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Forsblad-d'Elia, Helena
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Publications (10 of 96) Show all publications
Forsblad-d'Elia, H., Law, L., Bengtsson, K., Söderberg, S. & Lindqvist, P. (2019). Educed strain and increased stiffness of common carotid arteries in patients with ankylogin spondylitis. Paper presented at Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019. Annals of the Rheumatic Diseases, 78, 1241-1241
Open this publication in new window or tab >>Educed strain and increased stiffness of common carotid arteries in patients with ankylogin spondylitis
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2019 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1241-1241Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Ankylosing spondylitis (AS) is associated with an increased risk of cardiovascular disease (CVD) which also contributes to the increased mortality observed in AS. It is therefore important to develop non-invasive, accurate methods for early detection of atherosclerotic vascular changes. Studies, in other populations, have demonstrated associations between arterial stiffness and atherosclerotic burden and incident cardiovascular events. The arterial stiffness can be examined by ultrasound providing the β stiffness index that evaluates mechanical deformation properties. Technological advancements in ultrasound have developed a method assessing strain, using speckle tracking technique, which measures deformation mechanics in more dimensions. The speckle tracking method assessing arterial wall motion might permit earlier detection of subclinical CVD.

Objectives: To study, for the first time, bilateral common carotid arterial (CCA) circumferential strain and β stiffness index in patients with AS and 1) compare the results with age and sex-matched controls and 2) explore relationships between circumferential strain and β stiffness index with disease activity, physical function and traditional risk factors for CVD in patients with AS.

Methods: A cohort of 149 patients with AS from Northern Sweden (Modif NY, mean age 55.3±11.2 years, 102(68.5%) men, 146(98%) HLAB27) were assessed with spinal radiographs for mSASSS, clinical examination and BASMI, BASFI, ASDAS-CRP and BASDAI. Forty-six patients with AS (50.4±8.7 years, 31(67%) men) and 46 age- and sex-matched controls (49.8±9.2 years, 31(67%) men) with no known hypertension, diabetes or previous CV events were compared. Bilateral CCA ultrasound was carried out on all patients and controls. The circumferential systolic strain was measured and the β stiffness index was calculated. To analyze factors associated with strain and β stiffness index univariate and standard multivariable linear regression analyses were used. Variables with a univariate p-value ≤ 0.1 were considered for the multivariable models. For dichotomous variables, yes was coded 1 and no was coded 0.

Results: The mean strain was significantly lower in AS patients compared with controls, 7.9±2.6% vs 10.3±1.9%, p<0.001 and the mean β stiffness index was significantly higher in AS compared to controls, 13.1±1.6 mmHg/mm vs 12.3±1.3 mmHg/mm, p=0.018.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-161723 (URN)10.1136/annrheumdis-2019-eular.4587 (DOI)000472207103509 ()
Conference
Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019
Note

Supplement: 2

Meeting Abstract: SAT0325

Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Torres, L., Klingberg, E., Nurkkala, M., Carlsten, H. & Forsblad-d'Elia, H. (2019). Hepatocyte growth factor is a potential biomarker for osteoproliferation and osteoporosis in ankylosing spondylitis. Osteoporosis International, 30(2), 441-449
Open this publication in new window or tab >>Hepatocyte growth factor is a potential biomarker for osteoproliferation and osteoporosis in ankylosing spondylitis
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2019 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, no 2, p. 441-449Article in journal (Refereed) Published
Abstract [en]

Summary: We explored relations between serum hepatocyte growth factor (HGF), disease activity, osteoproliferation, and bone mineral density (BMD) in ankylosing spondylitis (AS), in comparison with healthy controls. HGF was increased especially in male AS patients and smokers and associated with both lower BMD and more chronic radiographic changes in the spine.

Introduction Ankylosing spondylitis (AS) is characterized by both osteoproliferation and increased bone loss. Biomarkers are requested to predict the processes. The aims of this study were to compare serum levels of hepatocyte growth factor (HGF), matrix metalloproteinase-3 (MMP-3), and vascular endothelial growth factor (VEGF) in AS patients with healthy controls (HC) and to explore the associations with disease activity, osteoproliferation, and bone mineral density (BMD).

Methods: Serum from AS patients (modified NY-criteria) and HC was analyzed for HGF, MMP-3, and VEGF with ELISA. Disease activity parameters were collected. Osteoproliferation was assessed with modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and BMD was measured in femoral neck.

Results: Totally, 204 AS patients and 80 sex and age matched HC were included. Serum HGF was higher in the AS patients compared with the HC, whereas serum MMP-3 and VEGF were not. Serum HGF was also higher in smokers and in the male AS patients positively correlated with age, BASMI, and mSASSS, and negatively correlated with BMD. The biomarkers were all positively associated with ESR, CRP, and WBC. In multiple linear regression analysis serum HGF remained associated with higher mSASSS and lower BMD, after adjusting for age, sex, CRP, smoking, and body mass index.

