found when using the B cell assay in intermediate-risk patients (43%, ICER €5,314), while the IL-6 test in seronegative patients resulted in the lowest UDNB (-11.4%, ICER €7,650). If a threshold of €20,000 is applied, the B cell assay would be preferred over the other alternatives, with a 78% probability of being cost effective for intermediate-risk patients, 57% for all patients, and 73% for seronegative patients. CONCLUSION Diagnostic add-on tests favoring specificity over sensitivity with a headroom less than €370 per test are cost effective, with the largest diagnostic benefit occurring in intermediate-risk patients.
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Affiliation(s)
- Jolanda J Luime
- Erasmus Medical Center and Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leander R Buisman
- Erasmus Medical Center and Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mark Oppe
- Erasmus University Rotterdam, and EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Johanna M. W. Hazes, MD, PhD: Erasmus Medical Center, Rotterdam, The Netherlands
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Karreman MC, Weel AEAM, van der Ven M, Vis M, Tchetverikov I, Nijsten TEC, Wakkee M, Hazes JMW, Luime JJ. Performance of screening tools for psoriatic arthritis: a cross-sectional study in primary care. Rheumatology (Oxford) 2017; 56:597-602. [PMID: 28013202 DOI: 10.1093/rheumatology/kew410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Indexed: 11/14/2022] Open
Abstract
Objective . To compare the screening performance of the Psoriasis Epidemiology Screening Tool (PEST), Psoriatic Arthritis Screening and Evaluation (PASE) and Early Arthritis for Psoriatic Patients (EARP) questionnaires for detecting PsA among psoriasis patients in a primary care setting. Methods In a cross-sectional study, 473 primary care psoriasis patients at risk for PsA completed the PEST, PASE and EARP questionnaires and were clinically evaluated by a trained research nurse. A PsA case was defined by a rheumatologist according to the CASPAR criteria. Sensitivity and specificity were determined for the PEST and EARP cut-offs (⩾3) and the PASE cut-offs (⩾44 and ⩾47). Results PsA was diagnosed in 53 patients. The PEST had a sensitivity of 0.68 and a specificity of 0.71. The PASE was validated for two different cut-offs. The cut-off of 47 led to a sensitivity of 0.59 and a specificity of 0.66, whereas the lower cut-off of 44 led to a sensitivity of 0.66 and a specificity of 0.57. For the EARP we found a sensitivity of 0.87 with a specificity of 0.34. Conclusion The PEST questionnaire has the most favourable trade-off between sensitivity and specificity to screen for PsA. However, as the prevalence of psoriasis and PsA is fairly low in primary care, screening only psoriasis patients with musculoskeletal complaints may be a better allocation of resources.
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Affiliation(s)
| | - Angelique E A M Weel
- Department of Rheumatology, Erasmus University Medical Centre.,Department of Rheumatology, Maasstad Hospital, Rotterdam
| | | | - Marijn Vis
- Department of Rheumatology, Erasmus University Medical Centre
| | | | - Tamar E C Nijsten
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Jolanda J Luime
- Department of Rheumatology, Erasmus University Medical Centre
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Brouwer J, Fleurbaaij R, Hazes JMW, Dolhain RJEM, Laven JSE. Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis Care Res (Hoboken) 2017; 69:1142-1149. [PMID: 27723275 PMCID: PMC5575464 DOI: 10.1002/acr.23124] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/29/2022]
Abstract
Objective Subfertility is frequently encountered among female rheumatoid arthritis (RA) patients and has been associated with disease activity and antirheumatic drugs. However, little is known about the results of the fertility assessments in these women. Our aim was to study the outcome of fertility assessments in subfertile women with RA. Methods A cross‐sectional study was performed in a nationwide cohort of female RA patients who were pregnant or trying to conceive between 2002 and 2010 (Pregnancy‐Induced Amelioration of Rheumatoid Arthritis Study). Patients who had given consent for future contact (n = 260) received a questionnaire on reproductive history, fertility examinations, and fertility treatments. Medical files were obtained from attending gynecologists. Results A completed questionnaire was returned by 178 women (68%), of whom 96% had ended their efforts to conceive. Eighty‐two subjects (46%) had at least 1 subfertile episode, and for 61 women a diagnosis for subfertility was available. Unexplained subfertility (48%) and anovulation (28%) were the most common gynecologic diagnoses, and both occurred more often in RA patients than reported in the general population. Women with unexplained subfertility more often used nonsteroidal antiinflammatory drugs (NSAIDs) during the periconceptional period. Seventeen percent of all pregnancies were conceived after fertility treatments. Fertility treatments had equal or higher pregnancy rates in RA compared to other subfertile populations. Conclusion Unexplained subfertility is more often diagnosed in subfertile female RA patients than in the general population, and is related to periconceptional NSAID use. Despite the higher incidence of subfertility in women with RA, the outcome of fertility treatments in these women appears favorable.
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Affiliation(s)
- Jenny Brouwer
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rosalie Fleurbaaij
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johanna M W Hazes
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Joop S E Laven
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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