Désirée van der Heijde

University of Amsterdam, Amsterdamo, North Holland, Netherlands

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Publications (608)3659.3 Total impact

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    ABSTRACT: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. 3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41 (1.91 to 3.03), p<0.001, for an elevated systolic pulmonary arterial pressure on heart ultrasound (US-PAPs):1.36 (1.03 to 1.80), p=0.032, for any cardiovascular event (new DUs, elevated US-PAPs or LV failure): 3.56 (2.26 to 5.62), p<0.001, and for death (1.53 (1.16 to 2.02), p=0.003). In patients with SSc, HDU at presentation predicts the occurrence of DUs at follow-up and is associated with cardiovascular worsening and decreased survival. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Annals of the rheumatic diseases. 02/2015;
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    ABSTRACT: To compare the risk of cardiovascular disease (CVD) in ankylosing spondylitis (AS) and population controls, and to examine the associations between disease activity and CVD risk. A cross-sectional study was done of patients with AS grouped according to Ankylosing Spondylitis Disease Activity Score (ASDAS) into ASDAS-high and ASDAS-low. Markers of vascular pathology, impaired endothelial function [asymmetric dimethylarginine (ADMA)], and arterial stiffness [augmentation index (AIx) and pulse wave velocity (PWV)], and traditional CVD risk factors [blood pressure, lipids, body mass index (BMI), CVD risk scores] were compared between AS and controls as well as across ASDAS-high versus ASDAS-low versus controls using ANCOVA analyses. Altogether, 151 patients with AS and 134 controls participated. Patients had elevated ADMA (μmol/l) and AIx (%) compared to controls: mean difference (95% CI): 0.05 (0.03, 0.07), p < 0.001 and 2.6 (0.8, 4.3), p = 0.01, respectively. AIx increased with higher ASDAS level, p(trend) < 0.04. There were no significant group differences of PWV. BMI was higher in ASDAS-high compared to ASDAS-low (p = 0.02). Total cholesterol was lower in AS compared to controls, and lower with higher ASDAS, p(trend) = 0.02. CVD risk scores were similar across groups except for Reynolds Risk Score, where the ASDAS-high group had a significantly higher score, compared to both ASDAS-low and controls. Elevated ADMA and AIx in AS support a higher CVD risk in AS. Elevated AIx and BMI in AS with high ASDAS indicate an association between disease activity and CVD risk. Lower total cholesterol in AS may contribute to underestimation of CVD risk.
    The Journal of Rheumatology 02/2015; · 3.17 Impact Factor
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    ABSTRACT: To test medication adherence using the Compliance-Questionnaire-Rheumatology (CQR). Invitation letter and CQR were sent to 240 patients with rheumatoid arthritis. Followup CQR was sent 3 months later. Adherence was evaluated using CQR 80% cutoff scores. Seventy-eight patients who were being treated with disease-modifying antirheumatic drugs provided full information on the CQR at both points in time. Eleven patients (14.1%) were classified as adherent based on taking compliance (TC), with only 3 patients (3.8%) adherent in regard to correct dosing (CD) [followup: 13 (16.7%) and 3 (3.8%) for TC and CD, respectively]. Nonadherence was not related to disease activity or side effects. We demonstrated low adherence, suggesting differences between doctors' records and patients' practice of antirheumatic drug therapy.
    The Journal of rheumatology. 01/2015;
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    ABSTRACT: Objective The ability to interpret scores from Patient Reported Outcome Measures at the individual patient level depends on the availability of valid, clinically meaningful benchmarks of response and state-attainment. The goal was to develop multinational estimates for Minimal Clinically Important Improvement (MCII) and Patient Acceptable Symptomatic State (PASS). Methods A multinational sample of patients with osteoarthritis (OA), were evaluated before and 4 weeks after treatment with nonsteroidal anti-inflammatory drugs. Patients completed either the Western Ontario and McMaster (WOMAC) NRS3.1 Index (hip and knee OA) or the Australian/Canadian (AUSCAN) NRS3.1 Index (hand OA) before and after treatment. Patients rated the clinical importance of their response to treatment and their satisfaction with the health state achieved from which multinational MCII and PASS estimates were calculated for both the WOMAC and AUSCAN Indices. A total of 609 patients from 7 countries participated in the study. MCII and PASS estimates varied slightly by instrument and subscale. Absolute (and percentage) change for MCII ranged between 6 to 9 (10% to 17%) for WOMAC and 4 to 9 (8% to 15%) for AUSCAN. PASS estimates ranged from 39 to 48 for WOMAC and 38 to 45 for AUSCAN. Some between-country variation was observed in MCII and PASS. Conclusion Preliminary multinational estimates for MCII and PASS have been developed for several countries. Further research is required to evaluate the robustness, temporal consistency and age- and gender-dependency of the preliminary estimates as well as their generalizability to other countries, languages, cultures, regions and other condition-specific outcome measures. This article is protected by copyright. All rights reserved. Copyright © 2014 American College of Rheumatology.
