Abstract
Objectives
To examine the incidence, predictors and outcomes associated with severe gastrointestinal (GI) disease in a large inception SSc cohort.
Methods
SSc subjects with <2 years of ...disease duration were identified from two multicentre cohorts. Severe GI disease was defined as: malabsorption, hyperalimentation, pseudo-obstruction and/or ⩾10% weight loss in association with the use of antibiotics for bacterial overgrowth or oesophageal stricture. Kaplan-Meier, multivariate logistic regression and Cox proportional hazard analyses were performed to determine the cumulative incidence rate, independent clinical correlates and mortality rate associated with severe GI disease. A longitudinal mixed model was used to assess the impact of severe GI disease on the Short Form Health Survey.
Results
In this inception SSc cohort, the probability of developing severe GI disease was estimated at 9.1% at 2 years and 16.0% at 4 years. In multivariate analysis, severe GI disease was associated with inflammatory myositis (odds ratio 4.68, 95% CI 1.65, 13.24), telangiectasias (odds ratio 2.45, 95% CI 1.19, 5.04) and modified Rodnan skin score (odds ratio 1.03, 95% CI 1.01, 1.07). Severe GI disease was associated with a >2-fold increase in the risk of death (hazard ratio 2.27, 95% CI 1.27, 4.09) and worse health-related quality of life Short Form Health Survey physical (β = −2.37, P = 0.02) and mental (β = −2.86, P = 0.01) component summary scores.
Conclusion
Severe GI disease is common in early SSc and is associated with significant morbidity and increased mortality. More research is needed to understand, prevent and mitigate severe GI disease in SSc.
Background:
Axial spondyloarthritis (axSpA) presents diagnostic challenges incurring a delay of up to a decade and relies considerably on radiographic and MRI evidence of sacroiliitis which has led ...to the development of classification criteria which also rely on imaging. However, it has been suggested that such criteria may not be appropriate for axSpA patients presenting with other forms of SpA, especially psoriatic, because imaging features may vary in frequency and/or may be atypical. This hypothesis has never been tested in a prospective inception cohort of patients presenting with undiagnosed back pain.
Objectives:
We aimed to compare the spectrum of radiographic and MRI abnormalities in the sacroiliac joint (SIJ) of an inception cohort of patients presenting with undiagnosed back pain and psoriasis, iritis, and colitis.
Methods:
We used data from the prospective multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study, which is aimed at early detection of axial SpA in patients referred by the respective specialist after first presenting with these disorders. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, AAU, or colitis undergo routine clinical evaluation by a rheumatologist for axial SpA followed by imaging. In SASPIC I, MRI evaluation of the SIJ was ordered per rheumatologist decision. In SASPIC II, MRI evaluation was ordered for all patients. Radiographs and MRI scans were assessed by two central readers and comparisons of the three groups were based on concordant assessments of imaging features. Evaluation of MRI scans included both global assessment for presence/absence of axSpA with confidence scale (-10 to +10), active and structural lesions typical of axSpA per recent ASAS definitions, and granular assessment of individual lesions according to SIJ quadrants and halves in consecutive semicoronal slices through the SIJ. Groups were compared by ANOVA and the chi-square test.
Results:
A total of 240 patients were recruited, 143 from SASPIC I and 97 from SASPIC II, 101 (42.1%) being diagnosed with axSpA (65.3% male, mean age 34.4 years, mean symptom duration 8.7 years, B27 positive 55.4%). Mean age of colitis (N=101), psoriasis (N=61), iritis (N=78) patients were 33.4, 36.6, 34.3 years, respectively, mean symptom duration was 6.8, 7.2, 9.4 years, respectively, and % males were 45.5%, 52.5%, 51.3%, respectively. There were no significant group differences for unilateral versus bilateral radiographic sacroiliitis and no significant differences in the frequencies, type, or distribution of MRI lesions (Table 1).
Conclusion:
Data from the SASPIC prospective inception cohort does not support the view that imaging of the SIJ differs in psoriatic axSpA, which appears similar to axSpA associated with iritis or colitis. These data support the umbrella concept of axSpA.
