Désirée van der Heijde

Diakonhjemmet Hospital (Norway), Kristiania (historical), Oslo, Norway

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Publications (758)4876.63 Total impact

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    ABSTRACT: Objective. To test the feasibility of collecting, storing, retrieving and analysing necessary information to fulfil a preliminary set of quality indicators (QIs) that have been proposed by an international task force in a large multinational clinical practice database of patients with RA. Methods. Data from all 12 487 patients with 46 005 visits in the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology database from January 2008 until January 2012 were analysed to test the feasibility of collecting information on 10 QIs: time to diagnosis; frequency of visits; assessment of autoantibodies and radiographs, disease activity and function; disease remission, low disease activity, normal function; time to first DMARD and type of first DMARD. For each QI, two aspects were assessed: information availability and target achievement. Results. Information was available for <50% of patients regarding the following QIs: time to diagnosis, assessment of ACPAs or radiographs, time to first DMARD and type of first DMARD. Information was available for function assessment in 49% of visits and 67% of patients and for disease activity assessment in 85% of visits and 86% of patients. Information relevant to the QI frequency of visits was available for all patients. Relevant information to calculate the proportion of patients who achieved a defined target could be obtained for all QIs. Conclusion. Collecting storing, retrieving and analysing the core data necessary to meaningfully assess quality of care is feasible in a multinational, practice-based electronic database.
    Rheumatology (Oxford, England) 04/2015; DOI:10.1093/rheumatology/kev108 · 4.44 Impact Factor
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    ABSTRACT: A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9-9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners. 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 04/2015; DOI:10.1136/annrheumdis-2014-206971 · 9.27 Impact Factor
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    ABSTRACT: To identify factors associated with elevated arterial stiffness in a 5-year follow-up of patients with ankylosing spondylitis (AS). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath AS disease activity index (BASDAI) and AS disease activity score (ASDAS) were recorded in 2003, and arterial stiffness (Augmentation Index (AIx) and pulse wave velocity (PWV)) in 2008/2009. Patients were grouped into quartiles according to baseline CRP, ESR and BASDAI and four ASDAS groups. Trend analyses were performed using ANCOVA (AIx/PWV as dependent variable) with separate models for CRP, ESR, BASDAI and ASDAS (age and gender adjusted). Independent predictors of future AIx and PWV levels were identified in multivariate linear regression models. In total, 85 patients participated. Increasing baseline values of CRP, ESR and ASDAS were associated with elevated AIx on follow-up (p(trend) 0.01, 0.05 and 0.04, respectively). Similar non-significant patterns were seen for PWV. In the multivariate analyses, baseline CRP and ASDAS were independently associated with future elevated AIx (p=0.03 and0.02, respectively). In the multivariate PWV model, results for CRP and ASDAS were non-significant. Baseline CRP and ASDAS were associated with future elevated arterial stiffness measured as AIx, supporting that disease activity is related to future risk of cardiovascular disease in patients with AS. 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 03/2015; DOI:10.1136/annrheumdis-2014-206773 · 9.27 Impact Factor
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    ABSTRACT: Evaluate long-term outcomes in psoriatic arthritis (PsA) patients who achieved or did not achieve minimal disease activity (MDA) through 5 years of golimumab treatment in GO-REVEAL. The GO-REVEAL trial was a phase 3, randomized, double-blind trial with placebo-control through wk24 followed by an open-label extension of golimumab 50/100mg treatment up to 5 years. In these post-hoc analyses, MDA was defined by the presence of ≥5/7 PsA outcome measures (≤1 swollen joint, ≤1 tender joint, Psoriasis Area and Severity Index [PASI] ≤1, patient pain score ≤15, patient global disease activity [PtGA] score ≤20 (0-100), Health Assessment Questionnaire-Disability Index [HAQ-DI] ≤0.5, and ≤1 tender enthesis point). Treatment with golimumab yielded significantly higher MDA response rates versus patients randomized to placebo at wk14 (23.5% vs. 1.0%; p<0.0001), wk24 (28.1% vs. 7.7%; p<0.0001), and wk52 (42.4% vs. 30.2%; p=0.037). MDA was achieved at least once by ∼50% of golimumab-treated patients