Loading…
Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis
Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to iden...
Saved in:
| Published in: | Rheumatology international 2019-06, Vol.39 (6), p.1061-1067 |
|---|---|
| Main Authors: | , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c375t-35db08b34757c44e7e182d9edfca826727046c85899eddf4f58d1c9c0af604103 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c375t-35db08b34757c44e7e182d9edfca826727046c85899eddf4f58d1c9c0af604103 |
| container_end_page | 1067 |
| container_issue | 6 |
| container_start_page | 1061 |
| container_title | Rheumatology international |
| container_volume | 39 |
| creator | Sahutoglu, Tuncay Artim Esen, Bahar Aksoy, Murat Kurtoglu, Mehmet Poyanli, Arzu Gul, Ahmet |
| description | Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to identify those with AAA with at least 6-month clinical and radiological follow-up data. Chart review revealed 12 patients (11 males) with AAA amongst 1224 patients; follow-up data from 11 patients were available. The most common symptoms were lower back and abdominal pain. The only pre-treatment complication was a spontaneous rupture. All but one patient received corticosteroid and cyclophosphamide pulses for the induction, and corticosteroid and azathioprine for the maintenance treatment; one patient received only the maintenance treatment. Two patients had surgical graft interposition, without postoperative complications. Seven patients had endovascular stenting; five of them (71.4%) showed radiological regression after 32.5 (13.4–53.8) months, while four (57%) had clinical improvement after 11.8 (0.2–29.4) months. However, one non-responsive patient developed stent infection and exsanguinated during percutaneous drainage, and one patient developed femoral artery pseudo-aneurysm at the catheter insertion site. Another patient developed a new aneurysm under the maintenance treatment. Medical treatment alone yielded radiological regression in one of two patients. Current immunosuppressive, surgical or endovascular approaches can provide clinical and radiological improvements lately in BD patients with AAA. Furthermore, complication rates seem to be high with interventional approaches. These findings suggest an unmet need for safer alternative treatments. |
| doi_str_mv | 10.1007/s00296-019-04283-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2194154306</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2193894459</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-35db08b34757c44e7e182d9edfca826727046c85899eddf4f58d1c9c0af604103</originalsourceid><addsrcrecordid>eNp9kMtO3TAQhq0KVA60L8CistQNm8A4dmKHXTniJiGxoVLVjeXjTKhRLgdPgpQn4kF4MVwOLRILNmPN-Jt_Zn7G9gUcCgB9RAB5VWYgqgxUbmQ2f2ILoaTORAm_ttgChM4zk8IO2yW6g5SXJXxmOxKMMUqLBfu9bEMfvGu5H6ZIyIeGu1U9dKFPNTfEMXjuepziTB3x0PMT_PP0iCOvA6EjPOaORxzjQGv0Y3jARLt2pkBf2HbjWsKvr-8e-3l2erO8yK6uzy-XP64yL3UxZrKoV2BWUulCe6VQozB5XWHdeGfyUucaVOlNYapUqxvVFKYWvvLgmhKUALnHDja66zjcT0ij7QJ5bNu09jCRzUWlRKEklAn9_g69S1enfV8oaSqliipR-Yby6SqK2Nh1DJ2LsxVg_zpvN87b5Lx9cd7Oqenbq_S06rD-3_LP6gTIDUDpq7_F-Db7A9lne_WPsQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2193894459</pqid></control><display><type>article</type><title>Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis</title><source>Springer Link</source><creator>Sahutoglu, Tuncay ; Artim Esen, Bahar ; Aksoy, Murat ; Kurtoglu, Mehmet ; Poyanli, Arzu ; Gul, Ahmet</creator><creatorcontrib>Sahutoglu, Tuncay ; Artim Esen, Bahar ; Aksoy, Murat ; Kurtoglu, Mehmet ; Poyanli, Arzu ; Gul, Ahmet</creatorcontrib><description>Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to identify those with AAA with at least 6-month clinical and radiological follow-up data. Chart review revealed 12 patients (11 males) with AAA amongst 1224 patients; follow-up data from 11 patients were available. The most common symptoms were lower back and abdominal pain. The only pre-treatment complication was a spontaneous rupture. All but one patient received corticosteroid and cyclophosphamide pulses for the induction, and corticosteroid and azathioprine for the maintenance treatment; one patient received only the maintenance treatment. Two patients had surgical graft interposition, without postoperative complications. Seven patients had endovascular stenting; five of them (71.4%) showed