    Arthritis care & research. 01/2015;
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    ABSTRACT: Chronic pain and progressive loss of physical function with AS may adversely affect health-related quality of life (HRQoL). The objective of this study was to assess the 5-year data regarding spinal mobility, physical function and HRQoL in patients with AS who participated in the Adalimumab Trial Evaluating Long-term Efficacy and Safety for AS (ATLAS) study. Patients received blinded adalimumab 40 mg or placebo every other week for 24 weeks, then open-label adalimumab for up to 5 years. Spinal mobility was evaluated using linear BASMI (BASMIlin). BASDAI, total back pain, CRP, BASFI, Short Form-36 and AS quality of life (ASQoL) were also assessed. Correlations between BASMIlin and clinical, functional and ASQoL outcomes after 12 weeks and after 5years of adalimumab exposure were evaluated using Spearman's rank correlation. Associations were further analysed using multivariate regression. Three hundred and eleven patients received ≥1 dose of adalimumab; 125 of the 208 patients originally randomized to adalimumab received treatment for 5 years. Improvements in BASMIlin were sustained through 5 years, with a mean change of -0.6 from baseline in the population who completed 5 years of treatment with adalimumab. Improvements in disease activity, physical function and ASQoL were also sustained through 5 years. BASMIlin was significantly correlated with all evaluated clinical outcomes (P < 0.001). The highest correlation was with BASFI at 12 weeks (r = 0.52) and at 5 years (r = 0.65). Multivariate regression analysis confirmed this association (P < 0.001). Treatment with adalimumab for up to 5 years demonstrated sustained benefits in spinal mobility, disease activity, physical function and HRQoL in patients with active AS. Spinal mobility was significantly associated with short- and long-term physical function in these patients. Trial registration: Clinicaltrials.gov; https://clinicaltrials.gov/ NCT00085644. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology.
    Rheumatology (Oxford, England) 12/2014; · 4.44 Impact Factor
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    ABSTRACT: Objective: Previous reports of RAPID-axSpA (NCT01087762) demonstrated efficacy and safety of certolizumab pegol (CZP) over 24 weeks (wks) in patients with axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). We herein report efficacy and safety data from a 96-wk interim data cut of RAPID-axSpA. Methods: RAPID-axSpA is double-blind and placebo-controlled to Wk24, dose-blind to Wk48 and open-label to Wk204. Outcome variables assessed included ASAS20/40 and ASAS-partial remission responses (analyzed by non-responder imputation [NRI]), and ASDAS, ASDAS Inactive Disease, ASDAS Major Improvement, BASDAI, BASFI and BASMI-linear (analyzed by last observation carried forward [LOCF]). Safety data are shown for patients treated with ≥1 dose of CZP. Results: 325 patients were randomized, of whom 218 received CZP from Wk0. Of these, 93% completed Wk24, 88% Wk48 and 80% Wk96. Improvements in ASAS responses were maintained to Wk96 (ASAS20: 67.4%, 72.0%, 62.8% at Wks 24, 48, 96, respectively), as well as improvements in ASDAS, BASDAI (mean score: 3.3, 3.1, 3.0 at Wks 24, 48, 96, respectively), BASFI and BASMI-linear. Comparable improvements were observed with both dosing regimens (200mg Q2W/400mg Q4W) and in AS and nr-axSpA patients. In the Safety Set, adverse events occurred in 279 patients (88.6%) and serious adverse events in 41 (13.0%). No deaths or malignancies were reported. Conclusion: Clinical improvements to Wk24 in both CZP dosing regimens were sustained to Wk96. Similar sustained improvements were observed in AS and nr-axSpA subpopulations. The safety profile was in-line with previous reports from RAPID-axSpA, with no new safety signals observed with longer exposure duration. This article is protected by copyright. All rights reserved. Copyright © 2014 American College of Rheumatology.
