Franciscus Hospital

Roosendaal, Netherlands

Franciscus Hospital

Roosendaal, Netherlands

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Heimans L.,Leiden University | Wevers-de Boer K.V.C.,Leiden University | Visser K.,Leiden University | Goekoop R.J.,Haga Hospital | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objectives To assess which treatment strategy is most effective in inducing remission in early (rheumatoid) arthritis. Methods 610 patients with early rheumatoid arthritis (RA 2010 criteria) or undifferentiated arthritis (UA) started treatment with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (Disease Activity Score <1.6 after 4 months) tapered prednisone to zero and those with persistent remission after 8 months, tapered and stopped MTX. Patients not in early remission were randomised to receive either MTX plus hydroxychloroquine plus sulfasalazine plus low-dose prednisone (arm 1) or to MTX plus adalimumab (ADA) (arm 2). If remission was present after 8 months both arms tapered to MTX monotherapy; if not, arm 1 changed to MTX plus ADA and arm 2 increased the dose of ADA. Remission rates and functional and radiological outcomes were compared between arms and between patients with RA and those with UA. Results 375/610 (61%) patients achieved early remission. After 1 year 68% of those were in remission and 32% in drug-free remission. Of the randomised patients, 25% in arm 1 and 41% in arm 2 achieved remission at year 1 (p<0.01). Outcomes were comparable between patients with RA and those with UA. Conclusions Initial MTX and prednisone resulted in early remission in 61% of patients with early (rheumatoid) arthritis. Of those, 68% were in remission and 32% were in drug-free remission after 1 year. In patients not in early remission, earlier introduction of ADA resulted in more remission at year 1 than first treating with disease-modifying antirheumatic drug combination therapy plus prednisone.


Wevers-De Boer K.,Leiden University | Visser K.,Leiden University | Heimans L.,Leiden University | Ronday H.K.,HAGA Hospital | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Aim: Classifying more patients as rheumatoid arthritis (RA) (2010 American College of Rheumatology/European League Against Rheumatism criteria for RA) may improve treatment outcomes but may cause overtreatment in daily practice. The authors determined the efficacy of initial methotrexate (MTX) plus prednisone treatment in patients with 1987 or 2010 classified RA and undifferentiated arthritis (UA). Method: 610 recent onset RA or UA patients started with MTX 25 mg/week and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks. Percentage remissions after 4 months were compared between RA (1987 or 2010 criteria) and UA. Predictors for remission were identified. Results: With the 2010 criteria, 19% more patients were classified as RA than with the 1987 criteria, but similar remission rates were achieved: 291/479 (61%) 2010 classified RA and 211/264 (58%) 1987 classified RA patients (p=0.52), and 79/122 (65%) UA patients (p=0.46). Anticitrullinated protein antibodies (ACPA) positive RA patients achieved more remission (66%) than ACPA negative RA patients (51%, p=0.001), but also had a lower mean baseline Disease Activity Score (DAS) (3.2 vs 3.6, p<0.001). Independent predictors for remission were male sex, low joint counts, DAS and Health Assessment Questionnaire, low body mass index and ACPA positivity. Conclusion: Initial treatment with MTX and a tapered high dose of prednisone results in similarly high remission percentages after 4 months (about 60%) in RA patients, regardless of fulfilling the 1987 or 2010 criteria, and in UA patients. Independent predictors indicate that initiating treatment while disease activity is relatively low results in more remission.


Franken M.,Atrium Medical | Franken M.,Franciscus Hospital | Grimm B.,Atrium Medical | Heyligers I.,Atrium Medical
Journal of Bone and Joint Surgery - Series B | Year: 2010

We have investigated the accuracy of the templating of digital radiographs in planning total hip replacement using two common object-based calibration methods with the ball placed laterally (method 1) or medially (method 2) and compared them with two non-object-based methods. The latter comprised the application of a fixed magnification of 121% (method 3) and calculation of magnification based on the object-film-distance (method 4). We studied the post-operative radiographs of 57 patients (19 men, 38 women, mean age 73 years (53 to 89)) using the measured diameter of the prosthetic femoral head and comparing it with the true value. Both object-based methods (1 and 2) produced large errors (mean/maximum: 2.55%/17.4% and 2.04%/6.46%, respectively). Method 3 applying a fixed magnification and method 4 (object-film-distance) produced smaller errors (mean/maximum 1.42%/5.22% and 1.57%/ 4.24%, respectively; p < 0.01). The latter results were clinically relevant and acceptable when planning was allowed to within one implant size. Object-based calibration (methods 1 and 2) has fundamental problems with the correct placement of the calibration ball. The accuracy of the fixed magnification (method 3) matched that of object-film-distance (method 4) and was the most reliable and efficient calibration method in digital templating. ©2010 British Editorial Society of Bone and Joint Surgery.


