154 results on '"MacGregor, Alexander J."'
Search Results
2. Risk-adjusted CUSUM control charts for shared frailty survival models with application to hip replacement outcomes: a study using the NJR dataset
- Author
-
Begun, Alexander, Kulinskaya, Elena, and MacGregor, Alexander J
- Published
- 2019
- Full Text
- View/download PDF
3. Clarification from the National Joint Registry
- Author
-
MacGregor, Alexander J
- Published
- 2012
4. Multi-ancestry genome-wide association analyses identify novel genetic mechanisms in rheumatoid arthritis
- Author
-
Ishigaki, Kazuyoshi, Sakaue, Saori, Terao, Chikashi, Luo, Yang, Sonehara, Kyuto, Yamaguchi, Kensuke, Amariuta, Tiffany, Too, Chun Lai, Laufer, Vincent A., Scott, Ian C., Viatte, Sebastien, Takahashi, Meiko, Ohmura, Koichiro, Murasawa, Akira, Hashimoto, Motomu, Ito, Hiromu, Hammoudeh, Mohammed, Emadi, Samar Al, Masri, Basel K., Halabi, Hussein, Badsha, Humeira, Uthman, Imad W., Wu, Xin, Lin, Li, Li, Ting, Plant, Darren, Barton, Anne, Orozco, Gisela, Verstappen, Suzanne M. M., Bowes, John, MacGregor, Alexander J., Honda, Suguru, Koido, Masaru, Tomizuka, Kohei, Kamatani, Yoichiro, Tanaka, Hiroaki, Tanaka, Eiichi, Suzuki, Akari, Maeda, Yuichi, Yamamoto, Kenichi, Miyawaki, Satoru, Xie, Gang, Zhang, Jinyi, Amos, Christopher I., Keystone, Edward, Wolbink, Gertjan, van der Horst-Bruinsma, Irene, Cui, Jing, Liao, Katherine P., Carroll, Robert J., Lee, Hye-Soon, Bang, So-Young, Siminovitch, Katherine A., de Vries, Niek, Alfredsson, Lars, Rantapää-Dahlqvist, Solbritt, Karlson, Elizabeth W., Bae, Sang-Cheol, Kimberly, Robert P., Edberg, Jeffrey C., Mariette, Xavier, Huizinga, Tom, Dieudé, Philippe, Schneider, Matthias, Kerick, Martin, Denny, Joshua C., Matsuda, Koichi, Matsuo, Keitaro, Mimori, Tsuneyo, Matsuda, Fumihiko, Fujio, Keishi, Tanaka, Yoshiya, Kumanogoh, Atsushi, Traylor, Matthew, Lewis, Cathryn M., Eyre, Stephen, Xu, Huji, Saxena, Richa, Arayssi, Thurayya, Kochi, Yuta, Ikari, Katsunori, Harigai, Masayoshi, Gregersen, Peter K., Yamamoto, Kazuhiko, Louis Bridges, S., Padyukov, Leonid, Martin, Javier, Klareskog, Lars, Okada, Yukinori, Raychaudhuri, Soumya, Ishigaki, Kazuyoshi, Sakaue, Saori, Terao, Chikashi, Luo, Yang, Sonehara, Kyuto, Yamaguchi, Kensuke, Amariuta, Tiffany, Too, Chun Lai, Laufer, Vincent A., Scott, Ian C., Viatte, Sebastien, Takahashi, Meiko, Ohmura, Koichiro, Murasawa, Akira, Hashimoto, Motomu, Ito, Hiromu, Hammoudeh, Mohammed, Emadi, Samar Al, Masri, Basel K., Halabi, Hussein, Badsha, Humeira, Uthman, Imad W., Wu, Xin, Lin, Li, Li, Ting, Plant, Darren, Barton, Anne, Orozco, Gisela, Verstappen, Suzanne M. M., Bowes, John, MacGregor, Alexander J., Honda, Suguru, Koido, Masaru, Tomizuka, Kohei, Kamatani, Yoichiro, Tanaka, Hiroaki, Tanaka, Eiichi, Suzuki, Akari, Maeda, Yuichi, Yamamoto, Kenichi, Miyawaki, Satoru, Xie, Gang, Zhang, Jinyi, Amos, Christopher I., Keystone, Edward, Wolbink, Gertjan, van der Horst-Bruinsma, Irene, Cui, Jing, Liao, Katherine P., Carroll, Robert J., Lee, Hye-Soon, Bang, So-Young, Siminovitch, Katherine A., de Vries, Niek, Alfredsson, Lars, Rantapää-Dahlqvist, Solbritt, Karlson, Elizabeth W., Bae, Sang-Cheol, Kimberly, Robert P., Edberg, Jeffrey C., Mariette, Xavier, Huizinga, Tom, Dieudé, Philippe, Schneider, Matthias, Kerick, Martin, Denny, Joshua C., Matsuda, Koichi, Matsuo, Keitaro, Mimori, Tsuneyo, Matsuda, Fumihiko, Fujio, Keishi, Tanaka, Yoshiya, Kumanogoh, Atsushi, Traylor, Matthew, Lewis, Cathryn M., Eyre, Stephen, Xu, Huji, Saxena, Richa, Arayssi, Thurayya, Kochi, Yuta, Ikari, Katsunori, Harigai, Masayoshi, Gregersen, Peter K., Yamamoto, Kazuhiko, Louis Bridges, S., Padyukov, Leonid, Martin, Javier, Klareskog, Lars, Okada, Yukinori, and Raychaudhuri, Soumya
- Abstract
Rheumatoid arthritis (RA) is a highly heritable complex disease with unknown etiology. Multi-ancestry genetic research of RA promises to improve power to detect genetic signals, fine-mapping resolution and performances of polygenic risk scores (PRS). Here, we present a large-scale genome-wide association study (GWAS) of RA, which includes 276,020 samples from five ancestral groups. We conducted a multi-ancestry meta-analysis and identified 124 loci (P < 5 × 10−8), of which 34 are novel. Candidate genes at the novel loci suggest essential roles of the immune system (for example, TNIP2 and TNFRSF11A) and joint tissues (for example, WISP1) in RA etiology. Multi-ancestry fine-mapping identified putatively causal variants with biological insights (for example, LEF1). Moreover, PRS based on multi-ancestry GWAS outperformed PRS based on single-ancestry GWAS and had comparable performance between populations of European and East Asian ancestries. Our study provides several insights into the etiology of RA and improves the genetic predictability of RA.
- Published
- 2022
- Full Text
- View/download PDF
5. Predictors of and outcomes following orthopaedic joint surgery in patients with early rheumatoid arthritis followed for 20 years
- Author
-
Gwinnutt, James M., Symmons, Deborah P. M., MacGregor, Alexander J., Chipping, Jacqueline R., Lapraik, Chloe, Marshall, Tarnya, Lunt, Mark, and Verstappen, Suzanne M. M.
- Published
- 2017
- Full Text
- View/download PDF
6. Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery
- Author
-
Podmore, Bélène, Hutchings, Andrew, Skinner, John A, MacGregor, Alexander J, and van der Meulen, Jan
- Abstract
AIMS: Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. METHODS: In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality). RESULTS: Patients with comorbidities had a longer LOS and higher readmission and mortality rates than patients without. In hip arthroplasty patients with heart disease, for example, LOS was 1.20 days (95% confidence interval (CI) 1.15 to 1.25) longer and readmission rate was 1.52% (95% CI 1.34% to 1.71%) and mortality 0.19% (95% CI 0.15% to 0.23%) higher. Similar patterns were observed for knee arthroplasty patients. Patients without comorbidities reported large improvements in function (mean improvement OHS 21.3 (SD 9.91) and OKS 15.9 (SD 10.0)). Patients with comorbidities reported only slightly smaller improvements. In patients with heart disease, mean improvement in OHS was 0.39 (95% CI 0.27 to 0.51) and in OKS 0.56 (95% CI 0.45 to 0.67) less than in patients without comorbidities. There were no significant differences in EQ-5D improvement. CONCLUSION: Comorbidities were associated with small increases in adverse safety risks but they have little impact on pain or function in patients undergoing hip or knee arthroplasty. These results do not support restricting access to hip and knee arthroplasty for patients with common comorbidities. Cite this article: Bone Joint J 2021;103-B(1):56-64.
- Published
- 2021
7. Age Differences in Genetic and Environmental Variations in Stress-Coping During Adulthood: A Study of Female Twins
- Author
-
Hur, Yoon-Mi, MacGregor, Alexander J., Cherkas, Lynn, Williams, Frances M. K., and Spector, Tim D.
