Research ArticleArticle
Cost-effective Tapering Algorithm in Rheumatoid Arthritis Patients: Combination of Multibiomarker Disease Activity Score and Autoantibody Status
Melanie Hagen, Matthias Englbrecht, Judith Haschka, Michaela Reiser, Arnd Kleyer, Axel Hueber, Bernhard Manger, Camille Figueiredo, Jayme Fogagnolo Cobra, Hans-Peter Tony, Stephanie Finzel, Stefan Kleinert, Jörg Wendler, Florian Schuch, Monika Ronneberger, Martin Feuchtenberger, Martin Fleck, Karin Manger, Wolfgang Ochs, Hans-Martin Lorenz, Hubert Nüsslein, Rieke Alten, Jörg Henes, Klaus Krüger, Georg Schett and Jürgen Rech
The Journal of Rheumatology December 2018, jrheum.180028; DOI: https://doi.org/10.3899/jrheum.180028
Melanie Hagen
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Matthias Englbrecht
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Judith Haschka
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Michaela Reiser
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Arnd Kleyer
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Axel Hueber
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Bernhard Manger
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Camille Figueiredo
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Jayme Fogagnolo Cobra
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Hans-Peter Tony
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Stephanie Finzel
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Stefan Kleinert
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Jörg Wendler
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Florian Schuch
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Monika Ronneberger
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Martin Feuchtenberger
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Martin Fleck
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Karin Manger
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Wolfgang Ochs
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Hans-Martin Lorenz
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Hubert Nüsslein
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Rieke Alten
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Jörg Henes
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Klaus Krüger
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Georg Schett
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Jürgen Rech
From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen. Address correspondence to Dr. J. Rech, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: juergen.rech@uk-erlangen.de. Accepted for publication September 7, 2018.
Abstract
Objective To analyze the effect of a risk-stratified disease-modifying antirheumatic drug (DMARD)–tapering algorithm based on multibiomarker disease activity (MBDA) score and anticitrullinated protein antibodies (ACPA) on direct treatment costs for patients with rheumatoid arthritis (RA) in sustained remission.
Methods The study was a posthoc retrospective analysis of direct treatment costs for 146 patients with RA in sustained remission tapering and stopping DMARD treatment, in the prospective randomized RETRO study. MBDA scores and ACPA status were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and direct treatment costs were evaluated every 3 months. MBDA and ACPA status were used as predictors creating a risk-stratified tapering algorithm based on relapse rates.
Results RA patients with a low MBDA score (< 30 units) and negative ACPA showed the lowest relapse risk (19%), while double-positive patients showed high relapse risk (61%). In ACPA-negative and MBDA-negative (< 30 units), and ACPA or MBDA single-positive (> 30 units) groups, DMARD tapering appears feasible. Considering only patients without flare, direct costs for synthetic and biologic DMARD in the ACPA/MBDA-negative and single positive groups (n = 41) would have been €372,245.16 for full-dose treatment over 1 year. Tapering and stopping DMARD in this low-risk relapse group allowed a reduction of €219,712.03 of DMARD costs. Average reduction of DMARD costs per patient was €5358.83.
Conclusion Combining MBDA score and ACPA status at baseline may allow risk stratification for successful DMARD tapering and cost-effective use of biologic DMARD in patients in deep remission as defined by the 28-joint count Disease Activity Score using erythrocyte sedimentation rate.
In this issue
The Journal of Rheumatology
Vol. 50, Issue 6
1 Jun 2023
Cost-effective Tapering Algorithm in Rheumatoid Arthritis Patients: Combination of Multibiomarker Disease Activity Score and Autoantibody Status
Melanie Hagen, Matthias Englbrecht, Judith Haschka, Michaela Reiser, Arnd Kleyer, Axel Hueber, Bernhard Manger, Camille Figueiredo, Jayme Fogagnolo Cobra, Hans-Peter Tony, Stephanie Finzel, Stefan Kleinert, Jörg Wendler, Florian Schuch, Monika Ronneberger, Martin Feuchtenberger, Martin Fleck, Karin Manger, Wolfgang Ochs, Hans-Martin Lorenz, Hubert Nüsslein, Rieke Alten, Jörg Henes, Klaus Krüger, Georg Schett, Jürgen Rech
The Journal of Rheumatology Dec 2018, jrheum.180028; DOI: 10.3899/jrheum.180028
Cost-effective Tapering Algorithm in Rheumatoid Arthritis Patients: Combination of Multibiomarker Disease Activity Score and Autoantibody Status
Melanie Hagen, Matthias Englbrecht, Judith Haschka, Michaela Reiser, Arnd Kleyer, Axel Hueber, Bernhard Manger, Camille Figueiredo, Jayme Fogagnolo Cobra, Hans-Peter Tony, Stephanie Finzel, Stefan Kleinert, Jörg Wendler, Florian Schuch, Monika Ronneberger, Martin Feuchtenberger, Martin Fleck, Karin Manger, Wolfgang Ochs, Hans-Martin Lorenz, Hubert Nüsslein, Rieke Alten, Jörg Henes, Klaus Krüger, Georg Schett, Jürgen Rech
The Journal of Rheumatology Dec 2018, jrheum.180028; DOI: 10.3899/jrheum.180028