Imaging Feature
Colitis (n=30
)
Psoriasis (n=19
)
Iritis (n=52
)
P value
Unilateral sacroiliitis (grade ≥2), N(%)
1 (3.3%)
0 (0%)
2 (3.8%)
0.69
mNY criteria +, N(%)
5 (16.7%)
6 (31.2%)
15 (28.8%)
0.39
Grade of sacroiliitis, mean(SD)
1.8 (2.2)
2.1 (2.7)
2.2 (2.4)
0.76
MRI indicative of axSpA, N(%)
15 (50.0%)
11 (57.9%)
32 (61.5%)
0.60
MRI indicative of axSpA (confidence ≥5/10), N(%)
14 (46.7%)
10 (52.6%)
30 (57.7%)
0.63
MRI active lesion typical of axSpA, N(%)
6 (20.0%)
6 (31.6%)
18 (34.6%)
0.37
MRI structural lesion typical of axSpA, N(%)
11 (36.7%)
7 (36.8%)
18 (34.6%)
0.98
MRI with unilateral lesion (any)
2 (6.7%)
3 (15.8%)
11 (21.2%)
0.22
MRI with unilateral lesion (BME)
1 (3.3%)
2 (10.5%)
5 (9.6%)
0.54
MRI with unilateral lesion (Erosion)
0 (0%)
0 (0%)
3 (5.8%)
0.23
MRI with unilateral lesion (Sclerosis)
1 (3.3%)
1 (5.3%)
3 (5.8%)
0.89
MRI with unilateral lesion (Fat)
0 (0%)
0 (0%)
0 (0%)
NA
MRI with iliac lesion
17 (56.7%)
12 (63.2%)
32 (61.5%)
0.88
MRI with sacral lesion
12 (40.0%)
11 (57.9%)
31 (59.6%)
0.21
Disclosure of Interests:
Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, BMS, Boehringer, Galapagos, Gilead, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, Ulrich Weber: None declared, Jon Chan: None declared, Raj Carmona: None declared, James Yeung: None declared, Sibel Aydin: None declared, Jodie Reis: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Olga Ziouzina: None declared, Dianne Mosher: None declared, Stephanie Keeling: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared.
BackgroundThe use of magnetic resonance imaging (MRI) seems to be increasing in patients with gonalgia. Findings such as osteoarthritis and meniscal damages are very prevalent in older patients, ...often simultaneously 1–3. These findings are of undetermined significance, as invasive therapeutic procedures provide no additional benefit 4.ObjectivesThe aim of this study is to analyze MRI indications and clinical impact in this population in our center.MethodsWe retrospectively analyzed 215 medical records of patients older than 50 yo having undergone a knee MRI in 2009. Medical charts were reviewed up to 2014 for: patient characteristics, MRI indication, ordering physician specialty, radiography prior to MRI, MRI findings and clinical impacts of the MRI.ResultsPatient's average age was 60.6±7.5. Main MRI indications were meniscopathy: 148 (68.8%) and chronic pain: 92 (42.8%). Most MRIs were ordered by general practitioners (GP): 148 (68.8%) and orthopedic surgeons (OS): 55 (25.6%). Chronic pain investigation was significantly higher in GPs than in OS (48.0% vs 27.3%, p=0.008). Findings show that 185 (86%) patients had osteoarthritis (OA) and 170 (79.1%) had meniscal lesions. Overall, 87 (40.5%) patients were seen by an OS and 27 (31%) of them underwent an invasive intervention. Among the 81 patients with moderate-to-severe OA on MRI, 36 (46%) had evidence of moderate-to-severe OA on a previous plain radiography, 28 (34.6%) were seen by an OS, and 3 (3,7%) underwent a meniscectomy.ConclusionsOur study reproduces the known association between OA and degenerative meniscal changes in older patients. About half of our cohort could have been appropriately diagnosed and treated based on available radiographic information, thus avoiding the MRI and subsequent OS evaluation. Meniscectomy - an MRI dependent procedure - was rare, particularly in patients with advanced OA. Educational and pragmatic measures must be emphasized to limit the inappropriate use of this costly imaging modality.ReferencesBoden SD, Davis DO, Dina TS, Stoller DW, Brown SD, Vailas JC, et al. A prospective and blinded investigation of magnetic resonance imaging of the knee. Abnormal findings in asymptomatic subjects. Clin Orthop Relat Res. 1992 Sep;(282):177–85.Kornick J, Trefelner E, McCarthy S, Lange R, Lynch K, Jokl P. Meniscal abnormalities in the asymptomatic population at MR imaging. Radiology. 1990 Nov;177(2):463–5.Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S, et al. The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am. 2003;85-A:4–9.Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013 May 2;368(18):1675–84.Disclosure of InterestNone declared