- Published
- 2012
- Full Text
- View/download PDF
8. Clinical and biomechanical factors associated with falls and rheumatoid arthritis: baseline cohort with longitudinal nested case–control study
- Author
-
Smith, Toby O, primary, Clarke, Celia, additional, Wells, Jacob, additional, Dainty, Jack R, additional, Watts, Laura, additional, Yates, Max, additional, Pomeroy, Valerie M, additional, Stanmore, Emma, additional, O’Neill, Terence W, additional, and Macgregor, Alexander J, additional
- Published
- 2021
- Full Text
- View/download PDF
9. Clinical and biomechanical factors associated with falls and rheumatoid arthritis: baseline cohort with longitudinal nested case–control study.
- Author
-
Smith, Toby O, Clarke, Celia, Dainty, Jack R, Watts, Laura, Yates, Max, Pomeroy, Valerie M, Stanmore, Emma, O'Neill, Terence W, and Macgregor, Alexander J
- Subjects
RHEUMATOID arthritis risk factors ,TORQUE ,PAIN ,RANGE of motion of joints ,GAIT in humans ,POSTURAL balance ,MULTIVARIATE analysis ,CASE-control method ,REGRESSION analysis ,SURVEYS ,PHYSICAL activity ,MATHEMATICAL variables ,ACCIDENTAL falls ,QUESTIONNAIRES ,DIAGNOSIS ,MUSCLE strength ,DESCRIPTIVE statistics ,BIOMECHANICS ,FATIGUE (Physiology) ,LONGITUDINAL method - Abstract
Objective To identify the clinical and biomechanical characteristics associated with falls in people with RA. Methods A total of 436 people ≥60 years of age with RA completed a 1 year prospective survey of falls in the UK. At baseline, questionnaires recorded data including personal and medical history, pain and fatigue scores, health-related quality of life (HRQoL), physical activity and medication history. The occurrence of falls wasmonitored prospectively over 12 months by monthly self-reporting. A nested sample of 30 fallers (defined as the report of one or more falls in 12 months) and 30 non-fallers was evaluated to assess joint range of motion (ROM), muscle strength and gait parameters. Multivariate regression analyses were undertaken to determine variables associated with falling. Results Compared with non-fallers (n = 236), fallers (n = 200) were older (P = 0.05), less likely to be married (P = 0.03), had higher pain scores (P < 0.01), experienced more frequent dizziness (P < 0.01), were frequently taking psychotropic medications (P = 0.02) and reported lower HRQoL (P = 0.02). Among those who underwent gait laboratory assessments, compared with non-fallers, fallers showed a greater anteroposterior (AP; P = 0.03) and medial-lateral (ML) sway range (P = 0.02) and reduced isokinetic peak torque and isometric strength at 60° knee flexion (P = 0.03). Fallers also showed shorter stride length (P = 0.04), shorter double support time (P = 0.04) and reduced percentage time in swing phase (P = 0.02) and in knee range of motion through the gait cycle (P < 0.01). Conclusion People with RA have distinct clinical and biomechanical characteristics that place them at increased risk of falling. Assessment for these factors may be important to offer more targeted rehabilitation interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
10. Dynamic early identification of hip replacement implants with high revision rates. Study based on the NJR data from UK during 2004-2012
- Author
-
Begun, Alexander, primary, MacGregor, Alexander J., additional, Pchejetski, Dmitri, additional, and Kulinskaya, Elena, additional
- Published
- 2020
- Full Text
- View/download PDF
11. Accessing health services for musculoskeletal diseases during early COVID-19 lockdown: Results from a UK population survey
- Author
-
Smith, Toby O, primary, Durrant, Karen, additional, Birt, Linda, additional, Belderson, Pippa, additional, Chipping, Jackie, additional, Yates, Max, additional, Tsigarides, Jordan, additional, Notley, Caitlin, additional, Naughton, Felix, additional, Shepstone, Lee, additional, and MacGregor, Alexander J, additional
- Published
- 2020
- Full Text
- View/download PDF
12. Variation and implications of treatment decisions in early rheumatoid arthritis: results from a nationwide cohort study
- Author
-
Yates, Mark, primary, MacGregor, Alexander J, additional, Ledingham, Jo, additional, Norton, Sam, additional, Bechman, Katie, additional, Dennison, Elaine M, additional, and Galloway, James B, additional
- Published
- 2019
- Full Text
- View/download PDF
13. Validity of a two-component imaging-derived disease activity score for improved assessment of synovitis in early rheumatoid arthritis
- Author
-
Hensor, Elizabeth M A, McKeigue, Paul, Ling, Stephanie F, Colombo, Marco, Barrett, Jennifer H, Nam, Jackie L, Freeston, Jane, Buch, Maya H, Spiliopoulou, Athina, Agakov, Felix, Kelly, Stephen, Lewis, Myles J, Verstappen, Suzanne M M, MacGregor, Alexander J, Viatte, Sebastien, Barton, Anne, Pitzalis, Costantino, Emery, Paul, Conaghan, Philip G, and Morgan, Ann W
- Subjects
rheumatoid arthritis ,musculoskeletal diseases ,DAS28 ,ultrasonography ,Clinical Science ,synovitis - Abstract
OBJECTIVES: Imaging of joint inflammation provides a standard against which to derive an updated DAS for RA. Our objectives were to develop and validate a DAS based on reweighting the DAS28 components to maximize association with US-assessed synovitis.METHODS: Early RA patients from two observational cohorts (n = 434 and n = 117) and a clinical trial (n = 59) were assessed at intervals up to 104 weeks from baseline; all US scans were within 1 week of clinical exam. There were 899, 163 and 183 visits in each cohort. Associations of combined US grey scale and power Doppler scores (GSPD) with 28 tender joint count and 28 swollen joint count (SJC28), CRP, ESR and general health visual analogue scale were examined in linear mixed model regressions. Cross-validation evaluated model predictive ability. Coefficients learned from training data defined a re-weighted DAS28 that was validated against radiographic progression in independent data (3037 observations; 717 patients).RESULTS: Of the conventional DAS28 components only SJC28 and CRP were associated with GSPD in all three development cohorts. A two-component model including SJC28 and CRP outperformed a four-component model (R2 = 0.235, 0.392, 0.380 vs 0.232, 0.380, 0.375, respectively). The re-weighted two-component DAS28CRP outperformed conventional DAS28 definitions in predicting GSPD (Δtest log-likelihood CONCLUSION: A score based on SJC28 and CRP alone demonstrated stronger associations with synovitis and radiographic progression than the original DAS28 and should be considered in research on pathophysiological manifestations of early RA. Implications for clinical management of RA remain to be established.
- Published
- 2019
14. Validity of a 2-component imaging-derived disease activity score for improved assessment of synovitis in early rheumatoid arthritis
- Author
-
Hensor, Elizabeth M A, McKeigue, Paul, Ling, Stephanie, Colombo, Marco, Barrett, Jennifer H, Nam, Jackie L., Freeston, Jane, Buch, Maya, Spiliopoulou, Athina, Agakov, Felix, Kelly, Stephen, Verstappen, Suzanne, MacGregor, Alexander J, Viatte, Sebastien, Barton, Anne, Pitzalis, Costantino, Emery, Paul, Conaghan, Philip G, and Morgan, Ann W
- Subjects
musculoskeletal diseases ,ResearchInstitutes_Networks_Beacons/MICRA ,Lydia Becker Institute ,Manchester Institute for Collaborative Research on Ageing ,ResearchInstitutes_Networks_Beacons/lydia_becker_institute_of_immunology_and_inflammation ,DAS28 ,ultrasonography ,Rheumatoid arthritis ,synovitis - Abstract
Objectives: Imaging of joint inflammation provides a standard against which to derive an updated disease activity score (DAS) for rheumatoid arthritis (RA). Our objectives were to develop and validate a DAS based on reweighting the DAS28 components to maximize association with ultrasound-assessed synovitis.Methods: Early RA patients from two observational cohorts (n=434 & n=117), and a clinical trial (n=59) were assessed at intervals up to 104 weeks from baseline; all ultrasound scans were within 1 week of clinical exam. There were 899, 163 and 183 visits in each cohort. Associations of combined ultrasound grey scale and power Doppler scores (GSPD) with TJC28 & SJC28, CRP, ESR, general health visual analogue scale were examined in linear mixed model regressions. Cross-validation evaluated model predictive ability; coefficients learned from training data defined a re-weighted DAS28 which was validated against radiographic progression in independent data (3037 observations; 717 patients).Results: Of the conventional DAS28 components only SJC28 and CRP were associated with GSPD in all three development cohorts. A 2-component model including SJC28 and CRP outperformed a 4-component model (R-squared 0.235, 0.392, 0.380 vs. 0.232, 0.380, 0.375 respectively). The re-weighted 2-component DAS28CRP outperformed conventional DAS28 definitions in predicting GSPD (Δtest log-likelihoodConclusion: A score based on SJC28 and CRP alone demonstrated stronger associations with synovitis and radiographic progression than the original DAS28 and should be considered in research on pathophysiological manifestations of early RA. Implications for clinical management of RA remain to be established.
- Published
- 2019
15. The Genetic Epidemiology of Joint Hypermobility: A Population Study of Female Twins
- Author
-
Hakim, Alan J., Cherkas, Lynn F., Grahame, Rodney, Spector, Tim D., and MacGregor, Alexander J.
- Published
- 2004
16. Structural, Psychological, and Genetic Influences on Low Back and Neck Pain: A Study of Adult Female Twins
- Author
-
MACGREGOR, ALEXANDER J., ANDREW, TOBY, SAMBROOK, PHILIP N., and SPECTOR, TIM D.
- Published
- 2004
17. The Association of Body Mass Index and Osteoarthritis of the Knee Joint: An Examination of Genetic and Environmental Influences
- Author
-
Manek, Nisha J., Hart, Deborah, Spector, Timothy D., and MacGregor, Alexander J.
- Published
- 2003
18. GENETIC EXPRESSION IN OSTEOARTHRITIS IS JOINT SPECIFIC NOT GENERALIZED: EVIDENCE FROM A RADIOGRAPHIC STUDY OF TWINS.
- Author
-
MacGregor, Alexander J, Antoniades, Leto, Andrew, Toby, Barber, Mathew J, Hunter, David, Hart, Deborah J, and Spector, Tim D
- Published
- 2001
19. THE GENETIC CONTRIBUTION TO RADIOGRAPHIC HIP OSTEOARTHRITIS IN WOMEN: Results of a Classic Twin Study
- Author
-
MacGREGOR, ALEXANDER J., ANTONIADES, LETO, MATSON, MATTHEW, ANDREW, TOBY, and SPECTOR, TIM D.
- Published
- 2000
20. A TWO-STAGE, GENOME-WIDE SCREEN FOR SUSCEPTIBILITY LOCI IN PRIMARY RAYNAUD’S PHENOMENON
- Author
-
SUSOL, ELENE, MacGREGOR, ALEXANDER J., BARRETT, JENNIFER H., WILSON, HELEN, BLACK, CAROL, WELSH, KEN, SILMAN, ALAN, OLLIER, BILL, and WORTHINGTON, JANE
- Published
- 2000
21. A COTWIN CONTROL STUDY OF THE RELATIONSHIP BETWEEN HIP OSTEOARTHRITIS AND BONE MINERAL DENSITY
- Author
-
ANTONIADES, LETO, MacGREGOR, ALEXANDER J., MATSON, MATHEW, and SPECTOR, TIM D.
- Published
- 2000
22. CHARACTERIZING THE QUANTITATIVE GENETIC CONTRIBUTION TO RHEUMATOID ARTHRITIS USING DATA FROM TWINS
- Author
-
MacGREGOR, ALEXANDER J., SNIEDER, HAROLD, RIGBY, ALAN S., KOSKENVUO, MARKKU, KAPRIO, JAAKKO, AHO, KIMMO, and SILMAN, ALAN J.
- Published
- 2000
23. Revision rates and postoperative mortality following total hip replacement in patients with rheumatoid compared to osteoarthritis: an analysis of data from the National Joint Registry for England, Wales and Northern Ireland
- Author
-
Miller, Laura L., Prieto-Alhambra, Daniel, Lea Trela-Larsen, Wilkinson, J. M., Clark, Emma, Blom, Ashley, and Macgregor, Alexander J.
- Published
- 2018
24. Revision rates and postoperative mortality following total knee replacement in patients with rheumatoid compared to osteoarthritis: an analysis of data from the National Joint Registry for England, Wales and Northern Ireland
- Author
-
Miller, Laura L., Prieto-Alhambra, Daniel, Lea Trela-Larsen, Wilkinson, J. M., Macgregor, Alexander J., and Blom, Ashley
- Published
- 2018
25. Have the 10-year outcomes of patients with early inflammatory arthritis improved in the new millennium compared with the decade before? Results from the Norfolk Arthritis Register
- Author
-
Gwinnutt, James M, Symmons, Deborah P M, MacGregor, Alexander J, Chipping, Jacqueline R, Marshall, Tarnya, Lunt, Mark, and Verstappen, Suzanne M M
- Subjects
Adult ,Male ,Adolescent ,early rheumatoid arthritis ,Kaplan-Meier Estimate ,Severity of Illness Index ,outcomes research ,Arthritis, Rheumatoid ,Disability Evaluation ,Young Adult ,Humans ,Registries ,Mortality ,Aged ,Aged, 80 and over ,Arthritis ,Clinical and Epidemiological Research ,Middle Aged ,Prognosis ,disability ,England ,Cardiovascular Diseases ,epidemiology ,Female ,Follow-Up Studies - Abstract
Objective To compare the 10-year outcome (disease activity, disability, mortality) of two cohorts of patients with inflammatory polyarthritis (IP) recruited 10 years apart. Methods Patients with IP were recruited to the Norfolk Arthritis Register from 1990 to 1994 (cohort 1 (C1)) and from 2000 to 2004 (cohort 2 (C2)). Demographic and clinical data were collected at baseline and at years 1, 2, 3, 5, 7 and 10. Longitudinal disease activity (swollen/tender 51 joint counts (SJC51/TJC51)) and disability (Health Assessment Questionnaire (HAQ)) were compared between the cohorts using population-average negative binomial regression and generalised estimating equation analysis, respectively. Risk of 10-year mortality was compared between cohorts using Cox models. Risk of cardiovascular disease (CVD) mortality was compared between cohorts using competing risks analysis. Mortality rate ratios (MRR), adjusted for changes in mortality risk of the general population, were calculated using Poisson regression. Results In total 1653 patients were recruited (C1=1022, C2=631). Patients in C2 had 17% lower SJC51 than C1 over 10 years (95% CI −23% to −10%), whereas TJC51 and HAQ were comparable. C2 patients had reduced risk of all-cause and CVD mortality compared with C1 (all-cause: HR 0.72, 95% CI 0.56 to 0.95; CVD: subhazard ratio 0.58, 95% CI 0.37 to 0.93). After accounting for changes in mortality risk in the general population, the difference in mortality was non-significant (all-cause: MRR 0.78, 95% CI 0.56 to 1.10; CVD: MRR 0.77, 95% CI 0.48 to 1.24). Conclusion Disease activity significantly improved in the new millennium, whereas disability and mortality were unchanged.
- Published
- 2018
26. Patterns and predictors of skin score change in early diffuse systemic sclerosis from the European Scleroderma Observational Study
- Author
-
Herrick, Ariane, Peytrignet, Sebastien, Lunt, Mark, Pan, Xiaoyan, Dinsdale, Graham, Brown, Edith, Czirják, László, Distler, Jörg H.W., Distler, Oliver, Fligelstone, Kim, Gregory, William J, Ochiel, Rachel, Vonk, Madelon C, Ancuta, Codrina, Ong, Voon H, Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Øyvind, Jobanputra, Paresh, Jordan, Alison C, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C, Agard, Christian, Anderson, Marina E, Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya, Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Soren, MacGregor, Alexander J, McHugh, Neil, Müller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E, Hachulla, Eric, Hamilton, Jennifer, Inanç, Murat, McLaren, John S, van Laar, Jacob M., Pathare, Sanjay, Proudman, Susannah, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J, Grange, Claire, Trad, Georges-Selim, and Denton, Christopher P.
- Published
- 2018
27. Have the 10 year outcomes of patients with early inflammatory arthritis improved in the new millennium compared to the decade before? Results from the Norfolk Arthritis Register
- Author
-
Gwinnutt, James, Symmons, Deborah, MacGregor, Alexander J, Chipping, Jacqueline R., Marshall, Tarnya, Lunt, Mark, and Verstappen, Suzanne
- Subjects
Disability ,ResearchInstitutes_Networks_Beacons/MICRA ,Manchester Institute for Collaborative Research on Ageing ,Early Rheumatoid Arthritis ,Outcomes research ,Epidemiology ,Mortality - Abstract
Objective: To compare the 10 year outcome (disease activity, disability, mortality) of two cohorts of patients with inflammatory polyarthritis (IP) recruited 10 years apart.Methods: Patients with IP were recruited to the Norfolk Arthritis Register from 1990-94 (Cohort 1 (C1)) and 2000-04 (Cohort 2 (C2)). Demographic and clinical data were collected at baseline and at years 1, 2, 3, 5, 7 and 10. Longitudinal disease activity (swollen/tender 51 joint counts (SJC51/TJC51)) and disability (HAQ) were compared between the cohorts using population average negative binomial regression and generalised estimating equation analysis respectively. Risk of 10 year mortality was compared between cohorts using Cox models. Risk of cardiovascular (CVD) mortality was compared between cohorts using competing risks analysis. Mortality rate ratios (MRR), adjusted for changes in mortality risk of the general population, were calculated using Poisson regression.Results: In total 1653 patients were recruited (C1 = 1022, C2 = 631). Patients in C2 had 17% lower SJC51 than C1 over ten years (95% CI -23% to -10%) whereas TJC51 and HAQ were comparable. C2 patients had reduced risk of all-cause and CVD mortality compared to C1 (all cause: HR 0.72, 95% CI 0.56 to 0.95; CVD: SHR 0.58, 95% CI 0.37 to 0.93). After accounting for changes in mortality risk in the general population, the difference in mortality was non-significant (all cause: MRR 0.78, 95% CI 0.56 to 1.10; CVD: MRR 0.77, 95% CI 0.48 to 1.24).Conclusion: Disease activity significantly improved in the new millennium, whereas disability and mortality were unchanged.
- Published
- 2018
28. O14 Pro-inflammatory diets are associated with increased C-reactive protein and subsequent rheumatoid arthritis in the European Investigation of Cancer: Norfolk Arthritis Register cohort
- Author
-
Sayers, Ellie, primary, Dainty, Jack R, additional, Yates, Max, additional, Verstappen, Suzanne M, additional, Chipping, Jacqueline, additional, Carding, Simon R, additional, Luben, Robert N, additional, Khaw, Kay-Tee, additional, Wareham, Nick J, additional, and MacGregor, Alexander J, additional
- Published
- 2019
- Full Text
- View/download PDF
29. Validity of a two-component imaging-derived disease activity score for improved assessment of synovitis in early rheumatoid arthritis
- Author
-
Hensor, Elizabeth M A, primary, McKeigue, Paul, additional, Ling, Stephanie F, additional, Colombo, Marco, additional, Barrett, Jennifer H, additional, Nam, Jackie L, additional, Freeston, Jane, additional, Buch, Maya H, additional, Spiliopoulou, Athina, additional, Agakov, Felix, additional, Kelly, Stephen, additional, Lewis, Myles J, additional, Verstappen, Suzanne M M, additional, MacGregor, Alexander J, additional, Viatte, Sebastien, additional, Barton, Anne, additional, Pitzalis, Costantino, additional, Emery, Paul, additional, Conaghan, Philip G, additional, and Morgan, Ann W, additional
- Published
- 2019
- Full Text
- View/download PDF
30. Unexpected HLA haplotype sharing in dizygotic twin pairs discordant for rheumatoid arthritis
- Author
-
Jawaheer, Damini, MacGregor, Alexander J., Gregersen, Peter K., Silman, Alan J., and Ollier, William E. R.
- Published
- 1996
31. CIGARETTE SMOKING INCREASES THE RISK OF RHEUMATOID ARTHRITIS: Results from a Nationwide Study of Disease-Discordant Twins
- Author
-
Silman, Alan J., Newman, Jason, and MacGregor, Alexander J.
- Published
- 1996
32. Disability, fatigue, pain and their associates in early diffuse cutaneous systemic sclerosis:the European Scleroderma Observational Study
- Author
-
Peytrignet, Sébastien, Denton, Christopher P, Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Pan, Xiaoyan, Brown, Edith, Czirják, László, Distler, Jörg H W, Distler, Oliver, Fligelstone, Kim, Gregory, William J, Ochiel, Rachel, Vonk, Madelon, Ancuta, Codrina, Ong, Voon H, Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Øyvind, Jordan, Alison C, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C, Agard, Christian, Anderson, Marina E, Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H, Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Søren, MacGregor, Alexander J, McHugh, Neil, Müller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E, Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanç, Murat, McLaren, John S, van Laar, Jacob M, Pathare, Sanjay, Proudman, Susanna, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J, Grange, Claire, Trad, Georges-Selim, Herrick, Ariane L, Peytrignet, Sébastien, Denton, Christopher P, Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Pan, Xiaoyan, Brown, Edith, Czirják, László, Distler, Jörg H W, Distler, Oliver, Fligelstone, Kim, Gregory, William J, Ochiel, Rachel, Vonk, Madelon, Ancuta, Codrina, Ong, Voon H, Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Øyvind, Jordan, Alison C, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C, Agard, Christian, Anderson, Marina E, Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H, Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Søren, MacGregor, Alexander J, McHugh, Neil, Müller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E, Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanç, Murat, McLaren, John S, van Laar, Jacob M, Pathare, Sanjay, Proudman, Susanna, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J, Grange, Claire, Trad, Georges-Selim, and Herrick, Ariane L
- Abstract
Objectives: Our aim was to describe the burden of early dcSSc in terms of disability, fatigue and pain in the European Scleroderma Observational Study cohort, and to explore associated clinical features.Methods: Patients completed questionnaires at study entry, 12 and 24 months, including the HAQ disability index (HAQ-DI), the Cochin Hand Function Scale (CHFS), the Functional Assessment of Chronic Illness Therapy-fatigue and the Short Form 36 (SF36). Associates examined included the modified Rodnan skin score (mRSS), current digital ulcers and internal organ involvement. Correlations between 12-month changes were also examined.Results: The 326 patients recruited (median disease duration 11.9 months) displayed high levels of disability [mean (s.d.) HAQ-DI 1.1 (0.83)], with 'grip' and 'activity' being most affected. Of the 18 activities assessed in the CHFS, those involving fine finger movements were most affected. High HAQ-DI and CHFS scores were both associated with high mRSS (ρ = 0.34, P < 0.0001 and ρ = 0.35, P < 0.0001, respectively). HAQ-DI was higher in patients with digital ulcers (P = 0.004), pulmonary fibrosis (P = 0.005), cardiac (P = 0.005) and muscle involvement (P = 0.002). As anticipated, HAQ-DI, CHFS, the Functional Assessment of Chronic Illness Therapy and SF36 scores were all highly correlated, in particular the HAQ-DI with the CHFS (ρ = 0.84, P < 0.0001). Worsening HAQ-DI over 12 months was strongly associated with increasing mRSS (ρ = 0.40, P < 0.0001), decreasing hand function (ρ = 0.57, P < 0.0001) and increasing fatigue (ρ = -0.53, P < 0.0001).Conclusion: The European Scleroderma Observational Study highlights the burden of disability in early dcSSc, with high levels of disability and fatigue, associating with the degree of skin thickening (mRSS). Impaired hand function is a major contributor to overall disability.
- Published
- 2018
33. Disability, fatigue, pain and their associates in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study
- Author
-
Peytrignet, Sebastien, Denton, Christopher P., Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Pan, Xiaoyan, Brown, Edith, Czirjak, Laszlo, Distler, Jorg H. W., Distler, Oliver, Fligelstone, Kim, Gregory, William J., Ochiel, Rachel, Vonk, Madelon, Ancuta, Codrina, Ong, Voon H., Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Oyvind, Jordan, Alison C., Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C., Agard, Christian, Anderson, Marina E., Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H., Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Soren, MacGregor, Alexander J., McHugh, Neil, Muller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E., Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S., van Laar, Jacob M., Pathare, Sanjay, Proudman, Susanna, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J., Grange, Claire, Trad, Georges-Selim, Herrick, Ariane L., Peytrignet, Sebastien, Denton, Christopher P., Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Pan, Xiaoyan, Brown, Edith, Czirjak, Laszlo, Distler, Jorg H. W., Distler, Oliver, Fligelstone, Kim, Gregory, William J., Ochiel, Rachel, Vonk, Madelon, Ancuta, Codrina, Ong, Voon H., Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Oyvind, Jordan, Alison C., Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C., Agard, Christian, Anderson, Marina E., Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H., Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Soren, MacGregor, Alexander J., McHugh, Neil, Muller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E., Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S., van Laar, Jacob M., Pathare, Sanjay, Proudman, Susanna, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J., Grange, Claire, Trad, Georges-Selim, and Herrick, Ariane L.
