Piet Van Riel

• MD,PhD
• Professor Emeritus at Radboud University

Background Patients with rheumatoid arthritis (RA) experience higher cardiovascular risk compared to individuals without inflammatory rheumatic disease. Observational studies indicate that methotrexate (MTX) may decrease cardiovascular risk in patients with RA. It is, however, unclear whether sex differentially impacts cardiovascular risk in MTX us...

Background Chronic inflammation contributes to enhanced cardiovascular risk in patients with rheumatoid arthritis (RA). Biologic disease modifying antirheumatic drugs (bDMARDs) have been shown to effectively control inflammation in many conventional synthetic DMARD non-responders and improve cardiovascular outcomes. Objectives We here explored whe...

Objective To describe the prevalence of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA), and to evaluate the proportion of patients with AF receiving guideline-recommended anticoagulation for prevention of stroke, based on data from a large international audit. Methods The cohort was derived from the international audit SUrvey...

Background and aims: Rheumatoid arthritis (RA) patients are at a high risk of atherosclerotic cardiovascular disease (ASCVD). This implies a need for meticulous CVD risk factor recording and control. Objectives: The aim was to evaluate the international prevalence of ASCVD in RA patients and to audit the prevalence and control of CVD risk factors....

Objective To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). Methods An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professional...

Objective To evaluate the effect of an intervention to improve disease activity-based management of RA in daily clinical practice by addressing patient level barriers. Methods The DAS-pass strategy aims to increase patients’ knowledge about DAS28 and to empower patients to be involved in treatment (decisions). It consists of an informational leafl...

Aims: To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions. Further to evaluate the management and goal attainment of lipids and blood pressure (BP). Methods and results: The SUrvey of CVD Risk Factors in patients with RA was conducted in 14503 patients from 19...

Aim The objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention....

Objective: The systematic development of an intervention to improve disease activity-based management of rheumatoid arthritis (RA) in daily clinical practice that is based on patient-level barriers. Methods: The self-management strategy was developed through a step-wise approach, in a process of co-design with all stakeholders and by addressing pat...

Objectives We aimed to evaluate the use of an eHealth platform and a self-management outpatient clinic in patients with rheumatoid arthritis (RA) in a real-world setting. The effect on healthcare utilization and disease activity were studied. Methods Using hospital data of patients with RA between 2014 and 2019, the use of an eHealth platform and...

Obesity is very common in patients with inflammatory rheumatic diseases (IRDs), of which between 27% and 37% of patients have a body mass index ≥30 kg/m ² . In addition to further increasing the risk of developing cardiovascular diseases (CVDs) in this group of patients, obesity is associated with higher disease activity and a lower response to dru...

Objective The market entry of biosimilars is expected to bring budgetary relief. Our objective was to determine how the introduction of biosimilars influences medication cost in patients with rheumatoid arthritis and which patients gain access to biologicals due to the availability of biosimilars. Methods Using hospital data of patients with rheum...

Background/Introduction The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. Purpose To describe differences in lipid...

Background The cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is comparable to that of patients with diabetes mellitus (DM). Although several studies have indicated high prevalence's of DM in RA patients, little is known about how this affects their CVD risk. Objectives To examine indications for, and use of antihyper...

Background Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD). Purpose The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA disease characteristics, RA and CVD preventive medication in patient with RA. Methods The audit is termed SUrvey of cardiovascular disease R...

Background: Despite treatment according to the current management recommendations, a significant proportion of patients with rheumatoid arthritis (RA) remain symptomatic. These patients can be considered to have 'difficult-to-treat RA'. However, uniform terminology and an appropriate definition are lacking. Objective: The Task Force in charge of...

Objectives: Self-monitoring the disease course is a relatively new concept in the management of patients with inflammatory rheumatic diseases (IRDs). The aims of this pilot study were to obtain patients' experiences with online self-monitoring, to assess information about the agreement between the disease course assessed with patient-reported outc...

Objective Study the effect of non-mandatory transitioning from etanercept originator to etanercept biosimilar on retention rates in a shared decision making-promoting setting. Methods In 2016 all patients treated with etanercept originator and stable disease at the Rheumatology department in Bernhoven were offered transitioning to etanercept biosi...