    Arthritis & rheumatology (Hoboken, N.J.). 12/2014;
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    ABSTRACT: Recognition, diagnosis, and management of axial spondyloarthritis (axial SpA) continue to advance. The objectives of this study were to compare referrals, diagnosis, and management of axial SpA in Western Europe (WE), North America (US and Canada), and the rest of world (RoW) in academic and community rheumatology practices and to identify areas for further education. Rheumatologists responded online to the MAXIMA (Management of Axial SpA International and Multicentric Approaches) survey. Questions pertained to referral, diagnosis, and management of axial SpA. Rheumatologists (N = 809) from 56 countries completed the survey about patients with chronic back pain (≥3 months) starting before age 45 years. Responses from academic and community practice rheumatologists were generally similar. Most referrals were from primary care providers. Symptom duration of 3 years or more at referral was reported more frequently by WE and RoW than US respondents. More WE and RoW than US rheumatologists referred to the Assessment of SpondyloArthritis International Society criteria for axial SpA in clinical practice. Rheumatologists reported prescribing disease-modifying antirheumatic drugs for the management of axial SpA. Sulfasalazine was frequently prescribed across regions; methotrexate was more commonly prescribed by US rheumatologists compared with other regions. Referral patterns, diagnosis, and disease management for axial SpA were similar among WE, North America, and RoW rheumatologists and in academic/community practices, although more WE and RoW rheumatologists referred to Assessment of SpondyloArthritis International Society criteria in clinical practice. Disease-modifying antirheumatic drugs were commonly prescribed for axial SpA patients, although it was unclear whether these were prescribed for axial or peripheral symptoms.
    Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 12/2014; 20(8):411-7. · 1.19 Impact Factor
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    ABSTRACT: Objectives Uveitis is the most common extra-articular manifestation in patients with ankylosing spondylitis (AS), but the literature describing AS patient with a history of uveitis is limited. The objective was to examine if a history of uveitis in patient with AS is associated to increased disease activity and functional impairment, and to investigate whether uveitis is associated with an increased frequency of cardiovascular co-morbidities define here as hypertension and atherosclerosis. Methods Data were recorded cross-sectionally through patient interviews, blood samples, clinical examination and questionnaires. Carotid plaques were identified by ultrasonography. AS disease activity and function were compared across categories of uveitis using ANCOVA analyses. Associations between uveitis and hypertension and atherosclerosis (atherosclerotic cardiovascular disease (CVD) and /or carotid plaque) were analyzed in multivariate logistic regression models. Results Of 159 patients with AS (61.6% male, mean age 50.5 years), 84 (52.8%) had experienced one or more episodes of uveitis. AS disease activity was higher in patients with a history of uveitis; statistically significant for functional impairment (Bath AS Functional Index (BASFI)) (mean difference (95% CI)) lnBASFI 0.2 (0.0-0.3), p=0.05. Patients with uveitis had an increased odds ratio (OR (95% CI)) for hypertension (3.29 (1.29-8.41), p=0.01) and atherosclerosis (2.57 (1.15-5.72), p=0.02). Conclusions AS patient with a history of uveitis had non-significantly higher disease activity and significantly higher functional impairment. A history of uveitis was associated to hypertension as well as atherosclerosis. These results may be important in identifying AS patient with elevated risk of CVD, but should be confirmed in longitudinal cohorts.
