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Erschienen in: Clinical Rheumatology 8/2018

16.03.2018 | Original Article

A novel biomarker in patients with knee osteoarthritis: adropin

verfasst von: Gulsah Gundogdu, Koksal Gundogdu

Erschienen in: Clinical Rheumatology | Ausgabe 8/2018

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Abstract

Adropin is newly discovered peptide hormone. Osteoarthritis (OA) is a kind of joint disease characterized by progressive joint cartilage loss and joint pain. The present study was carried out to investigate adropin and tumor necrosis factor alpha (TNF-α) levels and the relationship between adropin in patients with knee OA classified by Kellgren-Lawrence (KL). A total of 60 knee OA patients and 30 healthy controls were included in this study. KL grading was carried out using the radiographic findings. Demographic characteristics and laboratory parameters were recorded. Adropin and TNF-α levels were determined by using enzyme-linked immunosorbent assay (ELISA). Adropin level was lower in the knee OA patients compared with the healthy controls (p < 0.001), whereas TNF-α level was higher (p < 0.001). Adropin level was negatively correlated with TNF-α level, blood white blood cell (WBC) count, and neutrophil-lymphocyte ratio (NLR). However, there was a significant decrease in adropin level and an increase in TNF-α level parallel to the increase in the KL grade. In addition, serum adropin level was found to be significantly lower in KL grade 1 groups compared with healthy controls (p < 0.01). There was a decrease in adropin level parallel to the increase in the body mass index (BMI), and there was a statistically significant decrease in adropin level in knee OA patients higher than BMI > 30 (p < 0.01). Mean NLR of KL grade 4 was significantly increased compared with other grades (p < 0.05). The consequence of the present study suggested that serum adropin level could be used as a new biomarker indicating the early grade of knee OA.
Literatur
1.
Zurück zum Zitat Nawaz MS, Amer N, Asim HM (2017) Grade 1-2 osteoarthritis of knee joint; outcome of combination of grade 1-2 knee joint mobilization with quadriceps isometrics in patients. Professional Med J 24(7):986–991CrossRef Nawaz MS, Amer N, Asim HM (2017) Grade 1-2 osteoarthritis of knee joint; outcome of combination of grade 1-2 knee joint mobilization with quadriceps isometrics in patients. Professional Med J 24(7):986–991CrossRef
2.
Zurück zum Zitat Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Cote P, Hogg-Johnson S, Cassidy JD, Haldeman S (2009) Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 32(2 Suppl):141–175 Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Cote P, Hogg-Johnson S, Cassidy JD, Haldeman S (2009) Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 32(2 Suppl):141–175
3.
Zurück zum Zitat Uysal FG, Basaran S (2009) Knee Osteoarthritis. Turk Fiz Tip Rehab D 55:1–7 Uysal FG, Basaran S (2009) Knee Osteoarthritis. Turk Fiz Tip Rehab D 55:1–7
4.
Zurück zum Zitat Sokolove J, Lepus CM (2013) Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis 5(2):77–94CrossRefPubMedPubMedCentral Sokolove J, Lepus CM (2013) Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis 5(2):77–94CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Maldonado M, Nam J (2013) The role of changes in extracellular matrix of cartilage in the presence of inflammation on the pathology of osteoarthritis. Biomed Res Int 2013:284873CrossRefPubMedPubMedCentral Maldonado M, Nam J (2013) The role of changes in extracellular matrix of cartilage in the presence of inflammation on the pathology of osteoarthritis. Biomed Res Int 2013:284873CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Amin S, LaValley MP, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, Niu JB, Gale DR, Felson DT (2005) The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis Rheum 52(10):3152–3159CrossRefPubMed Amin S, LaValley MP, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, Niu JB, Gale DR, Felson DT (2005) The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis Rheum 52(10):3152–3159CrossRefPubMed
8.
Zurück zum Zitat Katz JD, Agrawal S, Velasquez M (2010) Getting to the heart of the matter: osteoarthritis takes its place as part of the metabolic syndrome. Curr Opin Rheumatol 22(5):512–519CrossRefPubMed Katz JD, Agrawal S, Velasquez M (2010) Getting to the heart of the matter: osteoarthritis takes its place as part of the metabolic syndrome. Curr Opin Rheumatol 22(5):512–519CrossRefPubMed
9.
Zurück zum Zitat Bondeson J, Blom AB, Wainwright S, Hughes C, Caterson B, van den Berg WB (2010) The role of synovial macrophages and macrophage-produced mediators in driving inflammatory and destructive responses in osteoarthritis. Arthritis Rheum 62(3):647–657CrossRefPubMed Bondeson J, Blom AB, Wainwright S, Hughes C, Caterson B, van den Berg WB (2010) The role of synovial macrophages and macrophage-produced mediators in driving inflammatory and destructive responses in osteoarthritis. Arthritis Rheum 62(3):647–657CrossRefPubMed
10.
Zurück zum Zitat Franke S, Sommer M, Ruster C, Bondeva T, Marticke J, Hofmann G, Hein G, Wolf G (2009) Advanced glycation end products induce cell cycle arrest and proinflammatory changes in osteoarthritic fibroblast-like synovial cells. Arthritis Res Ther 11(5):1–19CrossRef Franke S, Sommer M, Ruster C, Bondeva T, Marticke J, Hofmann G, Hein G, Wolf G (2009) Advanced glycation end products induce cell cycle arrest and proinflammatory changes in osteoarthritic fibroblast-like synovial cells. Arthritis Res Ther 11(5):1–19CrossRef
11.
Zurück zum Zitat Kumar KG, Trevaskis JL, Lam DD, Sutton GM, Koza RA, Chouljenko VN, Kousoulas KG, Rogers PM, Kesterson RA, Thearle M, Ferrante AW, Mynatt RL, Burris TP, Dong JZ, Halem HA, Culler MD, Heisler LK, Stephens JM, Butler AA (2008) Identification of Adropin as a Secreted Factor Linking Dietary Macronutrient Intake with Energy Homeostasis and Lipid Metabolism. Cell Metab 8(6):468-481CrossRefPubMedPubMedCentral Kumar KG, Trevaskis JL, Lam DD, Sutton GM, Koza RA, Chouljenko VN, Kousoulas KG, Rogers PM, Kesterson RA, Thearle M, Ferrante AW, Mynatt RL, Burris TP, Dong JZ, Halem HA, Culler MD, Heisler LK, Stephens JM, Butler AA (2008) Identification of Adropin as a Secreted Factor Linking Dietary Macronutrient Intake with Energy Homeostasis and Lipid Metabolism. Cell Metab 8(6):468-481CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Lian WL, Gu XS, Qin YW, Zheng X (2011) Elevated Plasma Levels of Adropin in Heart Failure Patients. Internal Med 50(15):1523–1527CrossRef Lian WL, Gu XS, Qin YW, Zheng X (2011) Elevated Plasma Levels of Adropin in Heart Failure Patients. Internal Med 50(15):1523–1527CrossRef
13.
Zurück zum Zitat Butler AA, Tam CS, Stanhope KL, Wolfe BM, Ali MR, O’Keeffe M, St-Onge MP, Ravussin E, Havel PJ (2012) Low Circulating Adropin Concentrations with Obesity and Aging Correlate with Risk Factors for Metabolic Disease and Increase after Gastric Bypass Surgery in Humans. J Clin Endocr Metab 97(10):3783–3791CrossRefPubMed Butler AA, Tam CS, Stanhope KL, Wolfe BM, Ali MR, O’Keeffe M, St-Onge MP, Ravussin E, Havel PJ (2012) Low Circulating Adropin Concentrations with Obesity and Aging Correlate with Risk Factors for Metabolic Disease and Increase after Gastric Bypass Surgery in Humans. J Clin Endocr Metab 97(10):3783–3791CrossRefPubMed
14.
Zurück zum Zitat Chen M, Ouyang F, Zhou SH (2015) Adropin as a novel energy factor likely has the ability to regulate blood pressure. Med Hypotheses 85(2):234CrossRefPubMed Chen M, Ouyang F, Zhou SH (2015) Adropin as a novel energy factor likely has the ability to regulate blood pressure. Med Hypotheses 85(2):234CrossRefPubMed
15.
Zurück zum Zitat Celik E, Yilmaz E, Celik O, Ulas M, Turkcuoglu I, Karaer A, Simsek Y, Minareci Y, Aydin S (2013) Maternal and fetal adropin levels in gestational diabetes mellitus. J Perinat Med 41(4):375–380CrossRefPubMed Celik E, Yilmaz E, Celik O, Ulas M, Turkcuoglu I, Karaer A, Simsek Y, Minareci Y, Aydin S (2013) Maternal and fetal adropin levels in gestational diabetes mellitus. J Perinat Med 41(4):375–380CrossRefPubMed
16.
Zurück zum Zitat Gu XS, Li H, Zhu XY, Gu HB, Chen JC, Wang LC, Harding P, Xu WT (2015) Inverse correlation between plasma adropin and ET-1 levels in essential hypertension: a cross-sectional study. Medicine 94(40):1–5CrossRef Gu XS, Li H, Zhu XY, Gu HB, Chen JC, Wang LC, Harding P, Xu WT (2015) Inverse correlation between plasma adropin and ET-1 levels in essential hypertension: a cross-sectional study. Medicine 94(40):1–5CrossRef
17.