Objectives To develop two Disease and treatment related Knowledge about Rheumatoid Arthritis (DataK-RA) short forms using item response theory based linear optimal test design. Methods We used the open source excel add in “solver” to program a linear optimization algorithm to develop two short forms from the DataK-RA item bank. The algorithm was i...

Background The cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is comparable to that of patients with diabetes mellitus (DM). Although several studies have indicated high prevalences of glucose intolerance and DM in RA patients, little is known about how this affects their CVD risk. Objectives To examine indications fo...

Background The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. In subjects with coronary heart disease (CHD), audits o...

Background Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD). Observational data suggest a need for improved risk factor recording and management in such subjects. Objectives The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA and CVD preventive medication in pat...

Background: In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD...

The aim was to study the different strategies used to implement cardiovascular risk evaluation and management for patients with rheumatoid arthritis (RA) in daily clinical practice. A questionnaire survey was performed among both the members of the international Trans-Atlantic Cardiovascular Risk Consortium for Rheumatoid Arthritis (ATACC-RA) as we...

To re-evaluate the adherence to clinical practice guidelines recommended disease activity–based management of rheumatoid arthritis (RA) in daily clinical practice, among Dutch rheumatologists in the past decade. In 2007, disease activity was measured in only 16% of outpatient visits. All rheumatologists that participated in the 2007 study were invi...

Objectives: Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods: Disease characteristics, CVD risk factors and rele...

Background: The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Methods: Post-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disea...

Background For individuals with rheumatic diseases, it is important to be sufficiently physically active. Several standardized exercise programs have been developed for patients with rheumatic diseases, that have proven to be effective in increasing physical activity level for a short period of time or only in a selection of the patients. A more pe...

Background Smoking is a major risk factor for development of both cardiovascular disease (CVD) and rheumatoid arthritis (RA) and causes an attenuated response to antirheumatic treatment. Objectives The aim of this study was to compare disease activity and CVD risk factors across smoking status in RA patients. Further to evaluate the impact of smok...

These days, the use of biosimilars for the treatment of bio-naive patients is well established. However, the transition of patients being treated with a bio-originator to its biosimilar is still a topic of discussion. The main issue is which approach to use when initiating the non-medical transition. The first real-world examples contain both manda...

The shift from a paternalistic model of health care to a doctor-patient relationship in which the doctor and patient make shared decisions, requires an actively involved patient who takes responsibilities. This is why self-management by the patient with a chronic disease plays more of an important role in patient care nowadays; however, the degree...

Objectives We sought to investigate whether genetic effects on response to TNF inhibitors (TNFi) in rheumatoid arthritis (RA) could be localised by considering known genetic susceptibility loci for relevant traits and to evaluate the usefulness of these genetic loci for stratifying drug response. Methods We studied the relation of TNFi response, q...

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 assess...

Objective: To establish whether serum adalimumab (ADA) trough level (ADA-TL) and antidrug antibody (ADA-ab) level predict flare after stopping ADA in established RA patients with long-standing low disease activity. Methods: From the clinical trial Potential Optimalisation and Effectiveness of TNF-blockers, 210 RA patients stopping ADA, who had b...

Objective: This study evaluates exercise participation in patients with rheumatoid arthritis (RA) and the percentage of patients that meet the recommended level of physical activity (at least 150 minutes per week moderate-intensity physical activity) in two cross-sectional questionnaires in 2013 and 2016 in two Dutch RA cohorts. Methods: In 2013, a...

Patient-reported outcome measures (PROMs) are increasingly used in the assessment of patients with rheumatoid arthritis (RA). The aim of this study was to assess the construct validity and reproducibility of four types of PROMs (numerical rating scale (NRS), visual analogue scale (VAS), verbal rating scale (VRS), and Likert scale). In addition, pat...

Background For individuals with rheumatoid arthritis (RA), it is important to be sufficiently physically active. The international recommendation for physical activity states that each adult should perform moderate-intensity aerobic physical activity for at least 30 min, five days a week. In recent years, attention and awareness of the importance o...