    Seminars in Arthritis and Rheumatism 12/2014; · 3.63 Impact Factor
  • Arthritis & rheumatology (Hoboken, N.J.). 11/2014;
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    ABSTRACT: The aim of this study was to investigate the relationship between different disease activity indices (DAIs) and their individual components and radiographic progression in patients with RA. A systematic literature review until July 2013 was performed by two independent reviewers using the Medline and Embase databases. Longitudinal studies assessing the relationship between DAIs and single instruments and radiographic progression were included. The results were grouped based on the means of measurement (baseline vs time integrated) and analysis (univariable or multivariable). Fifty-seven studies from 1232 hits were included. All published studies that assessed the relationship between any time-integrated DAI including joint count and radiographic progression reached a statistically significant association. Among the single instruments, only swollen joint count and ESR were associated with radiographic progression, while no significant association was found for tender joint count. Data with respect to CRP are conflicting. Data on patient's global health, pain assessment and evaluator's global assessment are limited and do not support a positive association with progression of joint damage. Published data indicate that all DAIs that include swollen joints are related to radiographic progression while, of the individual components, only swollen joints and acute phase reactants are associated. Therefore composite DAIs are the optimal tool to monitor disease activity in patients with RA. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Rheumatology (Oxford, England) 11/2014; · 4.44 Impact Factor
  • Robert B M Landewé, Désirée M van der Heijde
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    ABSTRACT: The assessment of disease in rheumatological diseases is rather complicated, because it may involve different contexts (clinical practice, clinical trials, observational studies, registries, etc.) as well as different domains (disease activity, physical function, radiographic damage, quality of life, etc.). Furthermore, available tools can be comprehensive but also rather condense, may be patient-oriented or rather physician-oriented, and so on. In this article all these levels that may matter in case of a choice of disease assessment tool are discussed, arriving at a conclusion that choosing the appropriate tool for the assessment of disease is not 'cookbook medicine'.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):2-6. · 2.97 Impact Factor
  • Jurgen Braun, Uta Kiltz, Xenofon Baraliakos, Desiree M van der Heijde
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    ABSTRACT: The spondyloarthritides (SpA) are currently differentiated into axial and peripheral SpA. Patients with axial SpA (axSpA) may be further classified into the classical form ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). The SpA are genetically linked, and the subtypes including psoriatic arthritis (PsA) share characteristic clinical symptoms such as inflammatory back pain (IBP) and enthesitis. IMP can be due to sacroiliitis and spondylitis, enthesitis may occur with or without arthritis, and anterior uveitis, as well as other extraarticular manifestations such as psoriasis and chronic inflammatory bowel disease (IBD). In addition to clinical findings, imaging, mainly conventional radiography and magnetic resonance imaging (MRI), and laboratory results such as HLA B27 and CRP are important tools for classification and diagnosis of SpA. The Assessment of SpondyloArthritis international Society (ASAS), an international group of experts in the field of SpA since 1995, has published on assessments and outcome parameters in SpA. The publication of classification criteria for axSpA has now largely replaced the 1984 criteria for AS. However, the established cut-off between AS and nr-axSpA, 'definite' structural changes in the sacroiliac joints, has been recently debated because of limited reliability. Since imaging plays an important role in all criteria sets, the ASAS group has recently published definitions for inflammatory changes in the SIJ and the spine. The most important domains in AS are disease activity, function, spinal mobility, structural damage, and quality of life, some of which are discussed in this manuscript. For axSpA there are two major tools to assess disease activity, the BASDAI and the ASDAS, one for function, the BASFI, and several mobility measures including the BASMI. The AS Health Index (AS-HI) is introduced elsewhere in this supplement.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):96-104. · 2.97 Impact Factor
  • Uta Kiltz, Desiree M van der Heijde, Annelies Boonen, Jurgen Braun
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    ABSTRACT: Within the variable course of ankylos¬ing spondylitis (AS), peripheral arthritis, enthesitis, and involvement of other organs can add to the burden of the disease. The primary complaints of patients with spondyloarthritis (SpA) are pain, stiffness, fatigue, and limitation in activities and social participation. Instruments currently available for the assessment of patients with SpA focus predominantly on specific aspects of health such as pain, disease activity, and physical function and measure specific concepts like physical function and health-related quality of life (HR-QoL). However, the overall picture of impairments, limitations and restrictions in activities or social participation of patients with AS is not adequately assessed in SpA-specific questionnaires. Most of the existing questionnaires are not conceptualised with regard to their underlying construct. The International classification of functioning, disability and health (ICF) Core Set for AS may serve as an appropriate model and underlying construct to develop a health index, since the whole range of functioning and disability of patients with AS is captured. Based on these assumptions, ASAS developed for patients with SpA an instrument assessing health