The current health care system is severely challenged by for instance rising costs, fewer new blockbuster drugs and increasing numbers of hospitalizations due to side effects. Especially in the... Show moreThe current health care system is severely challenged by for instance rising costs, fewer new blockbuster drugs and increasing numbers of hospitalizations due to side effects. Especially in the area of chronic diseases the current disease fighting strategy is failing and a more personalized medicine approach is needed. In this thesis new sub-types of rheumatoid arthritis are characterized with metabolomics analysis and symptoms patterns. The sub-types are based on diagnostic knowledge from Chinese medicine. The two sub-types of RA patients were found to have differences in apoptosis regulation of T-cells and differences in urine acylcarnitine levels. A questionnaire was designed to distinguish the two sub-types and to evaluate symptom patterns of arthritis patients. In the future the response to treatment of these sub-types of patients can be studied and specific treatment can be targeted to these sub-types. Show less
The development of outcome measures in the field of rheumatology has shown a rapid and constructive advance in the last decades. It has been achieved to obtain more uniformity in the evaluation of... Show moreThe development of outcome measures in the field of rheumatology has shown a rapid and constructive advance in the last decades. It has been achieved to obtain more uniformity in the evaluation of inflammatory rheumatic disorders, especially concerning long-term outcomes and disease activity assessments. In the field of rheumatoid arthritis, clinical experts and researchers have done a lot of work under the umbrella of OMERACT (Outcome Measures in Rheumatology Clinical Trials). In the field of ankylosing spondylitis, major advances in the outcome and therapeutic advances in the last years have been possible because of projects piloted within ASAS (the Assessment of Spondyloarthritis international Society). The analyses and studies presented in this thesis were part of this process, with most of the work performed in international working groups under auspices of either OMERACT or ASAS or both. In rheumatoid arthritis, a detailed insight into radiographic scores was conducted (Sharp van der Heijde score, SENS). Performances of automated methods for measuring measurement of joint space narrowing were assessed. The delay to first specific treatment in early rheumatoid arthritis was also analyzed, and its impact on radiographic outcome was evaluated. In ankylosing spondylitis, three different methods aiming at scoring activity of the disease on MRI of the spine were compared, and a new disease activity score was developed (ASDAS). Show less
Rheumatoid arthritis (RA) is a disease characterized by arthritis of mainly the small joints of the hands and feet, which is thought to be the result of an autoimmune response. It is the most... Show moreRheumatoid arthritis (RA) is a disease characterized by arthritis of mainly the small joints of the hands and feet, which is thought to be the result of an autoimmune response. It is the most common inflammatory arthritis with a prevalence of 0.5-1.0% in European and North-American populations 1. There is substantial geographic variation in the occurrence of RA with very high prevalences reported in native American-Indian populations 2, and very low prevalences in populations from South-East Asia 3. The disease is approximately three times more frequent in women than in men, and the prevalence increases with age. Besides the potentially destructive arthritis, patients can be affected by various extraarticular features such as secondary Sj_gren__s syndrome, interstitial lung disease, pericarditis and pleuritis. Fortunately, the advent of tumor necrosis factor (TNF) inhibitors and other biological agents have led to a therapeutic revolution for patients with rheumatoid arthritis 4. Instead of having to resign to an inevitably progressive and debilitating disease course, modern-day treatment aims at achieving the lowest possible disease activity and ultimately remission. Nonetheless, rheumatoid arthritis continues to be a major cause of (partial) disability and of loss of productivity, and is associated with substantial economic costs 5. Classification criteria for the disease were first phrased in 1956 6 after Sir Alfred Garrod had introduced the term rheumatoid arthritis in 1876 in an attempt to counteract the unsatisfactory use of designations such as __chronic rheumatism__ and __rheumatic gout__ 7. The purpose of the classification criteria was to facilitate both clinical diagnosis and scientific research. For many years since, the 1987 American College of Rheumatology (ACR) classification criteria have been used to this end, despite the fact that the incorporation of items such as erosive radiographic changes led to limited diagnostic value of these criteria for patients with early arthritis 8. In order to facilitate the study of persons with earlier stages of disease, the ACR and the European League Against Rheumatism (EULAR) have recently developed the 2010 classification criteria for RA as shown in Table 1 9. It is worthwhile to note that these criteria are based on patient characteristics which were associated with the decision by the physician to start treatment with methotrexate. These criteria are a reflection of the shift towards increasingly earlier diagnosis and treatment of rheumatoid arthritis. Show less