Zurück zum Zitat Kumar KG, Zhang JY, Gao S, Rossi J, McGuinness OP, Halem HH, Culler MD, Mynatt RL, Butler AA (2012) Adropin Deficiency Is Associated With Increased Adiposity and Insulin Resistance. Obesity 20(7):1394–1402 Kumar KG, Zhang JY, Gao S, Rossi J, McGuinness OP, Halem HH, Culler MD, Mynatt RL, Butler AA (2012) Adropin Deficiency Is Associated With Increased Adiposity and Insulin Resistance. Obesity 20(7):1394–1402
18.
Zurück zum Zitat Li ZM, Li M (2017) Improvement in orthopedic outcome score and reduction in IL-1β, CXCL13, and TNF-α in synovial fluid of osteoarthritis patients following arthroscopic knee surgery. Genet Mol Res 16(3):1–9CrossRef Li ZM, Li M (2017) Improvement in orthopedic outcome score and reduction in IL-1β, CXCL13, and TNF-α in synovial fluid of osteoarthritis patients following arthroscopic knee surgery. Genet Mol Res 16(3):1–9CrossRef
19.
Zurück zum Zitat Sasek C (2015) An update on primary care management of knee osteoarthritis. Jaapa-J Am Acad Phys 28(1):37-44 Sasek C (2015) An update on primary care management of knee osteoarthritis. Jaapa-J Am Acad Phys 28(1):37-44
20.
Zurück zum Zitat Johnson VL, Hunter DJ (2014) The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol 28:5–15CrossRefPubMed Johnson VL, Hunter DJ (2014) The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol 28:5–15CrossRefPubMed
21.
Zurück zum Zitat Grazio S, Balen D (2009) Obesity: risk factor and predictor of osteoarthritis. Lijec Vjesn 131(1–2):22–26PubMed Grazio S, Balen D (2009) Obesity: risk factor and predictor of osteoarthritis. Lijec Vjesn 131(1–2):22–26PubMed
22.
Zurück zum Zitat Lementowski PW, Zelicof SB (2008) Obesity and osteoarthritis. Am J Orthop 37:148–151PubMed Lementowski PW, Zelicof SB (2008) Obesity and osteoarthritis. Am J Orthop 37:148–151PubMed
23.
Zurück zum Zitat Engstrom G, de Verdier MG, Rollof J, Nilsson PM, Lohmander LS (2009) C-reactive protein, metabolic syndrome and incidence of severe hip and knee osteoarthritis. A population-based cohort study. Osteoarthr Cartilage 17(2):168–173 Engstrom G, de Verdier MG, Rollof J, Nilsson PM, Lohmander LS (2009) C-reactive protein, metabolic syndrome and incidence of severe hip and knee osteoarthritis. A population-based cohort study. Osteoarthr Cartilage 17(2):168–173 
24.
Zurück zum Zitat Gandhi R, Razak F, Tso P, Davey JR, Mahomed NN (2010) Asian ethnicity and the prevalence of metabolic syndrome in the osteoarthritic total knee arthroplasty population. J Arthroplast 25(3):416–419CrossRef Gandhi R, Razak F, Tso P, Davey JR, Mahomed NN (2010) Asian ethnicity and the prevalence of metabolic syndrome in the osteoarthritic total knee arthroplasty population. J Arthroplast 25(3):416–419CrossRef
25.
Zurück zum Zitat Han CD, Yang IH, Lee WS, Park YJ, Park KK (2013) Correlation between metabolic syndrome and knee osteoarthritis: data from the Korean National Health and Nutrition Examination Survey (KNHANES). BMC Public Health 13(603):1–8 Han CD, Yang IH, Lee WS, Park YJ, Park KK (2013) Correlation between metabolic syndrome and knee osteoarthritis: data from the Korean National Health and Nutrition Examination Survey (KNHANES). BMC Public Health 13(603):1–8
26.
Zurück zum Zitat Hussain SM, Wang YY, Cicuttini FM, Simpson JA, Giles GG, Graves S, Wluka AE (2014) Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study. Semin Arthritis Rheu 43(4):429–436CrossRef Hussain SM, Wang YY, Cicuttini FM, Simpson JA, Giles GG, Graves S, Wluka AE (2014) Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study. Semin Arthritis Rheu 43(4):429–436CrossRef
27.