as operationalised by the ICF. The questionnaire was developed by preparing an item pool, linkage of the items to the comprehensive ICF core set for AS and test of the item pool in two cross-sectional studies. The analysis of the questionnaire and the response scale were done with Rasch analysis. Emphasis was on optimal targeting, the capacity of items to differentiate between different levels of health, and optimal coverage of items to the spectrum of ICF categories, so that the final questionnaire could represent as much of the entire range of difficulty levels as possible. The ASAS HI is a linear composite measure and includes 17 items which cover most of the ICF core set. Preliminary validity has been confirmed in a field test in 4 English-speaking countries. The ASAS HI should soon be used in clinical trials and in clinical practice to test its real life performance and to confirm that this new composite index captures relevant information on functioning and health of patients with AS.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):105-108. · 2.97 Impact Factor
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    ABSTRACT: The METEOR (Measurement of Efficacy of Treatment in the 'Era of Outcome' in Rheumatology) initiative aims at improving care for RA patients by assisting rheumatologists in strict monitoring and tight control of disease activity. The state of the art of the METEOR initiative, the technical organisation of the database and future perspectives are described.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):135-140. · 2.97 Impact Factor
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    ABSTRACT: To identify patients earlier, new classification criteria have been introduced for axial spondyloarthritis (axSpA). Patients who satisfy the clinical or imaging criteria for axSpA in the absence of definite sacroiliac joint changes on pelvic x-rays are classified as having non-radiographic axSpA. Although the burden associated with radiographic axSpA (i.e., ankylosing spondylitis) has been extensively studied, the impact of non-radiographic disease is not well understood. The purpose of this review is to provide an overview of the burden of illness in non-radiographic axSpA, including epidemiology and effects on patients׳ functioning and health-related quality of life (HR-QoL). A PubMed search was performed using relevant key words (e.g., "spondyloarthritis," "ankylosing spondylitis," "epidemiology," and "quality of life") to examine literature published from 2003 to 2013. Studies conducted to date suggest that radiographic progression is detected in approximately 10% of patients with non-radiographic axSpA over 2 years. Differences between patients with non-radiographic and radiographic axSpA were found in age, symptom duration, and gender distribution. Although less inflammation (i.e., lower C-reactive protein levels and less spinal inflammation on MRI) and less impairment in spinal mobility are observed in non-radiographic than in radiographic axSpA, the 2 conditions pose a similar burden in terms of disease activity, physical function, HR-QoL impairment. Patients with non-radiographic axSpA are more frequently female. Although patients with non-radiographic axSpA have shorter disease duration and lack radiological changes, they demonstrate a substantial burden of illness, with self-reported disease activity and functional impairments comparable to those found in patients with radiographic disease. Copyright © 2014 Elsevier Inc. All rights reserved.
    Seminars in Arthritis and Rheumatism 10/2014; · 3.63 Impact Factor
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    ABSTRACT: Increased numbers of IL-17-producing CD4(+) T cells have been observed in AS. However, it is not known whether these CD4(+) T cells are already present in early disease or if this is a late disease phenomenon only. Therefore we aimed to investigate whether IL-17-producing CD4(+) T cells are involved in early active axial SpA, including patients without imaging abnormalities, by determining the frequency and phenotype of IL-17-producing CD4(+) T cells in these patients.
    Rheumatology (Oxford, England) 10/2014; · 4.44 Impact Factor
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    ABSTRACT: This systematic literature review aimed to evaluate the use of conventional radiography (CR) in hand osteoarthritis (OA) and to assess the metric properties of the different radiographic scoring methods.
    Osteoarthritis and Cartilage 10/2014; 22(10):1710-23. · 4.66 Impact Factor
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    ABSTRACT: Background: The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a composite measure of disease activity in axial spondyloarthritis.Objectives: Our aims were to investigate the most appropriate ASDAS-C-reactive protein (ASDAS-CRP) calculation method when the conventional CRP (cCRP) is below the limit of detection, to study the arithmetic influence of low CRP values obtained by high sensitivity CRP (hsCRP) in ASDAS-CRP results and to test agreement between different ASDAS formulae.Methods: Patients with axial spondyloarthritis and cCRP below the limit of detection (5mg/L, n=257) were selected. ASDAS-cCRP was calculated using eleven imputation strategies for the cCRP (range 0-5, at 0.5 intervals). ASDAS-hsCRP and ASDAS-ESR were also calculated. Agreement between ASDAS formulae was tested.Results: ASDAS-CRP calculated with the cCRP imputation values of 1.5 and 2.0mg/L and ASDAS-erythrocyte sedimentation rate (ESR) had better agreement with ASDAS-hsCRP than other imputed formulae. Disagreement was mainly in lower disease activity states (inactive/moderate disease activity). When the CRP value is <2mg/L, the CRP component of the ASDAS-CRP formula can take very low values that may result in inappropriately low ASDAS-CRP values.Conclusion: When the cCRP is below the limit of detection or when the hsCRP is <2mg/L, the constant value of 2mg/L should be used to calculate ASDAS-CRP. There is good agreement between ASDAS-hsCRP and ASDAS-ESR; however, formulae are not interchangeable. © 2014 American College of Rheumatology.