Background The updated EULAR cardiovascular risk management (CVRM) guideline recommends cardiovascular disease risk assessment at least once every five years in all patients with rheumatoid arthritis (RA).¹ A literature search indicates that this guideline is marginally applied in clinical practice.² An important factor explaining dissimilarities i...

Background Within the field of rheumatoid arthritis (RA), patients report decreased health-related quality of life (HRQoL) as a result of living with physical factors such as pain and psychological factors such as negative mood. As these factors are associated with the disease trajectory, health care utilisation, and workplace disability of patient...

Background Inflammatory rheumatic diseases (IRDs) such as Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA) are characterised by a fluctuating disease course. Because of these fluctuations, the disease activity in between outpatient visits can be different from the disease activity objectively measured at outpatient visits. In order to captur...

Background Rheumatoid arthritis (RA) patients are at high risk of cardiovascular disease (CVD). Risk age estimations are recommended as adjuncts to assessment of absolute 10 year risk of fatal CVD events. Two risk age models based on the Systematic Coronary Risk Evaluation (SCORE) algorithm have been developed; the cardiovascular risk age and the v...

Background Patient education can be used to support and enable people with Rheumatoid Arthritis (RA) to optimise health and wellbeing. It has been recommended as an integral part in management of RA in order to undertake self-management activities or to adhere to treatments. Disease-specific knowledge can be measured with a Patient Knowledge Questi...

Background Over the past 15 years, there has been a huge shift in the management of RA: the armamentarium has increased but also the way antirheumatic drug are being used has changed, e.g.treat to target. This has implications for how the communication between professional and patient needs to occur: hence shared decision making part of most guidel...

Background Regular and personalised monitoring of disease activity, physical activity, medication use and side effects is essential to improve and maintain patients’ health-related quality of life in spondyloartritis (SpA). Transparency on outcomes, safety, practice variation and efficiency of care are increasingly demanded. Furthermore, patient em...

Background Current guidelines say that there should be a prominent place for patient participation and shared decision making in rheumatic care. To achieve this Bernhoven introduced an online patient health record (OPHR) for patients with rheumatoid arthritis (RA) aiming to facilitate self management and giving insight in the individual disease cou...

Background Quantitative muscle ultrasound (QMUS) imaging has proven to be a useful, non-invasive technique to visualise normal and pathological skeletal muscle tissue.¹ Electromyography (EMG) findings are not always disease specific in patients suspected of idopathic inflammatory myopathies (IIM). Objectives To assess diagnostic value of QMUS in p...

Background With biological patents expiring, biosimilars are becoming a realistic, less costly alternative to their originator. The data from numerous randomised clinical trials support that it is safe, effective and cost saving to switch to a biosimilar. However, real world data about efficacy, safety, and cost-effectiveness of such a switch are l...

Objective Successfully stopping or reducing treatment for patients with rheumatoid arthritis (RA) in low disease activity (LDA) may improve cost-effectiveness of care. We evaluated the multi-biomarker disease activity (MBDA) score as a predictor of disease relapse after discontinuation of TNF inhibitor (TNFi) treatment. Methods 439 RA patients who...

Disease relapse by three criteria at 12 months for patients classified by baseline MBDA score excluding 26 patients with DAS28 ≥3.2 at baseline. (DOC)

Disease relapse by three criteria at 12 months for patients classified by baseline MBDA score for patients in DAS28 remission at baseline. (DOC)

Univariate associations between baseline variables and three definitions of disease relapse within 12 months in the stop group. (DOC)

Disease relapse by three criteria at 12 months for patients classified by baseline MBDA score in those patients included based on at least two available DAS28 scores <3.2 in the six months prior to inclusion. (DOC)

Univariate and multivariate analyses of high (>44) versus moderate or low baseline MBDA score as a predictor of disease relapse at 12 months. Sensitivity analysis with all patients with a missing visit (missing DAS28 score at 3, 6, 9 or 12 months) counted as a flare on all flare criteria. (DOC)

Objective To evaluate, from a societal perspective, the incremental cost‐effectiveness of withdrawing tumor necrosis factor inhibitors (TNFis) compared to continuation of these drugs within a one‐year randomized trial among patients with rheumatoid arthritis (RA) having longstanding stable disease activity or remission. Methods Data were collected...