BackgroundIn current rheumatology practice, the circumstances that prompt clinicians to order MRI in patients with suspected axSpA are unclear. In addition, the manner and degree to which MRI changes ...diagnostic ascertainment of axSpA in patients presenting with undiagnosed back pain has not been formally studied.Objectives1. To determine whether any particular patient demographic and/or disease characteristics are associated with rheumatologist ordering of MRI. 2. To assess the impact of MRI evaluation on diagnostic ascertainment of axial SpA in patients presenting with undiagnosed back pain.MethodsThe multicenter Screening for AxSpA in Psoriasis, Iritis, and Colitis (SASPIC) Study is aimed at early detection of axial SpA in consecutive patients presenting with undiagnosed back pain to the rheumatologist. Consecutive patients with any one of psoriasis, iritis, or colitis diagnosed by the relevant specialist undergo routine evaluation by a rheumatologist. The rheumatologist determines the presence/absence of axial SpA and the degree of confidence in the diagnosis (−10 (definitely not SpA) to +10 (definite SpA) on a NRS) at 3 consecutive stages: 1. After the clinical evaluation; 2. After the results of labs (B27, CRP) and radiography; 3. After the results of MRI. Differences in patient demographics and/or disease characteristics between those who did or did not have MRI were assessed by chi-square and t-tests. We assessed the degree of diagnostic reclassification after each step at the categorical level (axial SpA yes/no) and also according to the degree of confidence.Results244 patients (51.6% male, mean age 34.6 years, mean age at symptom onset 27.4 years, mean back pain duration 7.1 years, B27 +37.2%) were referred with AAU (29.9%), psoriasis (21.7%), Crohn’s colitis (32.8%), ulcerative colitis (19.3%). A diagnosis of axSpA was made in 67.5% after stage 1 clinical evaluation and in 56.4% at stage 2 after review of the labs and radiography. MRI evaluation varied across sites (mean(range): 73% (16.7%>100%) of patients), ordered in 141 patients, and significantly more frequently in those with probable inflammatory type back pain (probability >5 (0–10 scale) (p=0.04), when radiography was mNY- (p=0.005) and in those without Crohn’s colitis (p=0.001). No differences in ordering of MRI were noted according to age, gender, disease duration, back pain severity, NSAID response, B27 status, or CRP level. In patients with completed MRI scans, a diagnosis of axSpA was made in 70.5% after stage 1 clinical evaluation, in 56.4% after review of the labs and radiography, and in 47.3% after MRI review. 24 (18.6%) were recategorized from SpA to non-SpA and 4 (3.1%) from non-SpA to SpA. Confidence in diagnostic categorization was increased after MRI.ConclusionsIn a setting of undiagnosed back pain and higher risk for axial SpA, use of MRI is primarily driven by negative radiography. MRI was primarily helpful in ruling out SpA and reducing false positives.Disclosure of InterestNone declared
BackgroundClinicians need reliable biomarkers of disease progression contributing additional information sufficient to personalize treatments in patients with early immune-mediated inflammatory ...polyarthritis (EPA) and rheumatoid arthritis. Some single nucleotide polymorphisms (SNP) in immune-related genes impact the expression of encoded proteins.ObjectivesTo determine whether SNP in the Interleukin (IL)-4 Receptor (IL-4R), IL-4, and CD40 genes are associated with EPA disease outcomes.MethodsWe studied patients from the Early Undifferentiated PolyArthritis (EUPA) cohort. These patients were evaluated early (median 3.8 months), treated to remission and followed up at pre-specified intervals. Radiographs were scored according to Sharp/van der Heijde (SvH); significant damage was ≥5. SNPs were genotyped using an allele-specific primer extension (ASPE) assay and Luminex 100 analyzer. HLA-DR alleles were determined using the LABType rSSO assay (One Lambda). SNP and HLA-DR alleles were