    Arthritis & Rheumatology. 10/2014;

Publication Stats

23k Citations
3,659.30 Total Impact Points

Institutions

  • 2013–2014
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
    • University of Colorado
      • Department of Medicine
      Denver, Colorado, United States
    • Leiden University
      Leyden, South Holland, Netherlands
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
    • Hospital General Universitario de Elda
      Elda, Valencia, Spain
    • University of Southampton
      Southampton, England, United Kingdom
    • VU University Medical Center
      • Department of Rheumatology
      Amsterdamo, North Holland, Netherlands
  • 2010–2014
    • Oregon Health and Science University
      Portland, Oregon, United States
    • University of Coimbra
      Coímbra, Coimbra, Portugal
    • Radboud University Medical Centre (Radboudumc)
      • Department of Human Genetics
      Nymegen, Gelderland, Netherlands
    • Oslo University Hospital
      Kristiania (historical), Oslo County, Norway
    • Medisch Centrum Haaglanden
      's-Gravenhage, South Holland, Netherlands
  • 2007–2014
    • Diakonhjemmet Hospital (Norway)
      Kristiania (historical), Oslo County, Norway
    • Toronto Western Hospital
      Toronto, Ontario, Canada
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      Lutetia Parisorum, Île-de-France, France
    • Ludwig-Maximilian-University of Munich
      • Department of Physical Medicine and Rehabilitation
      München, Bavaria, Germany
  • 2004–2014
    • Charité Universitätsmedizin Berlin
      • • Department of Gastroenterology, Infectiology and Rheumatology
      • • Institute of Health Sciences Education and Nursing Science
      Berlín, Berlin, Germany
    • Carol Davila University of Medicine and Pharmacy
      • Department of Internal Medicine and Rheumatology
      Bucharest, Bucuresti, Romania
  • 2010–2013
    • Medical University of Vienna
      • Department of Medicine II
      Wien, Vienna, Austria
  • 2012
    • Mount Sinai Hospital, Toronto
      Toronto, Ontario, Canada
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
    • National Institute Of Rheumatology And Physiotherapy
      Budapeŝto, Budapest, Hungary
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia
    • Royal Prince Alfred Hospital
      Camperdown, New South Wales, Australia
    • University Hospital Southampton NHS Foundation Trust
      • Department of Rheumatology
      Southampton, England, United Kingdom
    • Centre Hospitalier Universitaire de Québec (CHUQ)
      Québec, Quebec, Canada
  • 2007–2012
    • University of Toronto
      • Division of Rheumatology
      Toronto, Ontario, Canada
  • 2005–2012
    • Leiden University Medical Centre
      • Department of Rheumatology
      Leiden, South Holland, Netherlands
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
    • Wiener Krankenanstaltenverbund
      Wien, Vienna, Austria
    • Nambour General Hospital
      Намбор, Queensland, Australia
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1999–2012
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 1997–2012
    • University of Leeds
      • School of Medicine
      Leeds, England, United Kingdom
  • 2011
    • Centre Hospitalier Universitaire de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
    • Merck
      Whitehouse Station, New Jersey, United States
    • Government of Quebec
      Québec, Quebec, Canada
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2008–2011
    • Norwegian University of Science and Technology
      Nidaros, Sør-Trøndelag, Norway
    • Menzies Research Institute
      Hobart Town, Tasmania, Australia
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom
    • Johnson & Johnson
      New Brunswick, New Jersey, United States
  • 2002–2011
    • Université René Descartes - Paris 5
      • • Faculté de Médecine
      • • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2001–2011
    • Stanford University
      • • Division of Rheumatology
      • • Division of Immunology
      Palo Alto, CA, United States
  • 1997–2011
    • Maastricht University
      • Department of Internal Medicine
      Maestricht, Limburg, Netherlands
  • 2007–2010
    • University of Alberta
      • Department of Medicine
      Edmonton, Alberta, Canada
  • 2005–2008
    • Hôpital Cochin (Hôpitaux Universitaires Paris Centre)
      Lutetia Parisorum, Île-de-France, France
  • 2004–2007
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2006
    • University of California, San Francisco
      • Division of Rheumatology
      San Francisco, CA, United States
    • Aix-Marseille Université
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2000
    • Freie Universität Berlin
      • Institute of Social and Cultural Anthropology
      Berlín, Berlin, Germany
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands