Copenhagen Center for Arthritis Research

Copenhagen, Denmark

Copenhagen Center for Arthritis Research

Copenhagen, Denmark
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Glinatsi D.,Copenhagen Center for Arthritis Research | Baker J.F.,Corporal Michael escenz Va Medical Center | Hetland M.L.,Copenhagen Center for Arthritis Research | Hetland M.L.,Copenhagen University | And 20 more authors.
Annals of the Rheumatic Diseases | Year: 2017

Objectives To examine whether MRI assessed inflammation and damage in the wrist of patients with early rheumatoid arthritis (RA) are associated with patient-reported outcomes (PRO s). Methods Wrist and hand MRIs of 210 patients with early RA from two investigator-initiated, randomised controlled studies (CIMESTR A/OP ERA) were assessed according to the Outcome Measures in Rheumatology RA MRI score (RAMRIS) for synovitis, tenosynovitis, osteitis, bone erosions and joint space narrowing (JSN) at baseline, 1 and 5 years follow-up. These features, and changes therein, were assessed for associations with health assessment questionnaires (HAQ), patient global visual analogue scales (VAS-PtGlobal) and VAS-pain using Spearman's correlations, generalised estimating equations and univariate/multivariable linear regression analyses. MRI features were further tested for trends against specific hand-related HAQ items using Jonckheere trend tests. Results MRI inflammation, but not damage, showed statistically significant associations with HAQ, VASPtGlobal and VAS-pain for status and change scores, independently of C reactive protein and swollen joint count. MRI-assessed synovitis was most consistently associated with PRO s, particularly VAS-PtGlobal and VAS-pain. MRI-assessed synovitis and tenosynovitis mean scores were positively associated with patientreported difficulty to cut meat and open a milk carton (p<0.01), and similar patterns were seen for other hand-related HAQ items. Incorporating metacarpophalangeal joints in the analyses did not strengthen the associations between MRI pathology and PRO s. Conclusions MRI-assessed inflammation, but not damage, in early RA wrists is associated with patientreported physical impairment, global assessment of disease activity and pain and influences the physical function in the hand. Trial registration number NCT00660647. © 2017.


De Thurah A.,Aarhus University Hospital | De Thurah A.,University of Aarhus | Esbensen B.A.,Copenhagen Center for Arthritis Research | Esbensen B.A.,Copenhagen University | And 3 more authors.
RMD Open | Year: 2017

Objective To compare the efficacy of embedded nurse-led versus conventional physician-led follow-up on disease activity in patients with rheumatoid arthritis (RA). Methods In a systematic literature search, we identified randomised controlled trials (RCTs) reporting on the efficacy of nurse-led follow-up on disease control in patients with RA compared with physician-led follow-up. Primary outcome was disease activity indicated by Disease Activity Score (DAS)-28. Secondary outcomes were: patient satisfaction, physical disability, fatigue, self-efficacy and quality of life. Outcomes were assessed after 1-year and 2 year follow-ups. Results Seven studies representing five RCTs, including a total of 723 participants, were included. All but one study included stable patients in low disease activity or remission at baseline. No difference in DAS-28 was found after 1 year (mean difference (MD) a '0.07 (95% CI a '0.23 to 0.09)). After 2 years, a statistically significant difference was seen in favour of nurse-led follow-up (MD a '0.28 (95% CI a '0.53 to a '0.04)). However, the difference did not reach a clinically relevant level. No difference was found in patient satisfaction after 1 year (standard mean difference (SMD) a '0.17 (95 % CI a '1.0 to 0.67), whereas a statistical significant difference in favour of nurse-led follow-up was seen after 2 years (SMD: 0.6 (95% CI-0.00 to 1.20)). Conclusion After 1 year no difference in disease activity, indicated by DAS-28, were found between embedded nurse-led follow-up compared with conventional physician-led follow-up, in RA patients with low disease activity or remission. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved.


Glintborg B.,Copenhagen Center for Arthritis Research | Glintborg B.,Glostrup Hospital | Gudbjornsson B.,Reykjavik University | Gudbjornsson B.,University of Iceland | And 15 more authors.
Rheumatology (United Kingdom) | Year: 2014