radiological regression after 32.5 (13.4–53.8) months, while four (57%) had clinical improvement after 11.8 (0.2–29.4) months. However, one non-responsive patient developed stent infection and exsanguinated during percutaneous drainage, and one patient developed femoral artery pseudo-aneurysm at the catheter insertion site. Another patient developed a new aneurysm under the maintenance treatment. Medical treatment alone yielded radiological regression in one of two patients. Current immunosuppressive, surgical or endovascular approaches can provide clinical and radiological improvements lately in BD patients with AAA. Furthermore, complication rates seem to be high with interventional approaches. These findings suggest an unmet need for safer alternative treatments.</description><identifier>ISSN: 0172-8172</identifier><identifier>EISSN: 1437-160X</identifier><identifier>DOI: 10.1007/s00296-019-04283-y</identifier><identifier>PMID: 30888471</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdomen ; Abdominal Pain ; Adrenal Cortex Hormones - therapeutic use ; Adult ; Aneurysm, False - epidemiology ; Aneurysms ; Aortic Aneurysm, Abdominal - etiology ; Aortic Aneurysm, Abdominal - therapy ; Aortic aneurysms ; Aortic Rupture ; Azathioprine - therapeutic use ; Behcet Syndrome - complications ; Behcet Syndrome - therapy ; Cyclophosphamide - therapeutic use ; Endovascular Procedures ; Female ; Femoral Artery ; Humans ; Immunosuppressive Agents - therapeutic use ; Induction Chemotherapy ; Low Back Pain ; Maintenance Chemotherapy ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Observational Research ; Patients ; Postoperative Complications - epidemiology ; Prosthesis-Related Infections - epidemiology ; Retrospective Studies ; Rheumatology ; Stents ; Vascular Grafting ; Vein & artery diseases ; Young Adult</subject><ispartof>Rheumatology international, 2019-06, Vol.39 (6), p.1061-1067</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>Rheumatology International is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-35db08b34757c44e7e182d9edfca826727046c85899eddf4f58d1c9c0af604103</citedby><cites>FETCH-LOGICAL-c375t-35db08b34757c44e7e182d9edfca826727046c85899eddf4f58d1c9c0af604103</cites><orcidid>0000-0001-8219-3720 ; 0000-0002-9116-3985 ; 0000-0002-7042-4066 ; 0000-0002-5659-3955 ; 0000-0002-8851-1109 ; 0000-0003-2015-4421</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,783,787,27936,27937</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30888471$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sahutoglu, Tuncay</creatorcontrib><creatorcontrib>Artim Esen, Bahar</creatorcontrib><creatorcontrib>Aksoy, Murat</creatorcontrib><creatorcontrib>Kurtoglu, Mehmet</creatorcontrib><creatorcontrib>Poyanli, Arzu</creatorcontrib><creatorcontrib>Gul, Ahmet</creatorcontrib><title>Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis</title><title>Rheumatology international</title><addtitle>Rheumatol Int</addtitle><addtitle>Rheumatol Int</addtitle><description>Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to identify those with AAA with at least 6-month clinical and radiological follow-up data. Chart review revealed 12 patients (11 males) with AAA amongst 1224 patients; follow-up data from 11 patients were available. The most common symptoms were lower back and abdominal pain. The only pre-treatment complication was a spontaneous rupture. All but one patient received corticosteroid and cyclophosphamide pulses for the induction, and corticosteroid and azathioprine for the maintenance treatment; one patient received only the maintenance treatment. Two patients had surgical graft interposition, without postoperative complications. Seven patients had endovascular stenting; five of them (71.4%) showed radiological regression after 32.5 (13.4–53.8) months, while four (57%) had clinical improvement after 11.8 (0.2–29.4) months. However, one non-responsive patient developed stent infection and exsanguinated during percutaneous drainage, and one patient developed femoral artery pseudo-aneurysm at the catheter insertion site. Another patient developed a new aneurysm under the maintenance treatment. Medical treatment alone yielded radiological regression in one of two patients. Current immunosuppressive, surgical or endovascular approaches can provide clinical and radiological improvements lately in BD patients with AAA. Furthermore, complication rates seem to be high with interventional approaches. These findings suggest an unmet need for safer alternative treatments.