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Erschienen in: Rheumatology International 11/2017

07.09.2017 | Health Services Research

Incidence of comprehensive hospitalization due to infection, cardiovascular disease, fractures, and malignancies in patients with rheumatoid arthritis

verfasst von: Naoki Sugimoto, Ayako Nakajima, Eisuke Inoue, Kumi Shidara, Hiroyuki Yamashita, Akio Mimori, Hitoshi Tokuda, Yohei Seto, Eiichi Tanaka, Shigeki Momohara, Atsuo Taniguchi, Hisashi Yamanaka

Erschienen in: Rheumatology International | Ausgabe 11/2017

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Abstract

To comprehensively analyze the overall incidence of hospitalization for comorbidities in patients with rheumatoid arthritis (RA). We prospectively analyzed overall hospitalizations for comorbidities using the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort. The incidence of hospitalized comorbidity was calculated. Risk factors for the most frequent hospitalized comorbidities were determined by multivariate logistic regression analysis. Among 5519 RA patients contributing 5336.5 person-years of observation, 435 incidences of hospitalized comorbidity [8.15/100 person-years; 95% confidence interval (CI) 7.40–8.95] were confirmed. The most frequent cause of hospitalized comorbidity was infection (1.52/100 person-years), primarily respiratory system infection (0.77/100 person-years), followed by malignancy (1.03/100 person-years), extra-articular manifestations (0.78/100 person-years), bone fracture (0.77/100 person-years), and acute coronary syndrome (0.22/100 person-years). Death occurred in 0.34/100 person-years (95% CI 0.20–0.53), and in 94.4% of cases the cause of death was the same as that of admission. The risk factors for the most frequent cause of hospitalization, hospitalized infection, were age [odds ratio (OR) 1.03; 95% CI 1.00–1.05], serum albumin level (OR 0.30; 95% CI 0.13–0.69), and corticosteroid use (prednisone > 5 mg/day; OR 3.66; 95% CI 1.81–7.35), but not methotrexate or biological agent use. The present study determined the overall burden of hospitalized comorbidities in patients with RA. These comprehensive data on hospitalized comorbidities may provide a basis for future improvements in the treatment of RA.
Literatur
1.
Zurück zum Zitat Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 21:885–906CrossRefPubMed Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 21:885–906CrossRefPubMed
2.
Zurück zum Zitat Solomon DH, Reed GW, Kremer JM et al (2015) Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis Rheumatol 67:1449–1455CrossRefPubMedPubMedCentral Solomon DH, Reed GW, Kremer JM et al (2015) Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis Rheumatol 67:1449–1455CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Bongartz T, Nannini C, Medina-Velasquez YF et al (2010) Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 62:1583–1591CrossRefPubMedPubMedCentral Bongartz T, Nannini C, Medina-Velasquez YF et al (2010) Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 62:1583–1591CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Lindhardsen J, Ahlehoff O, Gislason GH et al (2011) The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 70:929–934CrossRefPubMed Lindhardsen J, Ahlehoff O, Gislason GH et al (2011) The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 70:929–934CrossRefPubMed
5.
Zurück zum Zitat Wolfe F, Michaud K (2004) Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18,572 patients. Arthritis Rheum 50:1740–1751CrossRefPubMed Wolfe F, Michaud K (2004) Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18,572 patients. Arthritis Rheum 50:1740–1751CrossRefPubMed
6.
Zurück zum Zitat Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK (2000) Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 43:522–530CrossRefPubMed Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK (2000) Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 43:522–530CrossRefPubMed
7.
Zurück zum Zitat van Staa TP, Geusens P, Bijlsma JW, Leufkens HG, Cooper C (2006) Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 54:3104–3112CrossRefPubMed van Staa TP, Geusens P, Bijlsma JW, Leufkens HG, Cooper C (2006) Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 54:3104–3112CrossRefPubMed
8.