correlated to total (SvH ≥5) or erosive (Erosion ≥5) joint damage, functional incapacity (Modified Health Assessment Questionnaire (M-HAQ) ≥1.0) and remission according to Simplified disease activity index (SDAI ≤3.3) using generalized estimating equation (GEE) with repeated measures over 5 years. Results were presented with relative risk (RR) and 95% confidence intervals (CI). General linear model (GLM) with repeated measures was used for continuous outcomes.ResultsThe allelic distribution for the SNPs is presented in Table. IL-4 SNPs rs2243250 and rs2070874 were strongly correlated (r2=0.99); only rs2243250 is presented.The (G) allele at rs1801275 (IL-4R) was significantly associated with decreased radiographic damage (GLM: Estimate (standard error): 0.035 (0.017), p=0.043).A (T) allele at rs2243250 (IL-4) was positively associated with erosive damage (GEE: RR 1.26 (1.02–1.55), p=0.034) and functional incapacity (M-HAQ ≥1.0; GEE: RR 1.25 (1.00–1.55), p=0.048).A (T) allele at rs4810485 (CD40) was associated with a higher likelihood of reaching SDAI remission (GEE: RR 1.36 (1.13–1.64), p=0.001).As previously published1, the presence of at least one copy of the DERAA protective alleles was significantly associated with decreased erosive damage (GEE: RR 0.75 (0.58–0.96), p=0.02), a trend to decreased functional incapacity (GLM: M-HAQ ≥1.0; RR: 0.79 (0.61–1.02), p=0.07) and increased chance of SDAI remission (GEE: RR 1.19 (1.01–1.4), p=0.04).Combined presence of at least one copy of the DERAA alleles and two copies of rs2243250 (C) allele of IL-4 further reduced erosive damage (GEE: RR 0.67 (0.51–0.90), p=0.007), functional incapacity (GLM: RR 0.75 (0.56–1.00), p=0.051) and slightly increased the chance for SDAI remission (GEE: RR 1.21 (1.02–1.44), p=0.03).ConclusionsGenotyping the SNP rs1801275 (IL-4R), rs2243250 (IL-4), rs1883832/rs4810485 (CD40) and determining the HLA-DR allele of EUPA patients provided a set of stable genetic predictors of disease progression, both clinically and on radiographs. Their association together and with other stable predictors may contribute to develop reliable biomarker signatures suggesting significant associations with poor disease outcomes.ReferencesCarrier N et al. Arthritis Rheum 2009;60:698–707Disclosure of InterestNone declared
Objective
Large descriptive studies of pain in systemic sclerosis (SSc) are lacking. The present study estimated prevalence, severity, and associations between SSc clinical variables and pain in all ...patients with SSc and in limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) subsets.
Methods
Patients enrolled in a multicenter SSc registry (n = 585) completed a standardized clinical assessment and questionnaires about their physical and psychosocial health, including a pain severity numerical rating scale (NRS; range 0–10). Pain prevalence and severity were estimated with descriptive statistics. Crude and adjusted associations between specific SSc clinical variables and pain were estimated with linear regression for the entire group and by SSc subtype.
Results
Of the patients, 484 (83%) reported pain (268 46% mild pain NRS 1–4, 155 27% moderate pain NRS 5–7, and 61 10% severe pain NRS 8–10). More frequent episodes of Raynaud's phenomenon, active ulcers, worse synovitis, and gastrointestinal (GI) symptoms were associated with pain in multivariate analysis adjusting for demographic variables, depressive symptoms, and comorbid conditions. Patients with dcSSc reported only slightly higher mean ± SD pain than those with lcSSc (dcSSc 3.9 ± 2.8 versus lcSSc 3.4 ± 2.7; Hedges's g = 0.18, P = 0.05). Regression estimates did not differ significantly between SSc subsets.
Conclusion
Pain symptoms were common in the present study of patients with SSc and were independently associated with more frequent episodes of Raynaud's phenomenon, active ulcers, worse synovitis, and GI symptoms. Subsetting by extent of skin involvement was only minimally related to pain severity and did not affect associations with clinical variables. More attention to pain and how to best manage it is needed in SSc.