</description><subject>Abdomen</subject><subject>Abdominal Pain</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Aneurysm, False - epidemiology</subject><subject>Aneurysms</subject><subject>Aortic Aneurysm, Abdominal - etiology</subject><subject>Aortic Aneurysm, Abdominal - therapy</subject><subject>Aortic aneurysms</subject><subject>Aortic Rupture</subject><subject>Azathioprine - therapeutic use</subject><subject>Behcet Syndrome - complications</subject><subject>Behcet Syndrome - therapy</subject><subject>Cyclophosphamide - therapeutic use</subject><subject>Endovascular Procedures</subject><subject>Female</subject><subject>Femoral Artery</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Induction Chemotherapy</subject><subject>Low Back Pain</subject><subject>Maintenance Chemotherapy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Observational Research</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prosthesis-Related Infections - epidemiology</subject><subject>Retrospective Studies</subject><subject>Rheumatology</subject><subject>Stents</subject><subject>Vascular Grafting</subject><subject>Vein & artery diseases</subject><subject>Young Adult</subject><issn>0172-8172</issn><issn>1437-160X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kMtO3TAQhq0KVA60L8CistQNm8A4dmKHXTniJiGxoVLVjeXjTKhRLgdPgpQn4kF4MVwOLRILNmPN-Jt_Zn7G9gUcCgB9RAB5VWYgqgxUbmQ2f2ILoaTORAm_ttgChM4zk8IO2yW6g5SXJXxmOxKMMUqLBfu9bEMfvGu5H6ZIyIeGu1U9dKFPNTfEMXjuepziTB3x0PMT_PP0iCOvA6EjPOaORxzjQGv0Y3jARLt2pkBf2HbjWsKvr-8e-3l2erO8yK6uzy-XP64yL3UxZrKoV2BWUulCe6VQozB5XWHdeGfyUucaVOlNYapUqxvVFKYWvvLgmhKUALnHDja66zjcT0ij7QJ5bNu09jCRzUWlRKEklAn9_g69S1enfV8oaSqliipR-Yby6SqK2Nh1DJ2LsxVg_zpvN87b5Lx9cd7Oqenbq_S06rD-3_LP6gTIDUDpq7_F-Db7A9lne_WPsQ</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Sahutoglu, Tuncay</creator><creator>Artim Esen, Bahar</creator><creator>Aksoy, Murat</creator><creator>Kurtoglu, Mehmet</creator><creator>Poyanli, Arzu</creator><creator>Gul, Ahmet</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8219-3720</orcidid><orcidid>https://orcid.org/0000-0002-9116-3985</orcidid><orcidid>https://orcid.org/0000-0002-7042-4066</orcidid><orcidid>https://orcid.org/0000-0002-5659-3955</orcidid><orcidid>https://orcid.org/0000-0002-8851-1109</orcidid><orcidid>https://orcid.org/0000-0003-2015-4421</orcidid></search><sort><creationdate>20190601</creationdate><title>Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis</title><author>Sahutoglu, Tuncay ; Artim Esen, Bahar ; Aksoy, Murat ; Kurtoglu, Mehmet ; Poyanli, Arzu ; Gul, Ahmet</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-35db08b34757c44e7e182d9edfca826727046c85899eddf4f58d1c9c0af604103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdomen</topic><topic>Abdominal Pain</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Aneurysm, False - epidemiology</topic><topic>Aneurysms</topic><topic>Aortic Aneurysm, Abdominal - etiology</topic><topic>Aortic Aneurysm, Abdominal - therapy</topic><topic>Aortic aneurysms</topic><topic>Aortic Rupture</topic><topic>Azathioprine - therapeutic use</topic><topic>Behcet Syndrome - complications</topic><topic>Behcet Syndrome - therapy</topic><topic>Cyclophosphamide - therapeutic use</topic><topic>Endovascular Procedures</topic><topic>Female</topic><topic>Femoral Artery</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Induction Chemotherapy</topic><topic>Low Back Pain</topic><topic>Maintenance Chemotherapy</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Observational Research</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prosthesis-Related Infections - epidemiology</topic><topic>Retrospective Studies</topic><topic>Rheumatology</topic><topic>Stents</topic><topic>Vascular Grafting</topic><topic>Vein & artery diseases</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sahutoglu, Tuncay</creatorcontrib><creatorcontrib>Artim Esen, Bahar</creatorcontrib><creatorcontrib>Aksoy, Murat</creatorcontrib><creatorcontrib>Kurtoglu, Mehmet</creatorcontrib><creatorcontrib>Poyanli, Arzu</creatorcontrib><creatorcontrib>Gul, Ahmet</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Rheumatology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sahutoglu, Tuncay</au><au>Artim