Zurück zum Zitat Kim SY, Schneeweiss S, Liu J et al (2010) Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 12:R154CrossRefPubMedPubMedCentral Kim SY, Schneeweiss S, Liu J et al (2010) Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 12:R154CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Ochi K, Inoue E, Furuya T et al (2015) Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture. Osteoporos Int 26:961–968CrossRefPubMed Ochi K, Inoue E, Furuya T et al (2015) Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture. Osteoporos Int 26:961–968CrossRefPubMed
10.
Zurück zum Zitat Greenberg JD, Reed G, Kremer JM et al (2010) Association of methotrexate and tumour necrosis factor antagonists with risk of infectious outcomes including opportunistic infections in the CORRONA registry. Ann Rheum Dis 69:380–386CrossRefPubMed Greenberg JD, Reed G, Kremer JM et al (2010) Association of methotrexate and tumour necrosis factor antagonists with risk of infectious outcomes including opportunistic infections in the CORRONA registry. Ann Rheum Dis 69:380–386CrossRefPubMed
11.
Zurück zum Zitat Askling J, Fored CM, Brandt L et al (2005) Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum 52:1986–1992CrossRefPubMed Askling J, Fored CM, Brandt L et al (2005) Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum 52:1986–1992CrossRefPubMed
12.
Zurück zum Zitat Harigai M, Koike R, Miyasaka N, Pneumocystis Pneumonia under Anti-Tumor Necrosis Factor Therapy Study G (2007) Pneumocystis pneumonia associated with infliximab in Japan. N Engl J Med 357:1874–1876CrossRefPubMed Harigai M, Koike R, Miyasaka N, Pneumocystis Pneumonia under Anti-Tumor Necrosis Factor Therapy Study G (2007) Pneumocystis pneumonia associated with infliximab in Japan. N Engl J Med 357:1874–1876CrossRefPubMed
13.
Zurück zum Zitat Smitten AL, Choi HK, Hochberg MC et al (2007) The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom. Arthritis Rheum 57:1431–1438CrossRefPubMed Smitten AL, Choi HK, Hochberg MC et al (2007) The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom. Arthritis Rheum 57:1431–1438CrossRefPubMed
14.
Zurück zum Zitat Widdifield J, Bernatsky S, Paterson JM et al (2013) Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res (Hoboken) 65:353–361CrossRef Widdifield J, Bernatsky S, Paterson JM et al (2013) Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res (Hoboken) 65:353–361CrossRef
15.
Zurück zum Zitat Smolen JS, Aletaha D, Bijlsma JW et al (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637CrossRefPubMedPubMedCentral Smolen JS, Aletaha D, Bijlsma JW et al (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Nakajima A, Inoue E, Shimizu Y et al (2015) Presence of comorbidity affects both treatment strategies and outcomes in disease activity, physical function, and quality of life in patients with rheumatoid arthritis. Clin Rheumatol 34:441–449CrossRefPubMed Nakajima A, Inoue E, Shimizu Y et al (2015) Presence of comorbidity affects both treatment strategies and outcomes in disease activity, physical function, and quality of life in patients with rheumatoid arthritis. Clin Rheumatol 34:441–449CrossRefPubMed
17.
Zurück zum Zitat Radner H, Smolen JS, Aletaha D (2010) Impact of comorbidity on physical function in patients with rheumatoid arthritis. Ann Rheum Dis 69:536–541CrossRefPubMed Radner H, Smolen JS, Aletaha D (2010) Impact of comorbidity on physical function in patients with rheumatoid arthritis. Ann Rheum Dis 69:536–541CrossRefPubMed
18.
Zurück zum Zitat Radner H, Smolen JS, Aletaha D (2011) Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis. Rheumatology (Oxford) 50:381–388CrossRef Radner H, Smolen JS, Aletaha D (2011) Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis. Rheumatology (Oxford) 50:381–388CrossRef
19.
Zurück zum Zitat Ranganath VK, Maranian P, Elashoff DA et al (2013) Comorbidities are associated with poorer outcomes in community patients with rheumatoid arthritis. Rheumatology (Oxford) 52:1809–1817CrossRef Ranganath VK, Maranian P, Elashoff DA et al (2013) Comorbidities are associated with poorer outcomes in community patients with rheumatoid arthritis. Rheumatology (Oxford) 52:1809–1817CrossRef
20.
Zurück zum Zitat Wolfe F, Mitchell DM, Sibley JT et al (1994) The mortality of rheumatoid arthritis. Arthritis Rheum 37:481–494CrossRefPubMed Wolfe F, Mitchell DM, Sibley JT et al (1994) The mortality of rheumatoid arthritis. Arthritis Rheum 37:481–494CrossRefPubMed
21.
Zurück zum Zitat Osiri M, Sattayasomboon Y (2013) Prevalence and out-patient medical costs of comorbid conditions in patients with rheumatoid arthritis. Joint Bone Spine 80:608–612CrossRefPubMed Osiri M, Sattayasomboon Y (2013) Prevalence and out-patient medical costs of comorbid conditions in patients with rheumatoid arthritis. Joint Bone Spine 80:608–612CrossRefPubMed
22.