Purpose
To assess the diagnostic value of MRI examination in detecting and monitoring osteonecrotic lesions (ON) in childhood acute lymphoblastic leukaemia (ALL) after chemotherapy (CHT) and/or bone ...marrow transplantation (BMT).
Methods and materials
Seventy-three patients (37 males, mean age 12.4 years old) with ALL after treatment underwent a lower-limb MR examination between November 2006 and March 2012. In 47 there was clinical suspicion of ON, 26 were asymptomatic. Studies were performed with a 1 T and a 1.5 T scanner, acquiring short tau inversion recovery (STIR) and T1-weighted sequences in coronal plane from the hips to the ankles. The average acquisition time was 18 min. Considering baseline and follow-up examinations, the overall number of MRI studies was 195.
Results
Fifty-four of 73 patients showed ON at MRI study, with an overall number of 323 ON (89 involving articular surface, 24 with joint deformity, JD). Twenty-five of 47 symptomatic patients showed subchondral ON lesions, 11 developed JD. Three of 26 asymptomatic patients showed subchondral bone ON at baseline examination but no JD at follow-up. Twenty-two of 28 BMT, 32/45 CHT patients developed ON.
Conclusion
Our MRI protocol proved to be feasible in evaluating ON in paediatric patients. Studies should be addressed only to symptomatic patients.
BackgroundAchievement of radiographic remission in RA is dependent on early patient identification and effective triaging to enable prompt referral to enable tight control treatment strategies. ...Assessment within 12 weeks of symptom onset i.e. the “window of opportunity” is reportedly associated with less joint destruction and a higher likelihood of achieving remission. Based on RF or anti-CCP2 testing at the primary care level, approximately one half of early RA patients may test negative and not be referred. Further, since referral times can often be lengthy, rheumatologists in consult with GPs require more sensitive, disease specific tools to prioritize the referral of patients who are at greatest risk for radiographic progression. 14–3-3η is a soluble diagnostic RA marker that is involved in the pathophysiology of the disease and informs joint damage progression.ObjectivesThe aim of this study was to examine the combined benefit of 14–3-3η and anti-CCP2 testing in early undifferentiated polyarthritis to inform radiographic progression rate.MethodsSerum 14–3–3η levels were measured at baseline in 331 patients with recent onset polyarthritis (Sherbrooke EUPA), for which a follow up of at least 60 months was completed. Mean (SD) age was 60 years, 62% were female, and median (IQR) duration of symptoms was 4 (1.7–5.7) months. Radiographic progression was defined as a change in Sharp/van der Heijde score, ΔSHS≥1 at 18, 30, 42, and 60 months. Differences in mean ΔSHS based on 14 -3-3η positivity was assessed using the Mann-Whitney U-test at the diagnostic cut-off of ≥0.19 ng/ml. ANOVA analysis was performed to assess the significance of 14–3-3η and anti-CCP2 co-expression with radiographic progression over 60 months.ResultsAt baseline, 46% and 40% of patients were positive for 14–3-3η and anti-CCP2, respectively. Together, 14–3-3η or anti-CCP2 captured 55% of patients. Of these, 58% were positive for both markers whereas 42% were positive for one or the other. Over the course of 60 months, mean (SD) radiographic progression from baseline was significantly higher in 14–3-3η seropositive patients when compared with seronegative patients, 10.0 (15.6) vs. 6.3 (13.40) p=0.022. Radiographic progression based on biomarker co-expression analysis shows that patients who were positive for both anti-CCP2 and 14–3-3η had the most significant changes in radiographic outcomes over 60 months.TimepointGroupnMean ΔSHS ± SDp-valueBaseline to 60 monthsBoth negative1446.22±13.910.024Only 14–3–3η positive476.43±12.09Only anti-CCP2 positive256.40±10.01Both positive10011.66±16.76ConclusionsEarly undifferentiated polyarthritis patients who are positive for 14–3-3η and anti-CCP2 have more radiographic progression over 60 months. 14–3-3η positive status can assist with prioritization of high joint damage risk patient referrals to rheumatologists.Referencesde Rooy DPC et al. Rheum. 2011. 