Conclusions: Serum HGF was increased in male AS patients and associated with higher mSASSS and lower BMD. In addition, serum HGF was positively associated with risk factors for osteoproliferation such as age, CRP and smoking. HGF could be a potential biomarker of importance for the bone metabolism in AS.

Place, publisher, year, edition, pages
Springer London, 2019
Keywords
Ankylosing spondylitis, Hepatocyte growth factor (HGF), Matrix metalloproteinase-3 (MMP-3), teoporosis, Osteoproliferation, Vascular endothelial growth factor (VEGF)
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-158761 (URN)10.1007/s00198-018-4721-4 (DOI)000463597000019 ()30306221 (PubMedID)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-05-13Bibliographically approved
Deminger, A., Klingberg, E., Nurkkala, M., Carlsten, H., Jacobsson, L. T. H. & Forsblad-d'Elia, H. (2019). Hepatocyte growth factor is a predictor of development of new syndesmophytes in men with ankylosing spondylitis. A five year prospective study. Paper presented at Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019. Annals of the Rheumatic Diseases, 78, 1240-1240
Open this publication in new window or tab >>Hepatocyte growth factor is a predictor of development of new syndesmophytes in men with ankylosing spondylitis. A five year prospective study
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2019 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1240-1240Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Patients with ankylosing spondylitis (AS) have an increased risk of spinal new bone formation characterized by the development of syndesmophytes. Knowledge of predictors for development of syndesmophytes is limited. Hepatocyte growth factor (HGF) has regulatory effects on a variety of cells in many different organs. HGF signaling can affect both osteoclast and osteoblast lineages and has been shown to promote osteogenesis. Cross-sectional association between increased HGF and increased modified Stoke Ankylosing Spine Score (mSASSS) has previously been shown [1], whereas knowledge of HGF as a predictor for new bone formation is lacking.

Objectives: To study serum HGF as a predictor for development of new syndesmophytes in patients with AS followed for five years.

Methods: Serum levels of HGF was analyzed using ELISA in patients with AS (modified NY-criteria) and in healthy controls (HC) at baseline. Spinal lateral radiographs were obtained at baseline and at the 5-year follow-up and assessed for development of new syndesmophytes using mSASSS. Univariate and multivariable logistic regression analyses were used to assess predictors for development of ≥ 1 new syndesmophyte.

Results: Serum HGF and radiographs at baseline and follow-up were available for 163 patients, 88 men and 75 women, baseline mean age 50±12 years. AS patients had higher serum HGF than HC (n=80), p=0.050. In the AS group, 36 patients (22%) developed ≥ 1 syndesmophyte, 27 men and 9 women. In the total AS group, neither did baseline serum HGF differ between those who developed ≥ 1 new syndesmophyte and those who did not progress, nor did it predict development of ≥ 1 new syndesmophyte in the univariate analysis, p=0.25. Interestingly, men who developed ≥1 new syndesmophyte had higher serum HGF than the non-progressors (1706±454 vs 1420±338 pg/mL, p=0.001) and increased serum HGF at baseline predicted development of ≥ 1 syndesmophyte (OR per 1 SD HGF 2.39, 95% CI 1.31 to 4.36) in the univariate analysis. Serum HGF did not predict new syndesmophytes in women, p=0.13. Multivariable analysis for men including age, smoking, baseline syndesmophyte and serum HGF showed high HGF (OR per 1SD 1.90, 95% CI 1.01 to 3.59) and ≥1 baseline syndesmophyte (OR 3.48, 95% CI 1.09 to 11.07) to independently predict development of ≥ 1 new syndesmophyte. If baseline CRP was included in the multivariable model, serum HGF and baseline syndesmophytes remained the significant predictors.

Conclusion: High baseline serum HGF was shown to independently predict the development of at least one new syndesmophyte over five years in men with AS.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-161727 (URN)10.1136/annrheumdis-2019-eular.4559 (DOI)000472207103507 ()
Conference
Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019
Note

Supplement: 2

Meeting Abstract: SAT0323

Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Bengtsson, K., Forsblad-d'Elia, H., Klingberg, E., Lindstrom, U., Dehlin, M., Exarchou, S., . . . Jacobsson, L. T. H. (2019). Incidence of extra-articular manifestations in ankylosing spondylitis, proriatic arthritis and undifferentiated spondyloarthritis - results from a national register-based cohort study. Paper presented at Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019. Annals of the Rheumatic Diseases, 78, 1237-1237
Open this publication in new window or tab >>Incidence of extra-articular manifestations in ankylosing spondylitis, proriatic arthritis and undifferentiated spondyloarthritis - results from a national register-based cohort study
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2019 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1237-1237Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Identifiers
urn:nbn:se:umu:diva-161731 (URN)10.1136/annrheumdis-2019-eular.4422 (DOI)000472207103501 ()
Conference
Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019
Note

Supplement: 2

Meeting Abstract: SAT0317

Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Mofors, J., Arkema, E. V., Björk, A., Westermark, L., Kvarnström, M., Forsblad-d'Elia, H., . . . Wahren-Herlenius, M. (2019). Infections increase the risk of developing Sjögren's syndrome. Journal of Internal Medicine, 285(6), 670-680
Open this publication in new window or tab >>Infections increase the risk of developing Sjögren's syndrome
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2019 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 285, no 6, p. 670-680Article in journal (Refereed) Published
Abstract [en]

Objective: Environmental factors have been suggested in the pathogenesis of rheumatic diseases. We here investigated whether infections increase the risk of developing primary Sjögren's syndrome (pSS).

Methods: Patients with pSS in Sweden (n = 945) and matched controls from the general population (n = 9048) were included, and data extracted from the National Patient Register to identify infections occurring before pSS diagnosis during a mean observational time of 16.0 years. Data were analysed using conditional logistic regression models. Sensitivity analyses were performed by varying exposure definition and adjusting for previous health care consumption.

Results: A history of infection associated with an increased risk of pSS (OR 1.9, 95% CI 1.6–2.3). Infections were more prominently associated with the development of SSA/SSB autoantibody‐positive pSS (OR 2.7, 95% CI 2.0–3.5). When stratifying the analysis by organ system infected, respiratory infections increased the risk of developing pSS, both in patients with (OR 2.9, 95% CI 1.8–4.7) and without autoantibodies (OR 2.1, 95% CI 1.1–3.8), whilst skin and urogenital infections only significantly associated with the development of autoantibody‐positive pSS (OR 3.2, 95% CI 1.8–5.5 and OR 2.7, 95% CI 1.7–4.2). Furthermore, a dose–response relationship was observed for infections and a risk to develop pSS with Ro/SSA and La/SSB antibodies. Gastrointestinal infections were not significantly associated with a risk of pSS.

Conclusions: Infections increase the risk of developing pSS, most prominently SSA/SSB autoantibody‐positive disease, suggesting that microbial triggers of immunity may partake in the pathogenetic process of pSS.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
autoantibodies, infection, La, SSB, Ro, SSA, Sjögren's syndrome
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-161599 (URN)10.1111/joim.12888 (DOI)000473089500007 ()30892751 (PubMedID)
Funder
Swedish Research CouncilSwedish Rheumatism AssociationKing Gustaf V Jubilee FundSwedish Heart Lung FoundationStockholm County Council
Available from: 2019-07-18 Created: 2019-07-18 Last updated: 2019-07-18Bibliographically approved
Klingberg, E., Bilberg, A., Bjorkman, S., Hedberg, M., Jacobsson, L., Forsblad-d'Elia, H., . . . Larsson, I. (2019). Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Research & Therapy, 21, Article ID 17.
Open this publication in new window or tab >>Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study
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2019 (English)In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 21, article id 17Article in journal (Refereed) Published
Abstract [en]

Background: Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m2).

Methods: VLED (640 kcal/day) was taken during 12–16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up.

Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline.

Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria.

Results: Totally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48–62). At baseline increased BMI was associated with higher disease activity and poorer function.

The median weight loss was 18.7 kg (IQR 14.6–26.5) or 18.6% (IQR 14.7–26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p = 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively.

Conclusions: Short-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Psoriatic arthritis, Psoriasis, Obesity, Metabolic syndrome, Weight loss, VLED, Cardiovascular disease
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-155961 (URN)10.1186/s13075-019-1810-5 (DOI)000455454100002 ()30635024 (PubMedID)
Funder
Swedish Rheumatism Association
Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2019-02-07Bibliographically approved
Deminger, A., Klingberg, E., Geijer, M., Gothlin, J., Hedberg, M., Rehnberg, E., . . . Forsblad-d'Elia, H. (2018). A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis. Arthritis Research & Therapy, 20, Article ID 162.
Open this publication in new window or tab >>A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis
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2018 (English)In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 20, article id 162Article in journal (Refereed) Published
Abstract [en]