Zurück zum Zitat Kurz B, Lemke AK, Fay J, Pufe T, Grodzinsky AJ, Schünke M (2005) Pathomechanisms of cartilage destruction by mechanical injury. Ann Anat 187:473–485CrossRefPubMed Kurz B, Lemke AK, Fay J, Pufe T, Grodzinsky AJ, Schünke M (2005) Pathomechanisms of cartilage destruction by mechanical injury. Ann Anat 187:473–485CrossRefPubMed
28.
Zurück zum Zitat Vasilic-Brasnjevic S, Marinkovic J, Vlajinac H, Vasiljevic N, Jakovljevic B, Nikic M, Maksimovic M (2016) Association of body mass index and waist circumference with severity of knee osteoarthritis. Acta Reumatol Port 41:226–231PubMed Vasilic-Brasnjevic S, Marinkovic J, Vlajinac H, Vasiljevic N, Jakovljevic B, Nikic M, Maksimovic M (2016) Association of body mass index and waist circumference with severity of knee osteoarthritis. Acta Reumatol Port 41:226–231PubMed
29.
Zurück zum Zitat Sayin O, Tokgoz Y, Arslan N (2014) Investigation of adropin and leptin levels in pediatric obesity-related nonalcoholic fatty liver disease. J Pediatr Endocr Met 27(5-6):479–484 Sayin O, Tokgoz Y, Arslan N (2014) Investigation of adropin and leptin levels in pediatric obesity-related nonalcoholic fatty liver disease. J Pediatr Endocr Met 27(5-6):479–484
30.
Zurück zum Zitat Topuz M, Celik A, Aslantas T, Demir AK, Aydin S, Aydin S (2013) Plasma Adropin Levels Predict Endothelial Dysfunction Like Flow-Mediated Dilatation in Patients With Type 2 Diabetes Mellitus. J Invest Med 61(8):1161–1164CrossRef Topuz M, Celik A, Aslantas T, Demir AK, Aydin S, Aydin S (2013) Plasma Adropin Levels Predict Endothelial Dysfunction Like Flow-Mediated Dilatation in Patients With Type 2 Diabetes Mellitus. J Invest Med 61(8):1161–1164CrossRef
31.
Zurück zum Zitat Orlowsky EW, Kraus VB (2015) The role of innate immunity in osteoarthritis: when our first line of defense goes on the offensive. J Rheumatol 42(3):363–371CrossRefPubMedPubMedCentral Orlowsky EW, Kraus VB (2015) The role of innate immunity in osteoarthritis: when our first line of defense goes on the offensive. J Rheumatol 42(3):363–371CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat He R, Yang L, Guo L (2011) Painful locking of the knee due to bucket handle tear of mediopatellar plica. Chin J Traumatol 14:117–119PubMed He R, Yang L, Guo L (2011) Painful locking of the knee due to bucket handle tear of mediopatellar plica. Chin J Traumatol 14:117–119PubMed
33.
Zurück zum Zitat Nelson FR (2014) A background for the management of osteoarthritic knee pain. Pain Manag 4(6):427–436CrossRefPubMed Nelson FR (2014) A background for the management of osteoarthritic knee pain. Pain Manag 4(6):427–436CrossRefPubMed
34.
Zurück zum Zitat Hotamisligil GS, Shargill NS, Spiegelman BM (1993) Adipose Expression of Tumor-Necrosis-Factor-Alpha - Direct Role in Obesity-Linked Insulin Resistance. Science 259(5091):87–91CrossRefPubMed Hotamisligil GS, Shargill NS, Spiegelman BM (1993) Adipose Expression of Tumor-Necrosis-Factor-Alpha - Direct Role in Obesity-Linked Insulin Resistance. Science 259(5091):87–91CrossRefPubMed
35.
Zurück zum Zitat Spiegelman BM, Flier JS (2001) Obesity and the regulation of energy balance. Cell 104(4):531–543CrossRefPubMed Spiegelman BM, Flier JS (2001) Obesity and the regulation of energy balance. Cell 104(4):531–543CrossRefPubMed
36.
Zurück zum Zitat Chen XP, Xun KL, Chen LD, Wang YT (2009) TNF-alpha, a potent lipid metabolism regulator. Cell Biochem Funct 27(7):407–416CrossRefPubMed Chen XP, Xun KL, Chen LD, Wang YT (2009) TNF-alpha, a potent lipid metabolism regulator. Cell Biochem Funct 27(7):407–416CrossRefPubMed
37.