- Abstract
Objectives. Our aim was to describe the burden of early dcSSc in terms of disability, fatigue and pain in the European Scleroderma Observational Study cohort, and to explore associated clinical features. Methods. Patients completed questionnaires at study entry, 12 and 24 months, including the HAQ disability index (HAQ-DI), the Cochin Hand Function Scale (CHFS), the Functional Assessment of Chronic Illness Therapy-fatigue and the Short Form 36 (SF36). Associates examined included the modified Rodnan skin score (mRSS), current digital ulcers and internal organ involvement. Correlations between 12-month changes were also examined. Results. The 326 patients recruited (median disease duration 11.9 months) displayed high levels of disability [mean (s.d.) HAQ-DI 1.1 (0.83)], with 'grip' and 'activity' being most affected. Of the 18 activities assessed in the CHFS, those involving fine finger movements were most affected. High HAQ-DI and CHFS scores were both associated with high mRSS (rho = 0.34, P < 0.0001 and rho = 0.35, P < 0.0001, respectively). HAQ-DI was higher in patients with digital ulcers (P = 0.004), pulmonary fibrosis (P = 0.005), cardiac (P = 0.005) and muscle involvement (P = 0.002). As anticipated, HAQ-DI, CHFS, the Functional Assessment of Chronic Illness Therapy and SF36 scores were all highly correlated, in particular the HAQ-DI with the CHFS (rho = 0.84, P < 0.0001). Worsening HAQ-DI over 12 months was strongly associated with increasing mRSS (rho = 0.40, P < 0.0001), decreasing hand function (rho = 0.57, P < 0.0001) and increasing fatigue (rho = -0.53, P < 0.0001). Conclusion.The European Scleroderma Observational Study highlights the burden of disability in early dcSSc, with high levels of disability and fatigue, associating with the degree of skin thickening (mRSS). Impaired hand function is a major contributor to overall disability.
- Published
- 2018
34. Patterns and predictors of skin score change in early diffuse systemic sclerosis from the European Scleroderma Observational Study
- Author
-
Herrick, Ariane L., Peytrignet, Sebastien, Lunt, Mark, Pan, Xiaoyan, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan J., Dinsdale, Graham, Brown, Edith, Czirjak, Laszlo, Distler, Joerg H. W., Distler, Oliver, Fligelstone, Kim, Gregory, William J., Ochiel, Rachel, Vonk, Madelon C., Ancuta, Codrina, Ong, Voon H., Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Oyvind, Jobanputra, Paresh, Jordan, Alison C., Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C., Agard, Christian, Anderson, Marina E., Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H., Chung, Lorinda, Damjanov, Nemanja S., Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Soren, MacGregor, Alexander J., McHugh, Neil, Mueller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E., Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S., van Laar, Jacob M., Pathare, Sanjay, Proudman, Susanna M., Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J., Grange, Claire, Trad, Georges-Selim, Denton, Christopher P., Herrick, Ariane L., Peytrignet, Sebastien, Lunt, Mark, Pan, Xiaoyan, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan J., Dinsdale, Graham, Brown, Edith, Czirjak, Laszlo, Distler, Joerg H. W., Distler, Oliver, Fligelstone, Kim, Gregory, William J., Ochiel, Rachel, Vonk, Madelon C., Ancuta, Codrina, Ong, Voon H., Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Oyvind, Jobanputra, Paresh, Jordan, Alison C., Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C., Agard, Christian, Anderson, Marina E., Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H., Chung, Lorinda, Damjanov, Nemanja S., Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Soren, MacGregor, Alexander J., McHugh, Neil, Mueller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E., Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S., van Laar, Jacob M., Pathare, Sanjay, Proudman, Susanna M., Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J., Grange, Claire, Trad, Georges-Selim, and Denton, Christopher P.
- Abstract
Objectives Our aim was to use the opportunity provided by the European Scleroderma Observational Study to (1) identify and describe those patients with early diffuse cutaneous systemic sclerosis (dcSSc) with progressive skin thickness, and (2) derive prediction models for progression over 12 months, to inform future randomised controlled trials (RCTs). Methods The modified Rodnan skin score (mRSS) was recorded every 3months in 326 patients. Progressors' were defined as those experiencing a 5-unit and 25% increase in mRSS score over 12 months (3 months). Logistic models were fitted to predict progression and, using receiver operating characteristic (ROC) curves, were compared on the basis of the area under curve (AUC), accuracy and positive predictive value (PPV). Results 66 patients (22.5%) progressed, 227 (77.5%) did not (33 could not have their status assessed due to insufficient data). Progressors had shorter disease duration (median 8.1 vs 12.6 months, P=0.001) and lower mRSS (median 19 vs 21 units, P=0.030) than non-progressors. Skin score was highest, and peaked earliest, in the anti-RNA polymerase III (Pol3+) subgroup (n=50). A first predictive model (including mRSS, duration of skin thickening and their interaction) had an accuracy of 60.9%, AUC of 0.666 and PPV of 33.8%. By adding a variable for Pol3 positivity, the model reached an accuracy of 71%, AUC of 0.711 and PPV of 41%. Conclusions Two prediction models for progressive skin thickening were derived, for use both in clinical practice and for cohort enrichment in RCTs. These models will inform recruitment into the many clinical trials of dcSSc projected for the coming years. Trial registration number NCT02339441.
- Published
- 2018
35. Patterns and predictors of skin score change in early diffuse systemic sclerosis from the European Scleroderma Observational Study
- Author
-
Herrick, Ariane L, Peytrignet, Sebastien, Lunt, Mark, Pan, Xiaoyan, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan J, Dinsdale, Graham, Brown, Edith, Czirják, László, Distler, Jörg H W, Distler, Oliver, Fligelstone, Kim, Gregory, William J, Ochiel, Rachel, Vonk, Madelon C, Ancuţa, Codrina, Ong, Voon H, Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Øyvind, Jobanputra, Paresh, Jordan, Alison C, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C, Agard, Christian, Anderson, Marina E, Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H, Chung, Lorinda, Damjanov, Nemanja S, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Søren, MacGregor, Alexander J, McHugh, Neil, Müller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E, Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, İnanç, Murat, McLaren, John S, van Laar, Jacob M, Pathare, Sanjay, Proudman, Susanna M, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J, Grange, Claire, Trad, Georges-Selim, Denton, Christopher P, Herrick, Ariane L, Peytrignet, Sebastien, Lunt, Mark, Pan, Xiaoyan, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan J, Dinsdale, Graham, Brown, Edith, Czirják, László, Distler, Jörg H W, Distler, Oliver, Fligelstone, Kim, Gregory, William J, Ochiel, Rachel, Vonk, Madelon C, Ancuţa, Codrina, Ong, Voon H, Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Øyvind, Jobanputra, Paresh, Jordan, Alison C, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C, Agard, Christian, Anderson, Marina E, Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H, Chung, Lorinda, Damjanov, Nemanja S, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Søren, MacGregor, Alexander J, McHugh, Neil, Müller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E, Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, İnanç, Murat, McLaren, John S, van Laar, Jacob M, Pathare, Sanjay, Proudman, Susanna M, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J, Grange, Claire, Trad, Georges-Selim, and Denton, Christopher P
- Abstract
OBJECTIVES: Our aim was to use the opportunity provided by the European Scleroderma Observational Study to (1) identify and describe those patients with early diffuse cutaneous systemic sclerosis (dcSSc) with progressive skin thickness, and (2) derive prediction models for progression over 12 months, to inform future randomised controlled trials (RCTs).METHODS: The modified Rodnan skin score (mRSS) was recorded every 3 months in 326 patients. 'Progressors' were defined as those experiencing a 5-unit and 25% increase in mRSS score over 12 months (±3 months). Logistic models were fitted to predict progression and, using receiver operating characteristic (ROC) curves, were compared on the basis of the area under curve (AUC), accuracy and positive predictive value (PPV).RESULTS: 66 patients (22.5%) progressed, 227 (77.5%) did not (33 could not have their status assessed due to insufficient data). Progressors had shorter disease duration (median 8.1 vs 12.6 months, P=0.001) and lower mRSS (median 19 vs 21 units, P=0.030) than non-progressors. Skin score was highest, and peaked earliest, in the anti-RNA polymerase III (Pol3+) subgroup (n=50). A first predictive model (including mRSS, duration of skin thickening and their interaction) had an accuracy of 60.9%, AUC of 0.666 and PPV of 33.8%. By adding a variable for Pol3 positivity, the model reached an accuracy of 71%, AUC of 0.711 and PPV of 41%.CONCLUSIONS: Two prediction models for progressive skin thickening were derived, for use both in clinical practice and for cohort enrichment in RCTs. These models will inform recruitment into the many clinical trials of dcSSc projected for the coming years.TRIAL REGISTRATION NUMBER: NCT02339441.