Esen, Bahar</au><au>Aksoy, Murat</au><au>Kurtoglu, Mehmet</au><au>Poyanli, Arzu</au><au>Gul, Ahmet</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis</atitle><jtitle>Rheumatology international</jtitle><stitle>Rheumatol Int</stitle><addtitle>Rheumatol Int</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>39</volume><issue>6</issue><spage>1061</spage><epage>1067</epage><pages>1061-1067</pages><issn>0172-8172</issn><eissn>1437-160X</eissn><abstract>Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to identify those with AAA with at least 6-month clinical and radiological follow-up data. Chart review revealed 12 patients (11 males) with AAA amongst 1224 patients; follow-up data from 11 patients were available. The most common symptoms were lower back and abdominal pain. The only pre-treatment complication was a spontaneous rupture. All but one patient received corticosteroid and cyclophosphamide pulses for the induction, and corticosteroid and azathioprine for the maintenance treatment; one patient received only the maintenance treatment. Two patients had surgical graft interposition, without postoperative complications. Seven patients had endovascular stenting; five of them (71.4%) showed radiological regression after 32.5 (13.4–53.8) months, while four (57%) had clinical improvement after 11.8 (0.2–29.4) months. However, one non-responsive patient developed stent infection and exsanguinated during percutaneous drainage, and one patient developed femoral artery pseudo-aneurysm at the catheter insertion site. Another patient developed a new aneurysm under the maintenance treatment. Medical treatment alone yielded radiological regression in one of two patients. Current immunosuppressive, surgical or endovascular approaches can provide clinical and radiological improvements lately in BD patients with AAA. Furthermore, complication rates seem to be high with interventional approaches. These findings suggest an unmet need for safer alternative treatments.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30888471</pmid><doi>10.1007/s00296-019-04283-y</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8219-3720</orcidid><orcidid>https://orcid.org/0000-0002-9116-3985</orcidid><orcidid>https://orcid.org/0000-0002-7042-4066</orcidid><orcidid>https://orcid.org/0000-0002-5659-3955</orcidid><orcidid>https://orcid.org/0000-0002-8851-1109</orcidid><orcidid>https://orcid.org/0000-0003-2015-4421</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0172-8172 |
| ispartof | Rheumatology international, 2019-06, Vol.39 (6), p.1061-1067 |
| issn | 0172-8172 1437-160X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2194154306 |
| source | Springer Link |
| subjects | Abdomen Abdominal Pain Adrenal Cortex Hormones - therapeutic use Adult Aneurysm, False - epidemiology Aneurysms Aortic Aneurysm, Abdominal - etiology Aortic Aneurysm, Abdominal - therapy Aortic aneurysms Aortic Rupture Azathioprine - therapeutic use Behcet Syndrome - complications Behcet Syndrome - therapy Cyclophosphamide - therapeutic use Endovascular Procedures Female Femoral Artery Humans Immunosuppressive Agents - therapeutic use Induction Chemotherapy Low Back Pain Maintenance Chemotherapy Male Medicine Medicine & Public Health Middle Aged Observational Research Patients Postoperative Complications - epidemiology Prosthesis-Related Infections - epidemiology Retrospective Studies Rheumatology Stents Vascular Grafting Vein & artery diseases Young Adult |
| title | Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-11-13T07%3A05%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20course%20of%20abdominal%20aortic%20aneurysms%20in%20Beh%C3%A7et%20disease:%20a%20retrospective%20analysis&rft.jtitle=Rheumatology%20international&rft.au=Sahutoglu,%20Tuncay&rft.date=2019-06-01&rft.volume=39&rft.issue=6&rft.spage=1061&rft.epage=1067&rft.pages=1061-1067&rft.issn=0172-8172&rft.eissn=1437-160X&rft_id=info:doi/10.1007/s00296-019-04283-y&rft_dat=%3Cproquest_cross%3E2193894459%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c375t-35db08b34757c44e7e182d9edfca826727046c85899eddf4f58d1c9c0af604103%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2193894459&rft_id=info:pmid/30888471&rfr_iscdi=true |