Personalised medicine, new discoveries and studies on rare exposures or outcomes require large samples that are increasingly difficult for any single investigator to obtain. Collaborative work is limited by heterogeneities, both what is being collected and how it is defined. To develop a core set for data collection in rheumatoid arthritis (RA) res...

For patients with chronic pain conditions such as rheumatoid arthritis (RA), who experience elevated levels of distress, tailored guided internet-based cognitive-behavioral treatment may be effective in improving psychological and physical functioning, and reducing the impact of RA on daily life. A multicenter, randomized controlled trial was condu...

The updated European League Against Rheumatism (EULAR) guideline recommends cardiovascular disease (CVD) risk assessment at least once every 5 years in all patients with rheumatoid arthritis (RA). This viewpoint starts with a literature overview of studies that investigated the level of CVD risk factor (CVD-RF) screening in patients with RA in gene...

Chronic somatic conditions, such as psoriasis, arthritis psoriatica and rheumatoid arthritis, have a large impact on patients’ lives. Tailored therapist-guided internet-based cognitive-behavioural therapy (ICBT) has been shown to be effective in improving physical and psychological well-being in these patients. Two cases are presented here, in...

Objectives: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. Methods: In 13 rheumatology centres, data on CVD risk facto...

We read with interest the article by Yoshida and colleagues on the ability of muscle ultrasound for detecting of fasciitis among patients with dermatomyositis (DM) in the early phase of their disease (1). The authors used power Doppler ultrasonography to assess inflammation and vascularity of the fascia of different muscles.

Objective: To determine the impact of stopping tumor necrosis factor inhibitor (TNFi) treatment on patient-reported outcomes (PROs) of physical and mental health status, health utility, pain, disability and fatigue in patients with established rheumatoid arthritis (RA). Methods: In the pragmatic 12-month POET trial, 817 RA patients with ≥6 month...

Objective: To develop a Disease and treatment associated Knowledge in RA item bank (DataK-RA) based on item response theory. Methods: Initial items were developed from a systematic review. Rheumatology professionals identified relevant content trough a RAND modified Delphi scoring procedure and consensus meeting. RA patients provided additional...

Objective Systemic inflammation appears to contribute to the excess risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA). The objective of this study was to investigate the effect of different levels of disease activity over time, particularly low disease activity and remission, on CVD risk in patients with RA. Methods Data from the N...

Objective.: Ultrasonography (US) can be used for treatment decisions in RA patients. This study investigated the added value of US to clinical variables in predicting flare in RA patients with longstanding low disease activity when stopping TNF inhibitors (TNFi). Methods.: Cox models with and without using US added to clinical variables were dev...

To characterise the different types of pulmonary hypertension (PH) among idiopathic inflammatory myopathy (IIM). A retrospective case series with assessment of PH by right heart catheterisation, extent of interstitial lung disease (ILD) and outcome of vasoactive therapy.The group of patients with IIM with PH (n=9) showed a median age at PH diagnosi...

Background Baricitinib (BARI) is a selective inhibitor of Janus kinase,¹ improves disease activity in patients (pts) with rheumatoid arthritis (RA), and is associated with inhibition of structural joint damage.2–4 Response to BARI observed at week (wk) 4 may be useful to predict future response.⁵ Objectives To characterise pts with RA who achieved...

Background To reduce the risk of cardiovascular disease in rheumatoid arthritis (RA) patients, adequate cardiovascular risk management (CVRM) is necessary. CVRM implies assessment, treatment and monitoring of cardiovascular risk factors¹. The updated EULAR guideline states that cardiovascular risk assessment should be considered at least once every...

Background Rheumatoid Arthritis (RA) patients in the maintenance phase should be treated by escalating antirheumatics up to stable low disease activity and then often are treated with tumor necrosis factor inhibitors (TNFi) and conventional synthetic disease modifyers (csDMARD). Once this phase has been reached the risk of flare is an issue once dr...