- Published
- 2018
36. Twenty-year outcome and association between early treatment and mortality and disability in an inception cohort of patients with rheumatoid arthritis: Results from the Norfolk Arthritis Register
- Author
-
Gwinnutt, James M., Symmons, Deborah P. M., MacGregor, Alexander J., Chipping, Jacqueline R., Marshall, Tarnya, Lunt, Mark, and Verstappen, Suzanne M. M.
- Subjects
Arthritis, Rheumatoid ,Antirheumatic Agents ,Humans ,Rheumatoid Arthritis - Abstract
Objective To describe the outcome in patients with rheumatoid arthritis (RA) over 20 years from symptom onset, and to assess the association between early treatment (with disease‐modifying antirheumatic drugs/steroids) and mortality and disability during follow‐up. Methods Patients recruited to the Norfolk Arthritis Register (NOAR) between 1990 and 1994 who met the 2010 American College of Rheumatology/European League Against Rheumatism RA criteria at baseline were included in this analysis. Demographic and clinical variables were collected at baseline and at years 1–3, 5, 7, 10, 15, and 20. Disease activity (swollen joint count [SJC]/tender joint count [TJC]), disability (Health Assessment Questionnaire disability index [HAQ DI]), and mortality over 20 years were determined. Associations between treatment group (early treatment [ET], treatment ≤6 months after symptom onset; late treatment [LT], treatment >6 months after symptom onset; never treatment [NT], no treatment) and mortality and disability were assessed using weighted pooled logistic regression and weighted multilevel mixed‐effects linear regression, respectively. Inverse weights were used to account for confounding by indication and censoring. Results This study included 602 patients with RA (median age 56 years [interquartile range 44–68 years]; 65.9% women). The median SJCs and TJCs were low during the follow‐up period (1–3 swollen joints and 3–6 tender joints). The median HAQ DI score increased after year 1 but remained at low/moderate levels (median 1.25 after year 10). The risk of mortality was reduced in the ET and LT groups compared with that in the NT group. The ET group and the NT group had comparable HAQ DI scores during the follow‐up period (β = 0.03, 95% confidence interval [95% CI] −0.06, 0.12), while the HAQ DI score was increased in the LT group (for LT versus NT, β = 0.10 [95% CI 0.02, 0.17]). Conclusion The results of this study indicate the importance of early treatment with regard to the long‐term outcomes in patients with RA.
- Published
- 2017
37. Twenty‐Year Outcome and Association Between Early Treatment and Mortality and Disability in an Inception Cohort of Patients With Rheumatoid Arthritis:Results From the Norfolk Arthritis Register
- Author
-
Gwinnutt, James, Symmons, Deborah, Macgregor, Alexander J, Chipping, Jacqueline R., Marshall, Tarnya, Lunt, Mark, and Verstappen, Suzanne
- Abstract
Objective To describe the outcome in patients with rheumatoid arthritis (RA) over 20 years from symptom onset, and to assess the association between early treatment (with disease-modifying antirheumatic drugs/steroids) and mortality and disability during follow-up. Methods Patients recruited to the Norfolk Arthritis Register (NOAR) between 1990 and 1994 who met the 2010 American College of Rheumatology/European League Against Rheumatism RA criteria at baseline were included in this analysis. Demographic and clinical variables were collected at baseline and at years 1–3, 5, 7, 10, 15, and 20. Disease activity (swollen joint count [SJC]/tender joint count [TJC]), disability (Health Assessment Questionnaire disability index [HAQ DI]), and mortality over 20 years were determined. Associations between treatment group (early treatment [ET], treatment ≤6 months after symptom onset; late treatment [LT], treatment >6 months after symptom onset; never treatment [NT], no treatment) and mortality and disability were assessed using weighted pooled logistic regression and weighted multilevel mixed-effects linear regression, respectively. Inverse weights were used to account for confounding by indication and censoring. Results This study included 602 patients with RA (median age 56 years [interquartile range 44–68 years]; 65.9% women). The median SJCs and TJCs were low during the follow-up period (1–3 swollen joints and 3–6 tender joints). The median HAQ DI score increased after year 1 but remained at low/moderate levels (median 1.25 after year 10). The risk of mortality was reduced in the ET and LT groups compared with that in the NT group. The ET group and the NT group had comparable HAQ DI scores during the follow-up period (β = 0.03, 95% confidence interval [95% CI] −0.06, 0.12), while the HAQ DI score was increased in the LT group (for LT versus NT, β = 0.10 [95% CI 0.02, 0.17]). Conclusion The results of this study indicate the importance of early treatment with regard to the long-term outcomes in patients with RA.
- Published
- 2017
38. Predictors of, and outcomes following, orthopaedic joint surgery in patients with early rheumatoid arthritis followed for 20 years: results from the Norfolk Arthritis Register (NOAR)
- Author
-
Gwinnutt, James, Symmons, Deborah, Macgregor, Alexander J, Chipping, Jacqueline R., Lapraik , Chloe, Marshall, Tarnya, Lunt, Mark, and Verstappen, Suzanne
- Subjects
musculoskeletal diseases - Abstract
Objectives. To analyse predictors and outcomes of major orthopaedic surgery in a cohort of RA patients followed for 20 years.Methods. Patients were recruited to the Norfolk Arthritis Register from 1990 to 1994. Demographic and clinical variables (including the HAQ and swollen and tender joint counts) were assessed at baseline; the 2010 ACR/EULAR RA classification criteria were applied. Patients reported incident comorbidities and major orthopaedic joint surgery (replacement, synovectomy, fusion, excision) when reassessed at years 1, 2, 3, 5, 7, 10, 15 and 20. Baseline and time-varying predictors of orthopaedic surgery were assessed using a conditional risk set model, a type of multiple-failure survival analysis. Change in disability after surgery was assessed using weighted mixed-effects linear regression.Results. Of 589 RA patients [median age 56 years (IQR 45–68); 66.7% women] recruited to the Norfolk Arthritis Register with at least one follow-up, 102 reported a total of 180 major surgeries, with hip replacement being the most common (n = 68/180). Patients reporting major surgery had worse functional disability at all time points, but similar swollen/tender joint counts to those without major surgery. Each unit increase in HAQ score was associated with a doubling of the patient’s risk of having surgery by the next assessment [hazard ratio 2.11 per unit increase in HAQ (95% CI 1.64, 2.71)]. Patients had worse HAQ scores after surgery than patients not undergoing surgery [β = 0.17 (95% CI 0.03, 0.32)].Conclusion. HAQ was the strongest predictor of future major surgery. This supports the argument that HAQ should be included in routine clinical assessment.
- Published
- 2017
39. HLA-DRB1 amino acid positions 11/13, 71 and 74 are associated with inflammation level, disease activity and the Health Assessment Questionnaire disability index in patients with inflammatory polyarthritis
- Author
-
Ling, Stephanie F., Viatte, Sebastien, Lunt, Mark, Van Sijl, Alper M., Silva-Fernandez, Lucia, Symmons, Deborah P. M., Young, Adam, Macgregor, Alexander J., and Barton, Anne
- Subjects
musculoskeletal diseases - Abstract
Objective: Rheumatoid arthritis (RA) susceptibility HLA–DRB1 haplotypes based on amino acid positions 11/13, 71, and 74 predict radiographic damage. The mechanism of action is unknown, but it may be mediated by inflammation. We undertook this study to systematically investigate the effect of these amino acids on nonradiographic measures of disease activity/outcomes. Methods: We tested the association of RA susceptibility HLA–DRB1 amino acids with the C-reactive protein (CRP) level, the tender joint count (TJC), the swollen joint count (SJC), the Disease Activity Score in 28 joints (DAS28), and the Health Assessment Questionnaire (HAQ) score in the Norfolk Arthritis Register (NOAR) and Early Rheumatoid Arthritis Study (ERAS) cohorts. Longitudinal modeling of disease activity/outcomes was performed using generalized linear latent and mixed models. Mediation analysis was performed using directed acyclic graphs to investigate the paths from genetic factors to outcome. Results: A total of 2,158 patients were available for analysis in the NOAR cohort. Valine at position 11 showed the strongest association with the CRP level (P = 2.21 × 10−6), the SJC (P = 7.51 × 10−6), and the DAS28 (P = 0.002); it was marginally associated with the HAQ score (P = 0.044) but not with the TJC. The same amino acid and haplotype risk hierarchy observed for susceptibility and radiographic severity was observed for the CRP level and nonradiographic measures of disease activity/outcome, apart from the TJC. The results were replicated in the ERAS cohort. The effect of valine at position 11 on the SJC was mainly mediated by anti–citrullinated protein antibody status, the effect of which was mainly mediated by inflammation; however, the effect of valine at position 11 was also independent of the CRP level (P = 1.6 × 10−4). Conclusion: Genetic markers of RA susceptibility located within HLA–DRB1 determine the levels of clinical and systemic inflammation independently, and also determine all objective measures of disease activity and outcome.
