Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique

Objectives: In rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive and fast and may therefore have benefits over existing imaging modalities. We tested whether OST could measure disease activity validly in patients with RA. Methods: In 59 patients with RA and 10 patients with arthralgia, OST, joint counts, Disease Activity Score (DAS) 28 and ultrasonography (US) were performed. Additionally, MRI was performed in patients with DAS28<2.6. We developed and validated within the same cohort an algorithm for detection of joint inflammation by OST with US as reference. Results: At the joint level, OST and US performed similarly inproximal interphalangeal-joints (area under the receiver-operating curve (AUC) of 0.79, p<0.0001) andmetacarpophalangeal joints (AUC 0.78, p<0.0001). Performance was less similar in wrists (AUC 0.62, p=0.006). On the patient level, OST correlated moderately with clinical examination (DAS28 r=0.42, p=0.001), and US scores (r=0.64, p<0.0001). Furthermore, in patients with subclinical and low disease activity, there was a correlation between OST and MRI synovitis score (RAMRIS (Rheumatoid Arthritis MRI Scoring) synovitis), r=0.52, p=0.005. Conclusions: In this pilot study, OST performed moderately in the detection of joint inflammation in patients with RA. Further studies are needed to determine the diagnostic performance in a new cohort of patients with RA

Mavrilimumab, a fully human granulocyte-macrophage colony-stimulating factor receptor α monoclonal antibody: long-term safety and efficacy in patients with rheumatoid arthritis

Objective: Mavrilimumab, a human monoclonal antibody, targets granulocyte-macrophage colony-stimulating factor receptor alpha. We report mavrilimumab long-term safety and efficacy in rheumatoid arthritis patients in two phase IIb studies (1071, 1107) and open-label extension (OLE; NCT01712399). Methods: In 1071, patients with disease-modifying antirheumatic drug (DMARD)-inadequate responses received mavrilimumab 30, 100, 150 mg, or placebo every other week (eow), plus methotrexate. In 1107, patients with anti-tumor necrosis factor agent- and/or DMARD-inadequate responses received mavrilimumab 100 mg eow or golimumab 50 mg every 4 weeks, plus methotrexate. Patients entering the OLE received mavrilimumab 100 mg eow plus methotrexate. Mavrilimumab long-term safety and efficacy were assessed. Results: In total, 442 patients received mavrilimumab (14/245 patients from 1071, 9/70 from 1107, 52/397 from OLE discontinued mavrilimumab treatment throughout the studies). The cumulative safety exposure was 899 patient-years (PY); the median duration of mavrilimumab treatment was 2.5 (range 0.1–3.3) years. Most common treatment-emergent adverse events were nasopharyngitis (n=69, 7.68/100 PY), bronchitis (n=51, 5.68/100 PY). At Weeks 74/104: 3.5%/6.2% patients showed reduction in forced expiratory volume in 1 second; 2.9%/3.4% patients showed reduction in forced vital capacity, respectively (&gt;20% reduction from baseline to &lt;80% predicted). Most pulmonary changes were transient and only infrequently associated with adverse events. Mavrilimumab 100 mg eow demonstrated sustained efficacy; 65.0% and 40.6% patients achieved Disease Activity Score 28–C-reactive protein &lt;3.2 and &lt;2.6, respectively at Week 122. Conclusion: Mavrilimumab long-term treatment maintained response and was well-tolerated with no TEAE incidence increase. Safety data were comparable with both phase IIb qualifying studies

A Coaching Program for Recently Licensed Young Drivers in the Netherlands: Which Drivers are Attracted?

In line with European developments, a Dutch second phase coaching program was developed for young novice drivers to counteract their high accident risk. In this paper the design principles of the program are described. The empirical study focused on the entry characteristics of the participating young drivers (n=3117) as compared to a reference group of young drivers (n=345). Results show that the DX program attracted young drivers that in some respects showed a more risky profile than average young drivers in terms of speed violations, anger and the number of fines. In addition, four groups of participants with sharply differing driving styles could be distinguished

Financial volatility and public scrutiny as institutional determinants of financial industry firms' CSR

This article examines the relationship between the global financial crisis and Corporate Social Responsibility reporting of financial services firms. We challenge the view in existing studies that firms, when faced with economic hardship, tend to jettison CSR commitments. Instead, and building on insights into the institutional determinants of CSR, we argue that firms are constrained in their ability to abandon CSR by the extent to which they are subject to intense public scrutiny by regulators and the news media. We test this argument in the context of the European sovereign debt crisis drawing on a unique dataset of 170 firms in 15 different countries over a six-year period. Controlling for a battery of alternative explanations and comparing financial service providers to firms operating in other economic sectors, we find considerable evidence supporting our argument. Rather than abandoning CSR during times of economic hardship, financial industry firms ramp up their CSR commitments in order to manage their public image and foster public trust in light of intense public scrutiny

Identifying patients with axial spondyloarthritis: on a mission to achieve timely recognition

On average, there is a nine-year delay in the diagnosis of axial spondyloarthritis (formerly known as Bechterew’s disease). This dissertation shows that an MRI scan of the sacroiliac joints (or sacral joints) allows an earlier diagnosis of axial spondyloarthritis to be made in a reliable way. Although general practitioners play an important role in identifying potential spondyloarthritis patients and referring them to a rheumatologist, this dissertation shows that they only have a limited ability to recognise physical symptoms suggestive of axial spondyloarthritis. Teaching general practitioners about this disease proved to be an effective way to enhance the identification of potential spondyloarthritis patients as well as increase referrals of these patients to a rheumatologist