Visser K.,Leiden University | Goekoop-Ruiterman Y.P.M.,HAGA Hospital | De Vries-Bouwstra J.K.,VUMC | Ronday H.K.,HAGA Hospital | And 5 more authors.
Annals of the Rheumatic Diseases | Year: 2010

Objectives: To develop a matrix model for the prediction of rapid radiographic progression (RRP) in subpopulations of patients with recent-onset rheumatoid arthritis (RA) receiving different dynamic treatment strategies. Methods: Data from 465 patients with recent-onset RA randomised to receive initial monotherapy or combination therapy were used. Predictors for RRP (increase in Sharp-van der Heijde score ≥5 after 1 year) were identified by multivariate logistic regression analysis. For subpopulations, the estimated risk of RRP per treatment group and the number needed to treat (NNT) were visualised in a matrix. Results: The presence of autoantibodies, baseline C-reactive protein (CRP) level, erosion score and treatment group were significant independent predictors of RRP in the matrix. Combination therapy was associated with a markedly reduced risk of RRP. The positive and negative predictive values of the matrix were 62% and 91%, respectively. The NNT with initial combination therapy to prevent one patient from RRP with monotherapy was in the range 2-3, 3-7 and 7-25 for patients with a high, intermediate and low predicted risk, respectively. Conclusion: The matrix model visualises the risk of RRP for subpopulations of patients with recent-onset RA if treated dynamically with initial monotherapy or combination therapy. Rheumatologists might use the matrix for weighing their initial treatment choice.


Bergmans A.M.C.,Franciscus Hospital | Bergmans A.M.C.,Amphia Hospital | Rossen J.W.A.,St Elisabeth Hospital
Methods in Molecular Biology | Year: 2013

Bartonella henselae is the causative agent of cat-scratch disease (CSD), usually presenting itself as a -self-limiting lymphadenopathy. In this chapter an internally controlled Taqman probe-based real-time PCR targeting the groEL gene of Bartonella spp. is described. This assay allows for the rapid, sensitive, and simple detection of Bartonella spp. in samples from CSD or endocarditis suspects, and it is suitable for implementation in the diagnostic microbiology laboratory. © 2013 Springer Science+Business Media, LLC.


Hofstra J.M.,Radboud University Nijmegen | Branten A.J.W.,Radboud University Nijmegen | Wirtz J.J.J.M.,Laurentius Hospital | Noordzij T.C.,Franciscus Hospital | And 2 more authors.
Nephrology Dialysis Transplantation | Year: 2010

Background. Immunosuppressive therapy in idiopathic membranous nephropathy (iMN) is debated. Accurate identification of patients at high risk for end-stage renal disease (ESRD) allows early start of therapy in these patients. It is unknown if early start of therapy is more effective andor less toxic than late start (i.e. when GFR deteriorates).Methods. We conducted a randomized open-label study in patients with iMN, a normal renal function and a high risk for ESRD (urinary β2m >0.5 μgmin, UIgG >125 mg day). Patients started with immunosuppressive therapy (cyclophosphamide for 12 months, and steroids) either immediately after randomization or when renal function deteriorated (ΔsCr ≥+25 and sCr >135 μmoll or ΔsCr ≥+50). End points were remission rates, duration of the nephrotic syndrome (NS), renal function and complications.Results. The study included 26 patients (24 M2 F), age 48 ± 12 years; sCr 96 μmoll (range 68-126) and median proteinuria 10.0 g10 mmol Cr. Early treatment resulted in a more rapid onset of remission (P = 0.003) and a shorter duration of the NS (P = 0.009). However, at the end of the follow-up (72 ± 22 m), there were no differences in overall remission rate, sCr (93 versus 105 μmoll), proteinuria, relapse rate and adverse events.Conclusions. In high-risk patients with iMN, immunosuppressive treatment is effective in inducing a remission. Early treatment shortens the duration of the nephrotic phase, but does not result in better preservation of renal function. Our study indicates that treatment decisions must be based on risk and benefit assessment in the individual patient.