- Published
- 2016
40. Variation and implications of treatment decisions in early rheumatoid arthritis: results from a nationwide cohort study.
- Author
-
Yates, Mark, MacGregor, Alexander J, Ledingham, Jo, Norton, Sam, Bechman, Katie, Dennison, Elaine M, and Galloway, James B
- Subjects
- *
RHEUMATOID arthritis treatment , *ANTIRHEUMATIC agents , *AUDITING , *CONFIDENCE intervals , *DRUG prescribing , *LONGITUDINAL method , *MEDICAL protocols , *DECISION making in clinical medicine , *PHYSICIAN practice patterns , *MULTIPLE regression analysis , *TREATMENT effectiveness , *EARLY medical intervention , *DESCRIPTIVE statistics , *ODDS ratio ,THERAPEUTIC use of glucocorticoids - Abstract
Objectives Trial data have provided an evidence base to guide early treatment in RA. Few studies have investigated rheumatologists' adherence to guidelines, and subsequent impact on outcomes. The objectives of this study are to characterize baseline prescribing for patients with RA across the National Health Service, identifying treatment decisions that associate with patient outcomes. Methods A nationwide audit of RA collected information on treatment choices, DAS and sociodemographic factors at baseline. Treatment response was assessed at 3 months. Multilevel regression models were used to characterize departmental variations in prescribing. Heat maps were used to visualize geographical variation. Mixed effects regression models were constructed to assess the relationship between treatment decisions and disease outcomes, adjusting for patient and department level covariates. Results A total of 7154 patients with a diagnosis of RA were recruited from 136 departments. There was broad variation in prescribing choices, even between departments close to one another, with evidence of substantial deviation from guidelines. Over 75% of patients received glucocorticoids, fewer than half received combination conventional DMARDs. Early glucocorticoid therapy associated with achieving a good treatment response [odds ratio 1.93 (95% CI 1.31, 2.84), P -value = 0.001]. The association was maintained following propensity modelling and imputation. Conclusion Guideline adherence varies between departments and cannot be explained by case-mix alone. Departments that prescribe early adjunctive steroid achieve better short-term outcomes. Further research should work to ensure that the early arthritis evidence base translates into better outcomes for patients. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
41. 229 The impact of the EIA clinic on early RA care
- Author
-
Yates, Mark, primary, Galloway, James, additional, Snowden, Neil, additional, Norton, Sam, additional, Macgregor, Alexander J, additional, Rivett, Ali, additional, Souto, Miguel, additional, Dennison, Elaine M, additional, Hider, Sam L, additional, and Ledingham, Joanne M, additional
- Published
- 2018
- Full Text
- View/download PDF
42. Disability, fatigue, pain and their associates in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study
- Author
-
Peytrignet, Sébastien, primary, Denton, Christopher P, additional, Lunt, Mark, additional, Hesselstrand, Roger, additional, Mouthon, Luc, additional, Silman, Alan, additional, Pan, Xiaoyan, additional, Brown, Edith, additional, Czirják, László, additional, Distler, Jörg H W, additional, Distler, Oliver, additional, Fligelstone, Kim, additional, Gregory, William J, additional, Ochiel, Rachel, additional, Vonk, Madelon, additional, Ancuţa, Codrina, additional, Ong, Voon H, additional, Farge, Dominique, additional, Hudson, Marie, additional, Matucci-Cerinic, Marco, additional, Balbir-Gurman, Alexandra, additional, Midtvedt, Øyvind, additional, Jordan, Alison C, additional, Stevens, Wendy, additional, Moinzadeh, Pia, additional, Hall, Frances C, additional, Agard, Christian, additional, Anderson, Marina E, additional, Diot, Elisabeth, additional, Madhok, Rajan, additional, Akil, Mohammed, additional, Buch, Maya H, additional, Chung, Lorinda, additional, Damjanov, Nemanja, additional, Gunawardena, Harsha, additional, Lanyon, Peter, additional, Ahmad, Yasmeen, additional, Chakravarty, Kuntal, additional, Jacobsen, Søren, additional, MacGregor, Alexander J, additional, McHugh, Neil, additional, Müller-Ladner, Ulf, additional, Riemekasten, Gabriela, additional, Becker, Michael, additional, Roddy, Janet, additional, Carreira, Patricia E, additional, Fauchais, Anne Laure, additional, Hachulla, Eric, additional, Hamilton, Jennifer, additional, İnanç, Murat, additional, McLaren, John S, additional, van Laar, Jacob M, additional, Pathare, Sanjay, additional, Proudman, Susanna, additional, Rudin, Anna, additional, Sahhar, Joanne, additional, Coppere, Brigitte, additional, Serratrice, Christine, additional, Sheeran, Tom, additional, Veale, Douglas J, additional, Grange, Claire, additional, Trad, Georges-Selim, additional, and Herrick, Ariane L, additional
- Published
- 2017
- Full Text
- View/download PDF
43. Treatment outcome in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study (ESOS)
- Author
-
Herrick, Ariane L., Pan, Xiaoyan, Peytrignet, Sebastien, Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Brown, Edith, Czirjak, Laszlo, Distler, Joerg H. W., Distler, Oliver, Fligelstone, Kim, Gregory, William J., Ochiel, Rachel, Vonk, Madelon, Ancuta, Codrina, Ong, Voon H., Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Oyvind, Jordan, Alison C., Jobanputra, Paresh, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C., Agard, Christian, Anderson, Marina E., Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H., Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Soren, MacGregor, Alexander J., McHugh, Neil, Mueller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E., Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S., van Laar, Jacob M., Pathare, Sanjay, Proudman, Susannah, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J., Grange, Claire, Trad, Georges-Selim, Denton, Christopher P., Herrick, Ariane L., Pan, Xiaoyan, Peytrignet, Sebastien, Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Brown, Edith, Czirjak, Laszlo, Distler, Joerg H. W., Distler, Oliver, Fligelstone, Kim, Gregory, William J., Ochiel, Rachel, Vonk, Madelon, Ancuta, Codrina, Ong, Voon H., Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Oyvind, Jordan, Alison C., Jobanputra, Paresh, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C., Agard, Christian, Anderson, Marina E., Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H., Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Soren, MacGregor, Alexander J., McHugh, Neil, Mueller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E., Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S., van Laar, Jacob M., Pathare, Sanjay, Proudman, Susannah, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J., Grange, Claire, Trad, Georges-Selim, and Denton, Christopher P.
- Abstract
Objectives The rarity of early diffuse cutaneous systemic sclerosis (dcSSc) makes randomised controlled trials very difficult. We aimed to use an observational approach to compare effectiveness of currently used treatment approaches. Methods This was a prospective, observational cohort study of early dcSSc (within three years of onset of skin thickening). Clinicians selected one of four protocols for each patient: methotrexate, mycophenolate mofetil (MMF), cyclophosphamide or 'no immunosuppressant'. Patients were assessed three-monthly for up to 24 months. The primary outcome was the change in modified Rodnan skin score (mRSS). Confounding by indication at baseline was accounted for using inverse probability of treatment (IPT) weights. As a secondary outcome, an IPT-weighted Cox model was used to test for differences in survival. Results Of 326 patients recruited from 50 centres, 65 were prescribed methotrexate, 118 MMF, 87 cyclophosphamide and 56 no immunosuppressant. 276 (84.7%) patients completed 12 and 234 (71.7%) 24 months follow-up (or reached last visit date). There were statistically significant reductions in mRSS at 12 months in all groups: -4.0 (-5.2 to -2.7) units for methotrexate, -4.1 (-5.3 to -2.9) for MMF, -3.3 (-4.9 to -1.7) for cyclophosphamide and -2.2 (-4.0 to -0.3) for no immunosuppressant (p value for between-group differences=0.346). There were no statistically significant differences in survival between protocols before (p=0.389) or after weighting (p=0.440), but survival was poorest in the no immunosuppressant group (84.0%) at 24 months. Conclusions These findings may support using immunosuppressants for early dcSSc but suggest that overall benefit is modest over 12 months and that better treatments are needed.