overall. Irrespective of treatment randomisation, achievement of MDA at ≥3 and ≥4 consecutive visits was associated with significantly less radiographic progression and more improvement in MDA components allowing specific assessment of physical function (HAQ-DI) and overall disease activity (PtGA) at wk256 versus patients not achieving MDA. Logistic regression analyses indicated that a 1-unit higher baseline HAQ-DI score yielded a significantly lower likelihood of achieving MDA at ≥3 (odds ratio [95%CI]=0.514 [0.321,0.824]; p=0.006) and ≥4 (odds ratio [95%CI]=0.480 [0.290,0.795]; p=0.004) consecutive visits. Among golimumab-treated PsA patients, better long-term functional improvement, patient global assessment, and radiographic outcomes were observed when patients achieved persistent MDA. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
    Arthritis Care and Research 03/2015; DOI:10.1002/acr.22576 · 4.04 Impact Factor
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    ABSTRACT: To explore whether changes of MRI-defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort. We included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0-3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA. Among joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant. The Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs. 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 03/2015; DOI:10.1136/annrheumdis-2014-206829 · 9.27 Impact Factor
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    ABSTRACT: Objectives: Few longitudinal studies have studied the association between body mass index (BMI) and hand osteoarthritis (OA). We aimed to explore the association between BMI and progressive hand OA in a longitudinal study of the Oslo hand OA cohort. Method: Participants with existing hand OA had hand radiographs and BMI data taken at baseline and 7-year follow-up (n = 103). The radiographs were read according to the Kellgren–Lawrence (KL) scale. First, we examined the association between baseline BMI and incident OA (KL grade ≥ 2) in joints without OA at baseline (adjusted for age and sex) using generalized estimating equation (GEE) analyses. Second, we examined whether changes in BMI from baseline to follow-up were associated with increasing KL sum score from baseline to follow-up using linear regression. We repeated the analyses using changes in number of joints with symptomatic OA and patient-reported pain and physical function as the outcome. Results: The mean (SD) age at baseline was 61.6 (5.6) years and 91 (94%) of the cohort were women. The mean (SD) BMI was 25.7 (4.0) kg/m2 at baseline and the mean (SD) BMI change was 1.1 (2.0) kg/m2. There was no relationship between baseline BMI and development of more joints with OA during follow-up. Similarly, there was no association between change in BMI and hand OA progression, increasing hand pain or disability. Conclusions: In the Oslo hand OA cohort, higher BMI was not related to hand OA progression.
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    ABSTRACT: Objectives. To evaluate the efficacy and safety of sarilumab in combination with methotrexate (MTX) for treatment of rheumatoid arthritis (RA). Methods. Adults with moderate-to-severe RA and inadequate response to MTX were randomized (1:1:1) to sarilumab 150mg, 200 mg, or placebo every 2 weeks (q2w) with MTX for 52 weeks. Results. Baseline characteristics were similar among groups. For all three co-primary endpoints, sarilumab 150mg and 200mg groups demonstrated statistically significant improvements vs placebo: ACR20 response at Week 24 (58.0%, 66.4% vs 33.4%; p<0.0001), HAQ-DI at Week 16 (-0.53, -0.55, vs -0.29; p<0.0001) and mTSS at Week 52 (0.90, 0.25 vs 2.78; p<0.0001). The most common treatment-emergent adverse event was infection; serious infections incidence was 2.6%, 4.0%, and 2.3% (sarilumab 150mg, 200 mg, and placebo, respectively). Elevations in alanine aminotransferase >3-fold the upper limit of normal in 9.5%, 8.0%, and 2.1% of patients led to discontinuation of 24 patients. Elevated total cholesterol levels were observed in 36.8%, 43.0% and 18.3% of sarilumab 150mg, 200 mg and placebo patients, respectively. Neutrophil counts 500-<1000 Giga/L occurred in 5.1% and 7.8%, <500 Giga/L in 0.9% and 0.7% of sarilumab 150mg and 200mg patients, respectively, and none receiving placebo. Conclusions: In RA patients treated with sarilumab (150mg and 200mg q2w) in combination with MTX, both doses provided sustained clinical efficacy, significantly improving symptomatic, functional, and radiographic outcomes. Sarilumab was generally well tolerated. The adverse events observed in this study were consistent with IL-6 signaling blockade. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
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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.