Klarenbeek N.B.,Leiden University | Guler-Yuksel M.,Leiden University | Van Der Kooij S.M.,Leiden University | Han K.H.,Maasstad Hospital | And 6 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objective To compare clinical and radiological outcomes of four dynamic treatment strategies in recent-onset rheumatoid arthritis (RA) after 5 years follow-up. Methods 508 patients with recent-onset RA were randomly assigned into four treatment strategies: sequential monotherapy; step-up combination therapy; initial combination with prednisone; initial combination with infliximab. Treatment adjustments were made based on 3-monthly disease activity score (DAS) measurements (if DAS >2.4 next treatment step; if DAS ≤2.4 during ≥6 months taper to maintenance dose; if DAS <1.6 during ≥6 months stop antirheumatic treatment). Primary and secondary outcomes were functional ability, joint damage progression, health-related quality of life and (drug-free) remission percentages. Results After 5 years, 48% of patients were in clinical remission (DAS <1.6) and 14% in drug-free remission, irrespective of initial treatment. After an earlier improvement in functional ability and quality of life with initial combination therapy, from 1 year onwards clinical outcomes were comparable across the groups and stable during 5 years. The initial combination groups showed less joint damage in year 1. In years 2-5 annual progression was comparable across the groups. After 5 years, initial combination therapy resulted in significantly less joint damage progression, reflecting the earlier clinical response. Conclusion Irrespective of initial treatment, an impressive improvement in clinical and radiological outcomes of RA patients can be achieved with dynamic treatment aimed at reducing disease activity, leading to 48% remission, 14% drug-free remission and sustained functional improvement. Starting with combination therapy resulted in earlier clinical improvement and less joint damage without more toxicity.


Bergmans A.M.C.,Franciscus Hospital | van der Ent M.,Franciscus Hospital | Klaassen A.,Franciscus Hospital | Bohm N.,Franciscus Hospital | And 2 more authors.
Clinical Microbiology and Infection | Year: 2010

We developed a dermatophyte-specific single-tube real-time PCR assay based on internal transcribed sequences. This assay allows the rapid detection and identification of 11 clinically relevant species within the three dermatophyte genera Trichophyton, Microsporum and Epidermophyton in nail, skin and hair samples within a few hours. Analysis of 145 clinical samples (107 nail, 36 skin scale, and two hair) by both real-time PCR and a PCR-reverse line blot (PCR-RLB) assay described earlier revealed that 133 of the 145 samples had concordant real-time PCR and PCR-RLB detection results (83 positive, 49 negative, and one inhibited). Six samples were positive by real-time PCR and negative by PCR-RLB, and two were negative by real-time PCR and positive by PCR-RLB. Four samples demonstrated inhibition in one of the two PCR assays. Only one of 83 positive samples had discordant identification results between both assays (Trichophyton verrucosum and Trichophyton erinacei by real-time PCR and Trichophyton erinacei by PCR-RLB). Dermatophytes present in seven positive samples that were incompletely identified as Trichophyton sp. by PCR-RLB were identified to the species level by real-time PCR as Trichophyton interdigitale and Trichophyton rubrum in six cases and one case, respectively. One hundred and twenty of 145 samples were also analysed by conventional dermatophyte culture and by direct microscopy. Our single-tube real-time PCR assay proved to be suitable for direct detection and identification of dermatophytes in nail, skin and hair samples with minimal total assay time (4 h after overnight lysis) and hands-on time, without the need for post-PCR analysis, and with good sensitivity and specificity. © 2009 The Authors. Journal Compilation.


Van Tellingen C.,Franciscus Hospital
International Journal of Cardiology | Year: 2011

Symptomatic cardiac arrhythmias are a very disturbing sign to well-trained athletes, warranting prompt diagnosis and therapy, preferably not interfering with their physical performance at the time. A case is presented where exercise induced atrial flutter occurred in the aftermath of a viral infection. Basic tools like holter-monitoring and a heart-rate meter provided insight and understanding. Arrhythmia management really is a joint venture between athlete and physician to provide a tailor-made solution, using interventional techniques, cardiovascular conditioning and sometimes a pharmaceutical agent, all together carefully auto-monitored. © 2009 Elsevier Ireland Ltd. All rights reserved.


van Tellingen C.,Franciscus Hospital
International Journal of Cardiology | Year: 2010

In today's medicine ultrasound and imaging are dominant features. As a consequence a tactile maneuver like palpation of the pulse became something like a relic from the past, rather trivial and habitual but certainly not an activity to be haughty about in terms of skill and professional development. Nevertheless medical history tells a complete different story and rehabilitation of the pulse lore is highly desirable as a tool with sense and simplicity, reassuring when possible but for all as an inexpensive and accessible instrument with a substantial diagnostic yield. © 2008 Elsevier Ireland Ltd. All rights reserved.

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