Zurück zum Zitat Gupta-Ganguli M, Cox K, Means B, Gerling I, Solomon SS (2011) Does therapy with anti-TNF-alpha improve glucose tolerance and control in patients with type 2 diabetes? Diabetes Care 34(7):e121CrossRefPubMedPubMedCentral Gupta-Ganguli M, Cox K, Means B, Gerling I, Solomon SS (2011) Does therapy with anti-TNF-alpha improve glucose tolerance and control in patients with type 2 diabetes? Diabetes Care 34(7):e121CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Finck BN, Johnson RW (2000) Tumor necrosis factor-alpha regulates secretion of the adipocyte-derived cytokine, leptin. Microsc Res Techniq 50(3):209–215CrossRef Finck BN, Johnson RW (2000) Tumor necrosis factor-alpha regulates secretion of the adipocyte-derived cytokine, leptin. Microsc Res Techniq 50(3):209–215CrossRef
39.
Zurück zum Zitat Rask-Madsen C, Dominguez H, Ihlemann N, Hermann T, Kober L, Torp-Pedersen C (2003) Tumor necrosis factor-alpha inhibits insulin’s stimulating effect on glucose uptake and endothelium-dependent vasodilation in humans. Circulation 108(15):1815–1821CrossRefPubMed Rask-Madsen C, Dominguez H, Ihlemann N, Hermann T, Kober L, Torp-Pedersen C (2003) Tumor necrosis factor-alpha inhibits insulin’s stimulating effect on glucose uptake and endothelium-dependent vasodilation in humans. Circulation 108(15):1815–1821CrossRefPubMed
40.
Zurück zum Zitat Plomgaard P, Bouzakri K, Krogh-Madsen R, Mittendorfer B, Zierath JR, Pedersen BK (2005) Tumor necrosis factor-alpha induces skeletal muscle insulin resistance in healthy human subjects via inhibition of Akt substrate 160 phosphorylation. Diabetes 54:2939–2945CrossRefPubMed Plomgaard P, Bouzakri K, Krogh-Madsen R, Mittendorfer B, Zierath JR, Pedersen BK (2005) Tumor necrosis factor-alpha induces skeletal muscle insulin resistance in healthy human subjects via inhibition of Akt substrate 160 phosphorylation. Diabetes 54:2939–2945CrossRefPubMed
41.
Zurück zum Zitat Shao N, Cai Q (2015) High pretreatment neutrophil-lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer. Clin Transl Oncol 17(10):772–778CrossRefPubMed Shao N, Cai Q (2015) High pretreatment neutrophil-lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer. Clin Transl Oncol 17(10):772–778CrossRefPubMed
42.
Zurück zum Zitat Buyukkaya E, Karakas MF, Karakas E, Akcay AB, Tanboga IH, Kurt M, Sen N (2014) Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 20(2):159–163CrossRefPubMed Buyukkaya E, Karakas MF, Karakas E, Akcay AB, Tanboga IH, Kurt M, Sen N (2014) Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 20(2):159–163CrossRefPubMed
43.
Zurück zum Zitat Demirci S, Demirci S, Kutluhan S, Koyuncuoğlu HR, Yürekli VA (2016) The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis. Int J Neurosci 126(8):700–706PubMed Demirci S, Demirci S, Kutluhan S, Koyuncuoğlu HR, Yürekli VA (2016) The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis. Int J Neurosci 126(8):700–706PubMed
44.
Zurück zum Zitat Suliman MARM, Juma AAB, Almadhani AAA, Pathare AV, Alkindi SSA, Werner FU (2010) Predictive Value of Neutrophil to Lymphocyte Ratio in Outcomes of Patients with Acute Coronary Syndrome. Arch Med Res 41(8):618–622 Suliman MARM, Juma AAB, Almadhani AAA, Pathare AV, Alkindi SSA, Werner FU (2010) Predictive Value of Neutrophil to Lymphocyte Ratio in Outcomes of Patients with Acute Coronary Syndrome. Arch Med Res 41(8):618–622
45.
Zurück zum Zitat Tasoglu O, Boluk H, Onat SS, Tasoglu I, Ozgirgin N (2016) Is blood neutrophil-lymphocyte ratio an independent predictor of knee osteoarthritis severity? Clin Rheumatol 35(6):1579–1583CrossRefPubMed Tasoglu O, Boluk H, Onat SS, Tasoglu I, Ozgirgin N (2016) Is blood neutrophil-lymphocyte ratio an independent predictor of knee osteoarthritis severity? Clin Rheumatol 35(6):1579–1583CrossRefPubMed
Metadaten
Titel
A novel biomarker in patients with knee osteoarthritis: adropin
verfasst von
Gulsah Gundogdu
Koksal Gundogdu
Publikationsdatum
16.03.2018
Verlag
Springer London
Erschienen in
Clinical Rheumatology / Ausgabe 8/2018
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-018-4052-z

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