50:93.Disclosure of InterestG. Boire Grant/research support from: The 14–3-3eta measurements were performed free of charge by Augurex, Augurex remaining totally blinded to clinical data. All the analyzes were performed in Sherbrooke without sharing of clinical data of individual patients with Augurex personnel., N. Carrier: None declared, A. de Brum Fernandes: None declared, P. Liang: None declared, A. Masetto: None declared, Y. Gui Employee of: Augurex Life Sciences Corp., J. Savill Employee of: Augurex Life Sciences Corp., S. Michienzi Employee of: Augurex Life Sciences Corp., H. Menard: None declared, W. Maksymowych Consultant for: Augurex Life Sciences Corp., (Co-inventor of 14–3-3η), A. Marotta Employee of: Augurex Life Sciences Corp., (Co-inventor of 14–3-3η)
BackgroundSeveral standardized response criteria and disease activity indices are used to assess treatment efficacy in rheumatoid arthritis (RA). These measures comprise different types and number of ...variables resulting in different weighting of individual variables within each of them.ObjectivesThe aim of this analysis was to compare the performance of ACR, SDAI major and minor, and HAQ response criteria and to determine their level of agreement with the DAS28, SDAI, and CDAI definitions of low disease activity (LDA) and remission in RA patients treated with infliximab (IFX) or golimumab (GLM) in a real-world, Canadian, clinical practice setting.MethodsBioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM. The analysis was based on RA patients treated with IFX between 2002-2014 or GLM between 2010-2014. Response was assessed with ACR20, ACR50, ACR70, HAQ improvement of 0.22 and 0.5, SDAI major (≥22) and minor improvement (≥10). Disease state was assessed with DAS28, SDAI, and CDAI definitions of LDA (<3.2, ≤11, ≤10, respectively) and remission (<2.6, ≤3.3, ≤2.8, respectively). The level of agreement was assessed with the proportion of concordant pairs over the total number of cases in each cross-tabulation and the Kappa statistic.ResultsA total of 830 RA patients with 4,100 available observations were included. The criteria for each definition of response/disease state were met for the following proportion of cases: ACR20 (66.4%), ACR50 (44.5%), ACR70 (26.4%), ΔHAQ≥0.22 (65.5%), ΔHAQ≥0.5 (53.4%), SDAI major improvement (55.8%), SDAI minor improvement (80.8%), DAS28 remission (29.4%), CDAI remission (20.4%), SDAI remission (21.8%), CDAI LDA (57.5%), SDAI LDA (58.1%), and DAS28-ESR LDA (46.0%).Statistically significant (Kappa P<0.001) associations were observed for all combinations of variables examined. Overall, the ACR response criteria performed better than the HAQ and SDAI response criteria in their agreement with LDA and remission. In general, higher levels of response in all three measures (ACR20 vs. ACR50 vs. ACR70; ΔHAQ≥0.22 vs. ΔHAQ≥0.5; SDAI minor vs. major) showed better agreement with LDA and remission. The highest level of agreement between response criteria and disease state was observed between the strictest definitions, namely between ACR70 and CDAI/SDAI remission; whereas, SDAI minor improvement showed the lowest level of agreement with remission, irrespective of definition.ConclusionsThis analysis showed that significant variation exists in the agreement between the various efficacy outcome measures. Thus, the choice of outcome measure used to make treatment decisions could have a significant impact on patient management.Disclosure of InterestE. Keystone Consultant for: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, Speakers bureau: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, P. Baer Consultant for: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, Speakers bureau: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, A. Avina-Zubieta: None declared, A. Jaroszynska: None declared, J. Rodrigues: None declared, R. Arendse Consultant for: Janssen, D. Sholter: None declared, M. Starr Consultant for: Janssen, A. Masetto: None declared, J. Sampalis Shareholder of: JSS Medical Research, Employee of: JSS Medical Research, E. Rampakakis Employee of: JSS Medical Research, C. Tkaczyk Employee of: Janssen, M. Shawi Employee of: Janssen, A. Lehman Employee of: Janssen, F. Nantel Employee of: Janssen, S. Otawa Employee of: Janssen
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