Zurück zum Zitat Nakajima A, Inoue E, Taniguchi A, Momohara S, Yamanaka H (2016) Effectiveness of tacrolimus in comparison with methotrexate or biologics in propensity score-matched patients with rheumatoid arthritis. Mod Rheumatol 26:836–843CrossRefPubMed Nakajima A, Inoue E, Taniguchi A, Momohara S, Yamanaka H (2016) Effectiveness of tacrolimus in comparison with methotrexate or biologics in propensity score-matched patients with rheumatoid arthritis. Mod Rheumatol 26:836–843CrossRefPubMed
23.
Zurück zum Zitat Yamanaka H, Seto Y, Tanaka E et al (2013) Management of rheumatoid arthritis: the 2012 perspective. Mod Rheumatol 23:1–7CrossRefPubMed Yamanaka H, Seto Y, Tanaka E et al (2013) Management of rheumatoid arthritis: the 2012 perspective. Mod Rheumatol 23:1–7CrossRefPubMed
24.
Zurück zum Zitat Matsuda Y, Singh G, Yamanaka H et al (2003) Validation of a Japanese version of the Stanford Health Assessment Questionnaire in 3,763 patients with rheumatoid arthritis. Arthritis Rheum 49:784–788CrossRefPubMed Matsuda Y, Singh G, Yamanaka H et al (2003) Validation of a Japanese version of the Stanford Health Assessment Questionnaire in 3,763 patients with rheumatoid arthritis. Arthritis Rheum 49:784–788CrossRefPubMed
25.
Zurück zum Zitat Team TJET (1998) The development of the Japanese EuroQol instrument (in Japanese). J Health Care Soc 8:109–123 Team TJET (1998) The development of the Japanese EuroQol instrument (in Japanese). J Health Care Soc 8:109–123
26.
Zurück zum Zitat Prevoo ML, van ‘t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48CrossRefPubMed Prevoo ML, van ‘t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48CrossRefPubMed
27.
Zurück zum Zitat Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46:2287–2293CrossRefPubMed Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46:2287–2293CrossRefPubMed
28.
Zurück zum Zitat Bernatsky S, Hudson M, Suissa S (2007) Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford) 46:1157–1160CrossRef Bernatsky S, Hudson M, Suissa S (2007) Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford) 46:1157–1160CrossRef
29.
Zurück zum Zitat Smitten AL, Choi HK, Hochberg MC et al (2008) The risk of hospitalized infection in patients with rheumatoid arthritis. J Rheumatol 35:387–393PubMed Smitten AL, Choi HK, Hochberg MC et al (2008) The risk of hospitalized infection in patients with rheumatoid arthritis. J Rheumatol 35:387–393PubMed
30.
Zurück zum Zitat Au K, Reed G, Curtis JR et al (2011) High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis 70:785–791CrossRefPubMed Au K, Reed G, Curtis JR et al (2011) High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis 70:785–791CrossRefPubMed
31.
Zurück zum Zitat Dixon WG, Symmons DP, Lunt M, Watson KD, Hyrich KL, Silman AJ (2007) Serious infection following anti-tumor necrosis factor alpha therapy in patients with rheumatoid arthritis: lessons from interpreting data from observational studies. Arthritis Rheum 56:2896–2904CrossRefPubMedPubMedCentral Dixon WG, Symmons DP, Lunt M, Watson KD, Hyrich KL, Silman AJ (2007) Serious infection following anti-tumor necrosis factor alpha therapy in patients with rheumatoid arthritis: lessons from interpreting data from observational studies. Arthritis Rheum 56:2896–2904CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Curtis JR, Xi J, Patkar N, Xie A, Saag KG, Martin C (2007) Drug-specific and time-dependent risks of bacterial infection among patients with rheumatoid arthritis who were exposed to tumor necrosis factor alpha antagonists. Arthritis Rheum 56:4226–4227CrossRefPubMedPubMedCentral Curtis JR, Xi J, Patkar N, Xie A, Saag KG, Martin C (2007) Drug-specific and time-dependent risks of bacterial infection among patients with rheumatoid arthritis who were exposed to tumor necrosis factor alpha antagonists. Arthritis Rheum 56:4226–4227CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Galloway JB, Hyrich KL, Mercer LK et al (2011) Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford) 50:124–131CrossRef Galloway JB, Hyrich KL, Mercer LK et al (2011) Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford) 50:124–131CrossRef
34.
Zurück zum Zitat Hayashi H, Satoi K, Sato-Mito N et al (2012) Nutritional status in relation to adipokines and oxidative stress is associated with disease activity in patients with rheumatoid arthritis. Nutrition 28:1109–1114CrossRefPubMed Hayashi H, Satoi K, Sato-Mito N et al (2012) Nutritional status in relation to adipokines and oxidative stress is associated with disease activity in patients with rheumatoid arthritis. Nutrition 28:1109–1114CrossRefPubMed