Background While practical guidelines and recommendations play an important role in the treatment of RA, rheumatologists often tend to deviate from these guidelines (1). This may result in disparity of quality of care among individual doctors and hospitals. To establish the best possible care, quality measures are needed. These aim to quantify the...

Background In order to encourage patients to take an active role in their disease management and to enhance the dialogue between patients and healthcare providers, iMonitor was developed.¹ iMonitor is a Software Medical Device developed and funded by Pfizer. Patients can complete patient-reported outcome measures (PROMs) in this online system. This...

Background Since the disease activity of patients with RA tends to fluctuate between visits and disease flares are easily missed during regular visits, patients might benefit from a more closely spaced determination of disease activity, which could be realised by iMonitor¹. iMonitor is a Software Medical Device developed and funded by Pfizer. This...

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Objectives: A comprehensive review was performed to investigate the effect of route of administration on medication adherence and persistence in rheumatoid arthritis (RA) and to compare adherence/persistence with oral medications between RA and a non-painful disease (dyslipidaemia). Research design and methods: Comprehensive database searches were...

Objective Cardiovascular disease (CVD) risk calculators designed for use in the general population do not accurately predict the risk of CVD among patients with rheumatoid arthritis (RA), who are at increased risk of CVD. The process of developing risk prediction models involves numerous issues. Our goal was to develop a CVD risk calculator for pat...

Objectives.: Cardiovascular disease (CVD) risk calculators developed for the general population do not accurately predict CVD events in patients with RA. We sought to externally validate risk calculators recommended for use in patients with RA including the EULAR 1.5 multiplier, the Expanded Cardiovascular Risk Prediction Score for RA (ERS-RA) and...

Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recom...

Patients with rheumatoid arthritis (RA) are at higher risk of developing cardiovascular diseases (CVD). Interleukin (IL)-32 has previously been shown to be involved in the pathogenesis of RA and might be linked to the development of atherosclerosis. However, the exact mechanism linking IL-32 to CVD still needs to be elucidated. The influence of a f...

Objectives: To explore patterns of real-world early RA (ERA) care across countries. Methods: An online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and t...

For patients with chronic pain conditions such as rheumatoid arthritis (RA), who experience elevated levels of distress, tailored guided internet-based cognitive behavioral treatment may be effective in improving psychological and physical functioning, and reducing impact the impact of RA on daily life. A multicenter randomized controlled trial was...

Several studies have shown that the cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is underestimated.

The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-co...

Treating to target by monitoring disease activity and adjusting therapy to attain remission or low disease activity has been shown to lead to improved outcomes in chronic rheumatic diseases such as rheumatoid arthritis and spondyloarthritis. Patient-reported outcomes, used in conjunction with clinical measures, add an important perspective of disea...

Objectives: Gout is associated with cardiovascular diseases, and systemic inflammation has a role in this. CXCL8 (interleukin 8) levels were increased in synovial fluid of gout patients, and in serum in gout patients irrespective of their disease activity. We hypothesized that the well-known cardiovascular protective effects of allopurinol could b...

In rheumatoid arthritis (RA), disease activity cannot be measured in all individual patients according to a single variable. The Disease Activity Score (DAS) and the DAS28 have been developed to measure disease activity in RA both in daily clinical practice as well as in clinical trials on a group as well as individual level. The DAS/DAS28 is a con...

Objective: Studies on mortality associated with patients with systemic sclerosis (SSc) and myopathy have been limited by heterogeneous definitions of muscle involvement. The objective of this study is to determine whether homogeneous-defined SSc/polymyositis overlap (SSc-PM overlap) is associated with a worse survival rate compared with SSc withou...

Objective: To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other...

Patient assessment of disease activity in rheumatoid arthritis (RA) may be useful in clinical practice, offering a patient-friendly, location independent, and a time-efficient and cost-efficient means of monitoring the disease. The objective of this study was to identify patient-reported outcome measures (PROMs) to assess disease activity in RA and...

Background Poor compliance with drugs for rheumatoid arthritis (RA) can lead to treatment failure, delayed recovery, disease progression and a need for more aggressive therapy. Understanding factors associated with poor compliance has potential to improve treatment outcomes. Objectives A comprehensive review was performed to investigate: the effec...