- Published
- 2017
44. Treatment outcome in early diffuse cutaneous systemic sclerosis:the European Scleroderma Observational Study (ESOS)
- Author
-
Herrick, Ariane L, Pan, Xiaoyan, Peytrignet, Sébastien, Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Brown, Edith, Czirják, László, Distler, Jörg H W, Distler, Oliver, Fligelstone, Kim, Gregory, William J, Ochiel, Rachel, Vonk, Madelon, Ancuţa, Codrina, Ong, Voon H, Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Øyvind, Jordan, Alison C, Jobanputra, Paresh, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C, Agard, Christian, Anderson, Marina E, Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H, Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Søren, MacGregor, Alexander J, McHugh, Neil, Müller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E, Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S, van Laar, Jacob M, Pathare, Sanjay, Proudman, Susannah, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J, Grange, Claire, Trad, Georges-Selim, Denton, Christopher P, Herrick, Ariane L, Pan, Xiaoyan, Peytrignet, Sébastien, Lunt, Mark, Hesselstrand, Roger, Mouthon, Luc, Silman, Alan, Brown, Edith, Czirják, László, Distler, Jörg H W, Distler, Oliver, Fligelstone, Kim, Gregory, William J, Ochiel, Rachel, Vonk, Madelon, Ancuţa, Codrina, Ong, Voon H, Farge, Dominique, Hudson, Marie, Matucci-Cerinic, Marco, Balbir-Gurman, Alexandra, Midtvedt, Øyvind, Jordan, Alison C, Jobanputra, Paresh, Stevens, Wendy, Moinzadeh, Pia, Hall, Frances C, Agard, Christian, Anderson, Marina E, Diot, Elisabeth, Madhok, Rajan, Akil, Mohammed, Buch, Maya H, Chung, Lorinda, Damjanov, Nemanja, Gunawardena, Harsha, Lanyon, Peter, Ahmad, Yasmeen, Chakravarty, Kuntal, Jacobsen, Søren, MacGregor, Alexander J, McHugh, Neil, Müller-Ladner, Ulf, Riemekasten, Gabriela, Becker, Michael, Roddy, Janet, Carreira, Patricia E, Fauchais, Anne Laure, Hachulla, Eric, Hamilton, Jennifer, Inanc, Murat, McLaren, John S, van Laar, Jacob M, Pathare, Sanjay, Proudman, Susannah, Rudin, Anna, Sahhar, Joanne, Coppere, Brigitte, Serratrice, Christine, Sheeran, Tom, Veale, Douglas J, Grange, Claire, Trad, Georges-Selim, and Denton, Christopher P
- Abstract
OBJECTIVES: The rarity of early diffuse cutaneous systemic sclerosis (dcSSc) makes randomised controlled trials very difficult. We aimed to use an observational approach to compare effectiveness of currently used treatment approaches.METHODS: This was a prospective, observational cohort study of early dcSSc (within three years of onset of skin thickening). Clinicians selected one of four protocols for each patient: methotrexate, mycophenolate mofetil (MMF), cyclophosphamide or 'no immunosuppressant'. Patients were assessed three-monthly for up to 24 months. The primary outcome was the change in modified Rodnan skin score (mRSS). Confounding by indication at baseline was accounted for using inverse probability of treatment (IPT) weights. As a secondary outcome, an IPT-weighted Cox model was used to test for differences in survival.RESULTS: Of 326 patients recruited from 50 centres, 65 were prescribed methotrexate, 118 MMF, 87 cyclophosphamide and 56 no immunosuppressant. 276 (84.7%) patients completed 12 and 234 (71.7%) 24 months follow-up (or reached last visit date). There were statistically significant reductions in mRSS at 12 months in all groups: -4.0 (-5.2 to -2.7) units for methotrexate, -4.1 (-5.3 to -2.9) for MMF, -3.3 (-4.9 to -1.7) for cyclophosphamide and -2.2 (-4.0 to -0.3) for no immunosuppressant (p value for between-group differences=0.346). There were no statistically significant differences in survival between protocols before (p=0.389) or after weighting (p=0.440), but survival was poorest in the no immunosuppressant group (84.0%) at 24 months.CONCLUSIONS: These findings may support using immunosuppressants for early dcSSc but suggest that overall benefit is modest over 12 months and that better treatments are needed.TRIAL REGISTRATION NUMBER: NCT02339441.
- Published
- 2017
45. Quality measures for total ankle replacement, 30-day readmission and reoperation rates within 1year of surgery: a data linkage study using the NJR data set
- Author
-
Zaidi, Razi, Macgregor, Alexander J, and Goldberg, Andy
- Subjects
Adult ,Male ,Reoperation ,Time Factors ,Information Storage and Retrieval ,ARTHROPLASTIES ,Patient Readmission ,1117 Public Health and Health Services ,Arthroplasty, Replacement, Ankle ,Medicine, General & Internal ,General & Internal Medicine ,Humans ,Registries ,data linkage ,Aged ,COMPLICATIONS ,Science & Technology ,1103 Clinical Sciences ,Middle Aged ,United Kingdom ,Logistic Models ,national joint registry ,ankle replacement ,Female ,Life Sciences & Biomedicine ,1199 Other Medical and Health Sciences - Abstract
Objective: To report on the rate of 30-day readmission and the rate of additional or revision surgery within 12 months following total ankle replacement (TAR). Design: A data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database. These two databases were linked in a deterministic fashion. HES episodes 12 months following the index procedure were isolated and analysed. Logistic regression was used to model predictors of reoperation and revision for primary ankle replacement. Participants: All patients who underwent primary and revision ankle replacements according to the NJR between February 2008 and February 2013. Results: The rate of 30-day readmission following primary and revision ankle replacement was 2.2% and 1.3%, respectively. In the 12 months following primary and revision ankle replacements, the revision rate (where implants needed to be removed) was 1.2% with increased odds in those orthopaedic units preforming
- Published
- 2016
46. Twenty-Year Outcome and Association Between Early Treatment and Mortality and Disability in an Inception Cohort of Patients With Rheumatoid Arthritis: Results From the Norfolk Arthritis Register
- Author
-
Gwinnutt, James M., primary, Symmons, Deborah P. M., additional, MacGregor, Alexander J., additional, Chipping, Jacqueline R., additional, Marshall, Tarnya, additional, Lunt, Mark, additional, and Verstappen, Suzanne M. M., additional
- Published
- 2017
- Full Text
- View/download PDF
47. E21. REVISION RATES AND POSTOPERATIVE MORTALITY FOLLOWING TOTAL KNEE REPLACEMENT IN PATIENTS WITH RHEUMATOID COMPARED TO OSTEOARTHRITIS: AN ANALYSIS OF DATA FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES AND NORTHERN IRELAND
- Author
-
Miller, Laura L., primary, Prieto-Alhambra, Daniel, additional, Trela-Larsen, Lea, additional, Wilkinson, J M., additional, MacGregor, Alexander J., additional, and Blom, Ashley, additional
- Published
- 2017
- Full Text
- View/download PDF
48. EPIDEMIOLOGYE20. REVISION RATES AND POSTOPERATIVE MORTALITY FOLLOWING TOTAL HIP REPLACEMENT IN PATIENTS WITH RHEUMATOID COMPARED TO OSTEOARTHRITIS: AN ANALYSIS OF DATA FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES AND NORTHERN IRELAND
- Author
-
Miller, Laura L., primary, Prieto-Alhambra, Daniel, additional, Trela-Larsen, Lea, additional, Wilkinson, J M., additional, Clark, Emma, additional, Blom, Ashley, additional, and MacGregor, Alexander J., additional
- Published
- 2017
- Full Text
- View/download PDF
49. 150. A COMPARISON OF THE 10 YEAR OUTCOME OF TWO COHORTS OF PATIENTS WITH EARLY RHEUMATOID ARTHRITIS RECRUITED IN 1990–94 AND 2000–04: RESULTS FROM THE NORFOLK ARTHRITIS REGISTER
- Author
-
Gwinnutt, James M., primary, Symmons, Deborah P. M., additional, MacGregor, Alexander J., additional, Chipping, Jacqueline R., additional, Marshall, Tarnya, additional, Lunt, Mark, additional, and Verstappen, Suzanne M. M., additional
- Published
- 2017
- Full Text
- View/download PDF
50. O06. RAPID ASSESSMENT PREDICTS TREATMENT RESPONSE IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS
- Author
-
Yates, Mark, primary, Norton, Sam, additional, Ledingham, Jo M., additional, Snowden, Neil, additional, Rivett, Ali, additional, Dennison, Elaine M., additional, Macgregor, Alexander J., additional, and Galloway, James, additional
- Published
- 2017
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.