35.
Zurück zum Zitat Redlich K, Smolen JS (2012) Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 11:234–250CrossRefPubMed Redlich K, Smolen JS (2012) Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 11:234–250CrossRefPubMed
36.
Zurück zum Zitat Coulson KA, Reed G, Gilliam BE, Kremer JM, Pepmueller PH (2009) Factors influencing fracture risk, T score, and management of osteoporosis in patients with rheumatoid arthritis in the Consortium of Rheumatology Researchers of North America (CORRONA) registry. J Clin Rheumatol 15:155–160CrossRefPubMed Coulson KA, Reed G, Gilliam BE, Kremer JM, Pepmueller PH (2009) Factors influencing fracture risk, T score, and management of osteoporosis in patients with rheumatoid arthritis in the Consortium of Rheumatology Researchers of North America (CORRONA) registry. J Clin Rheumatol 15:155–160CrossRefPubMed
37.
Zurück zum Zitat Ishida O, Furuya T, Inoue E et al (2015) Risk factors for established vertebral fractures in Japanese patients with rheumatoid arthritis: results from a large prospective observational cohort study. Mod Rheumatol 25:373–378CrossRefPubMed Ishida O, Furuya T, Inoue E et al (2015) Risk factors for established vertebral fractures in Japanese patients with rheumatoid arthritis: results from a large prospective observational cohort study. Mod Rheumatol 25:373–378CrossRefPubMed
38.
Zurück zum Zitat Masuda H, Miyazaki T, Shimada K et al (2014) Disease duration and severity impacts on long-term cardiovascular events in Japanese patients with rheumatoid arthritis. J Cardiol 64:366–370CrossRefPubMed Masuda H, Miyazaki T, Shimada K et al (2014) Disease duration and severity impacts on long-term cardiovascular events in Japanese patients with rheumatoid arthritis. J Cardiol 64:366–370CrossRefPubMed
39.
Zurück zum Zitat Solomon DH, Kremer J, Curtis JR et al (2010) Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity. Ann Rheum Dis 69:1920–1925CrossRefPubMedPubMedCentral Solomon DH, Kremer J, Curtis JR et al (2010) Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity. Ann Rheum Dis 69:1920–1925CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat Suissa S, Bernatsky S, Hudson M (2006) Antirheumatic drug use and the risk of acute myocardial infarction. Arthritis Rheum 55:531–536CrossRefPubMed Suissa S, Bernatsky S, Hudson M (2006) Antirheumatic drug use and the risk of acute myocardial infarction. Arthritis Rheum 55:531–536CrossRefPubMed
41.
42.
Zurück zum Zitat Takii T, Yasuda S, Takahashi J et al (2010) Trends in acute myocardial infarction incidence and mortality over 30 years in Japan: report from the MIYAGI-AMI Registry Study. Circ J 74:93–100CrossRefPubMed Takii T, Yasuda S, Takahashi J et al (2010) Trends in acute myocardial infarction incidence and mortality over 30 years in Japan: report from the MIYAGI-AMI Registry Study. Circ J 74:93–100CrossRefPubMed
43.
Zurück zum Zitat Smitten AL, Simon TA, Hochberg MC, Suissa S (2008) A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Res Ther 10:R45CrossRefPubMedPubMedCentral Smitten AL, Simon TA, Hochberg MC, Suissa S (2008) A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Res Ther 10:R45CrossRefPubMedPubMedCentral
44.
Zurück zum Zitat Baecklund E, Iliadou A, Askling J et al (2006) Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 54:692–701CrossRefPubMed Baecklund E, Iliadou A, Askling J et al (2006) Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 54:692–701CrossRefPubMed
45.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed
46.
Zurück zum Zitat Radner H, Yoshida K, Mjaavatten MD et al (2015) Development of a multimorbidity index: impact on quality of life using a rheumatoid arthritis cohort. Semin Arthritis Rheum 45:167–173CrossRefPubMed Radner H, Yoshida K, Mjaavatten MD et al (2015) Development of a multimorbidity index: impact on quality of life using a rheumatoid arthritis cohort. Semin Arthritis Rheum 45:167–173CrossRefPubMed
Metadaten
Titel
Incidence of comprehensive hospitalization due to infection, cardiovascular disease, fractures, and malignancies in patients with rheumatoid arthritis
verfasst von
Naoki Sugimoto
Ayako Nakajima
Eisuke Inoue
Kumi Shidara
Hiroyuki Yamashita
Akio Mimori
Hitoshi Tokuda
Yohei Seto
Eiichi Tanaka
Shigeki Momohara
Atsuo Taniguchi
Hisashi Yamanaka
Publikationsdatum
07.09.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Rheumatology International / Ausgabe 11/2017
Print ISSN: 0172-8172
Elektronische ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-017-3811-5

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