    03/2015; 67(3). DOI:10.1002/art.38973
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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.
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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; DOI:10.3899/jrheum.141018 · 3.17 Impact Factor
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    ABSTRACT: To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness. Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed. At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses. Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment. • Eliminating gadolinium contrast administration results in low specificity for synovitis • For tenosynovitis, sensitivity is low without gadolinium contrast administration • Gadolinium contrast administration remains essential for evaluating synovitis and tenosynovitis in early arthritis.
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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; DOI:10.3899/jrheum.140982 · 3.17 Impact Factor
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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 and Research 01/2015; DOI:10.1002/acr.22538 · 4.04 Impact Factor
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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; DOI:10.1093/rheumatology/keu438 · 4.44 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; 44(3). DOI:10.1016/j.semarthrit.2014.05.017 · 3.63 Impact Factor
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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. DOI:10.1097/RHU.0000000000000180 · 1.25 Impact Factor
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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; DOI:10.1093/rheumatology/keu413 · 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
  • 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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30k Citations
4,876.63 Total Impact Points


  • 2007–2015
    • Diakonhjemmet Hospital (Norway)
      Kristiania (historical), Oslo, Norway
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      Lutetia Parisorum, Île-de-France, France
    • Toronto Western Hospital
      Toronto, Ontario, Canada
    • University of Alberta
      • Department of Medicine
      Edmonton, Alberta, Canada
    • Ludwig-Maximilian-University of Munich
      • Department of Physical Medicine and Rehabilitation
      München, Bavaria, Germany
  • 2005–2015
    • Leiden University Medical Centre
      • Department of Rheumatology
      Leyden, South Holland, Netherlands
    • Medisch Centrum Leeuwarden
      Leewarden, Friesland, Netherlands
    • University of the Pacific (California - USA)
      Stockton, California, United States
    • German Rheumatism Research Centre
      Berlín, Berlin, Germany
  • 2014
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
    • Oregon Health and Science University
      Portland, Oregon, United States
  • 2007–2014
    • Leiden University
      Leyden, South Holland, Netherlands
  • 2013
    • Novartis Institutes for BioMedical Research
      Cambridge, Massachusetts, United States
  • 2010–2013
    • Medical University of Vienna
      Wien, Vienna, Austria
    • Medisch Centrum Haaglanden
      's-Gravenhage, South Holland, Netherlands
  • 2005–2013
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
  • 2012
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia
  • 1997–2012
    • University of Leeds
      • School of Medicine
      Leeds, England, United Kingdom
  • 2011
    • Arthritis Research UK
      Chesterfield, England, United Kingdom
  • 2005–2011
    • University of Toronto
      Toronto, Ontario, Canada
  • 2002–2011
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands
  • 1997–2011
    • Maastricht University
      • Department of Internal Medicine
      Maestricht, Limburg, Netherlands
  • 1998–2009
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 2008
    • Menzies Research Institute
      Hobart Town, Tasmania, Australia
    • University of Oslo
      Kristiania (historical), Oslo, Norway
  • 2004–2007
    • University of Washington Seattle
      Seattle, Washington, United States
    • Carol Davila University of Medicine and Pharmacy
      • Department of Internal Medicine and Rheumatology
      Bucharest, Bucuresti, Romania
  • 2000–2006
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 2003–2005
    • Boston University
      Boston, Massachusetts, United States
    • St. Josefs Hospital
      Клоппенбург, Lower Saxony, Germany
    • Case Western Reserve University
      • School of Medicine
      Cleveland, Ohio, United States
  • 2001–2004
    • Stanford University
      • Division of Immunology
      Palo Alto, California, United States
  • 1999
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1989–1992
    • Radboud University Medical Centre (Radboudumc)
      • Department of Human Genetics
      Nymegen, Gelderland, Netherlands