Objective. The aim of this study was to describe dose regimens, dose escalation and clinical outcomes in TNF-a inhibitor (TNFi)-naive patients with PsA treated with infliximab in routine rheumatology care. Methods. We conducted an observational cohort study based on the nationwide Danish Rheumatologic Database (DANBIO) and Center for Rheumatology Research (ICEBIO) registries. Stratified by country, characteristics of patients treated with ≤3mg infliximab/kg body weight, 3-5 mg/kg or ≥5 mg/kg every 8 weeks were described. Outcomes were evaluated by ACR 20%, 50% and 70% (ACR20/50/70) responses and European League Against Rheumatism good response after 6 months, disease activity after 12 months, Kaplan-Meier plots and regression analyses. Results. Four hundred and sixty-two patients (376 Danish, 86 Icelandic) received treatment with infliximab. In Danish patients, the starting dose was ≤3mg/kg in 110 patients (29%), 3-5mg/kg in 157 (42%), ≥5mg/ kg in 38 (10%) and unregistered in 71 (19%). In Icelandic patients, corresponding numbers were 64 (74%), 17 (27%), 0 (0%) and 5 (6%). Patients with a higher body weight received lower doses per kilogram. Danish patients received higher doses than Icelandic patients at baseline [median 3.1 (interquartile range 3.0-3.8) vs 2.3 (2.1-2.9) mg/kg, P<0.05] and after 12 months [3.3 (3.0-4.5) vs 2.9 (2.2-3.5) mg/kg, P<0.0001]. After 12 months, 58% of Danish and 66% of Icelandic patients maintained treatment. Danish patients had shorter drug survival than Icelandic patients (1183 vs 483 days). In univariate analyses stratified by country, time until dose escalation, response rates, drug survival and 1-year's disease activity were independent of starting dose. Drug survival was shorter among patients not receiving concomitant MTX. Conclusion. In clinical practice,>70% of Icelandic and Danish PsA patients treated with infliximab received sustained doses below the 5 mg/kg every 8 weeks recommended in international guidelines. Lower starting doses did not affect drug survival or response. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.


PubMed | Stanford University, Amsterdam Rheumatology & Immunology Center, University of California at Los Angeles, The Doctors of Saint Johns Medical Group and 4 more.
Type: | Journal: Annals of the rheumatic diseases | Year: 2016

In rheumatoid arthritis (RA), MRI provides earlier detection of structural damage than radiography (X-ray) and more sensitive detection of intra-articular inflammation than clinical examination. This analysis was designed to evaluate the ability of early MRI findings to predict subsequent structural damage by X-ray.Pooled data from four randomised controlled trials (RCTs) involving 1022 RA hands and wrists in early and established RA were analysed. X-rays were scored using van der Heijde-modified or Genant-modified Sharp methods. MRIs were scored using Outcome Measures in Rheumatology (OMERACT) RA MRI Score (RAMRIS). Data were analysed at the patient level using multivariable logistic regression and receiver operating characteristic curve analyses.Progression of MRI erosion scores at Weeks 12 and 24 predicted progression of X-ray erosions at Weeks 24 and 52, with areas under the curve (AUCs) of 0.64 and 0.74, respectively. 12-week and 24-week changes in MRI osteitis scores were similarly predictive of 24-week and 52-week X-ray erosion progressions; pooled AUCs were 0.78 and 0.77, respectively. MRI changes in synovitis at Weeks 12 and 24 also predicted progression of X-ray joint damage (erosion and joint-space narrowing) at Weeks 24 and 52 (AUCs=0.72 and 0.65, respectively).Early changes in joint damage and inflammation detected with MRI predict changes in joint damage evident on subsequent X-rays. These findings support the use of MRI as a valid method for monitoring structural damage in short-duration RCTs.


Baker J.F.,University of Pennsylvania | Conaghan P.G.,University of Leeds | Emery P.,University of Leeds | Baker D.G.,Janssen Research & Development LLC | And 2 more authors.
Annals of the Rheumatic Diseases | Year: 2016

Purpose We assessed whether MRI measures of synovitis, osteitis and bone erosion were associated with patient-reported outcomes (PROs) in a longitudinal clinical trial setting among patients with rheumatoid arthritis (RA). Methods This longitudinal cohort of 291 patients with RA was derived from the MRI substudy of the GOBEFORE randomised controlled trial of golimumab among methotrexate-naïve patients. Correlations between RAMRIS scores (synovitis, osteitis, bone erosion) and physical function (Health Assessment Questionnaire (HAQ)), pain and global patient scores were determined at 0, 12, 24 and 52 weeks. Correlations between interval changes were also assessed. Multivariable regression models using robust generalised estimating equations evaluated associations over all time-points and their relationship to other clinical disease activity measures. Results Greater synovitis, osteitis and bone erosion scores were positively associated with HAQ at all timepoints (all p<0.05) and with pain and patient global scores at 24 and 52 weeks. Over all visits, synovitis was associated with HAQ, pain and patient global scores (p=0.03) independent of clinical disease activity measures. Improvements in synovitis and bone erosion were also associated with improvements in PROs. Less improvement in synovitis and progression in MRI erosion at 52 weeks were both independently associated with worsening in all PROs at 52 weeks while progression on X-ray was not associated. Similar associations were observed across treatment groups. Conclusions MRI measures of inflammation and structural damage correlate independently with physical function, pain and patient global assessments. These observations support the validity of MRI biomarkers. Trial registration number NCT00264537; Postresults. © 2016 BMJ Publishing Group Ltd & European League Against Rheumatism.