Background: Knowledge about predictors of new spinal bone formation in patients with ankylosing spondylitis (AS) is limited. AS-related spinal alterations are more common in men; however, knowledge of whether predictors differ between sexes is lacking. Our objectives were to study spinal radiographic progression in patients with AS and investigate predictors of progression overall and by sex. Methods: Swedish patients with AS, age (mean +/- SD) 50 +/- 13 years, were included in a longitudinal study. At baseline and at 5-year follow up, spinal radiographs were graded according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Predictors were assessed by questionnaires, spinal mobility tests and blood samples. Results: Of 204 patients included, 166 (81%) were re-examined and 54% were men. Men had significantly higher mean mSASSS at baseline and higher mean increase in mSASSS than women (1.9 +/- 2.8 vs. 1.2 +/- 3.3; p = 0.005) More men than women developed new syndesmophytes (30% vs. 12%; p = 0.007). Multivariate logistic regression analyses with progression >= 2 mSASSS units over 5 years or development of new syndesmophytes as the dependent variable showed that presence of baseline AS-related spinal radiographic alterations and obesity (OR 3.78, 95% CI 1.3 to 11.2) were independent predictors of spinal radiographic progression in both sexes. High C-reactive protein (CRP) was a significant predictor in men, with only a trend seen in women. Smoking predicted progression in men whereas high Bath Ankylosing Spondylitis Metrology Index (BASMI) and exposure to bisphosphonates during follow up (OR 4.78, 95% CI 1.1 to 20.1) predicted progression in women. Conclusion: This first report on sex-specific predictors of spinal radiographic progression shows that predictors may partly differ between the sexes. New predictors identified were obesity in both sexes and exposure to bisphosphonates in women. Among previously known predictors, baseline AS-related spinal radiographic alterations predicted radiographic progression in both sexes, high CRP was a predictor in men (with a trend in women) and smoking was a predictor only in men.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Ankylosing spondylitis, Outcomes research, Treatment, Inflammation, Longitudinal study, diography
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-151054 (URN)10.1186/s13075-018-1665-1 (DOI)000441209200001 ()30075808 (PubMedID)2-s2.0-85051078686 (Scopus ID)
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-09-05Bibliographically approved
Bengtsson, K., Klingberg, E., Deminger, A., Jacobsson, L. T., Bergfeldt, L. & Forsblad-d'Elia, H. (2018). Ankylosing spondylitis related factors predict the presence of cardiac conduction disturbances: a swedish longitudinal cohort study. Paper presented at Congress of the European-League-Against-Rheumatism (EULAR), JUN 13-16, 2018, Amsterdam, NETHERLANDS. Annals of the Rheumatic Diseases, 77, 337-338
Open this publication in new window or tab >>Ankylosing spondylitis related factors predict the presence of cardiac conduction disturbances: a swedish longitudinal cohort study
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2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 337-338Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-152916 (URN)10.1136/annrheumdis-2018-eular.2240 (DOI)000444351001043 ()
Conference
Congress of the European-League-Against-Rheumatism (EULAR), JUN 13-16, 2018, Amsterdam, NETHERLANDS
Note

Supplement: 2

Meeting Abstract: THU0236

Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2018-10-30Bibliographically approved
Bengtsson, K., Klingberg, E., Deminger, A., Jacobsson, L. T., Bergfeldt, L. & Forsblad-d'Elia, H. (2018). CARDIAC CONDUCTION DISTURBANCES IN PATIENTS WITH ANKYLOSING SPONDYLITIS - A SWEDISH LONGITUDINAL COHORT STUDY. Clinical and Experimental Rheumatology, 36(4), 714-714
Open this publication in new window or tab >>CARDIAC CONDUCTION DISTURBANCES IN PATIENTS WITH ANKYLOSING SPONDYLITIS - A SWEDISH LONGITUDINAL COHORT STUDY
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2018 (English)In: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 36, no 4, p. 714-714Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
CLINICAL & EXPER RHEUMATOLOGY, 2018
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-151068 (URN)000440741300096 ()
Available from: 2018-09-03 Created: 2018-09-03 Last updated: 2018-09-03Bibliographically approved
Södergren, A., Askling, J., Bengtsson, K., Forsblad-d'Elia, H., Jernberg, T., Lindström, U., . . . Jacobsson, L. T. (2018). Case fatality over 365 days after first acute coronary syndrome in patients with ankylosing spondylitis. Paper presented at Congress of the European-League-Against-Rheumatism (EULAR), JUN 13-16, 2018, Amsterdam, NETHERLANDS. Annals of the Rheumatic Diseases, 77, 341-341
Open this publication in new window or tab >>Case fatality over 365 days after first acute coronary syndrome in patients with ankylosing spondylitis
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2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 341-341Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-152909 (URN)000444351001050 ()
Conference
Congress of the European-League-Against-Rheumatism (EULAR), JUN 13-16, 2018, Amsterdam, NETHERLANDS
Note

Supplement: 2

Meeting Abstract: THU0243

Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2018-10-30Bibliographically approved
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