Jensen T.W.,Copenhagen University | Hansen M.S.,Copenhagen University | Horslev-Petersen K.,University of Southern Denmark | Hyldstrup L.,Copenhagen University | And 22 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objectives: The aims of this study were to investigate the influence of alendronate and intra-articular betamethasone treatment on bone mineral density (BMD) changes in hand, lumbar spine and femoral neck during 1 year of a treat-to-target study (Cyclosporine, Methotrexate, Steroid in RA (CIMESTRA)). Patients and methods A hundred and sixty patients with early, active rheumatoid arthritis (RA) received methotrexate, intra-articular betamethasone and ciclosporin /placebo-ciclosporin. Patients with Z-score ≤0 also started alendronate 10 mg/day. BMD of the hand (digital x-ray radiogrammetry (DXR-BMDhand)), BMD of lumbar spine and femoral neck (dual x-ray absorptiometry (DXA-BMDlumbar spine and DXA-BMD femoral neck)) and xrays of hands, wrists and forefeet (modified Sharp-van der Heijde score) were measured at baseline and 1 year, with complete data available in 107 patients. Results: The change in BMD in hand, lumbar spine and femoral neck was negatively associated with the dose of intra-articular betamethasone (p<0.01 for all), but the bone loss in hand was modest and in the axial skeleton comparable with that of healthy individuals. Alendronate did not influence changes in DXR-BMDhand, which averaged -2.8%, whereas significant changes were observed in DXA-BMDlumbar spine and DXA-BMDfemoral neck in alendronate-treated patients (1.8% and 0.8%) compared with untreated patients (-1.8% and -2.2%) (p<0.01 and 0.02). Alendronate did not affect the radiographic progression (alendronate-treated patients: 0 (range 0-19), non-alendronate: 0 (0-18)). Conclusions: In early active RA, intra-articular betamethasone injections added to disease-modifying antirheumatic drug (DMARD) treatment led to minimal loss of hip and lumbar BMD, and the loss could be prevented by treatment with alendronate. Alendronate treatment did not affect radiographic progression.


Arnbak B.,Hospital Lillebaelt | Arnbak B.,University of Southern Denmark | Hendricks O.,University of Southern Denmark | Hendricks O.,King Christian X Hospital for Rheumatic Diseases | And 17 more authors.
Scandinavian Journal of Rheumatology | Year: 2016

Objectives: To estimate the prevalence of inflammatory back pain (IBP) characteristics and analyse the discriminative value of IBP relative to axial spondyloarthritis (SpA) according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. Method: Patients who had low back pain for > 3 months were selected from a cohort of secondary care patients aged 18–40 years. Data included information on SpA features, human leucocyte antigen (HLA)-B27 typing, C-reactive protein (CRP) level, magnetic resonance imaging (MRI) of the sacroiliac joints, and self-reported IBP questions covering the pain characteristics included in the Calin, Berlin, and ASAS IBP definitions. Results: Of the 759 included patients, 99% [95% confidence interval (CI) 98–100] had at least one IBP characteristic. The prevalence of the single IBP characteristics ranged from 10% (95% CI 7–12) for ‘pain worst in the morning’ to 79% (95% CI 76–82) for ‘morning stiffness’. Two-thirds of the patients (67%, 95% CI 63–70), met at least one of the three IBP definitions. In all, 86 (11%) were classified as ‘SpA according to ASAS’. All three IBP definitions were significantly associated with ‘SpA according to ASAS’; however, the discriminative value was low, with sensitivity, specificity, and balanced accuracy values of 64, 50, and 57% for Calin, 59, 60, and 60% for Berlin, and 35, 79, and 57% for ASAS IBP definitions, respectively. Conclusions: In this study population, IBP characteristics were in general common and the discriminative value was low, as IBP could not differentiate patients with SpA according to ASAS criteria from patients with other causes of back pain. © 2016 Informa Healthcare on license from Scandinavian Rheumatology Research Foundation.


Tan Y.K.,Singapore General Hospital | Ostergaard M.,Copenhagen Center for Arthritis Research | Ostergaard M.,Copenhagen University | Bird P.,University of Sydney | Conaghan P.G.,University of Leeds
Clinical and Experimental Rheumatology | Year: 2014

Over the past decade there have been significant advances in the field of musculoskeletal imaging, especially in the application of ultrasound (US) and magnetic resonance imaging (MRI) to the management of rheumatoid arthritis (RA). Both modalities offer significant advantages over the previous standards of clinical examination and radiography, and allow direct visualisation of both joint inflammation and structural damage. Although measuring similar pathology, each of these imaging tools has its own benefits and limitations; understanding these will help researchers and clinicians to determine the appropriate role for these tools in RA joint assessment. This review article seeks to compare the usefulness of US and MRI in RA diagnosis, prognosis and outcome assessment. ©Clinical and Experimental Rheumatology 2014.

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