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An international SUrvey on non-iNvaSive tecHniques to assess the mIcrocirculation in patients with RayNaud’s phEnomenon (SUNSHINE survey)

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Abstract

To canvas opinion concerning the role of non-invasive techniques in the assessment of patients with Raynaud’s phenomenon (Rp) in clinical and research settings: four nailfold capillaroscopy methods [videocapillaroscopy (NVC), dermoscopy, stereomicroscopy, digital USB microscopy], four laser Doppler methods (laser Doppler flowmetry, imaging, anemometry/velocimetry, laser speckle contrast analysis), thermographic imaging, and upper limb arterial Doppler ultrasound. Emails with a link to the survey were sent to physicians from the European Scleroderma Trials and Research group (EUSTAR), the EULAR Study Group on Microcirculation in Rheumatic Diseases (SG_MC/RD) and members of the pediatric rheumatology Email board. The main descriptive analysis related to physicians looking after adult patients, with some analysis also of opinions from paediatric rheumatologists. 106 ‘adult physicians’ responded (a response rate of 25.8%), of whom 68.9% were European, and 81.1% practising for more than 10 years. Nineteen paediatricians responded. The most widely available technique was NVC (72.7%). Nailfold capillaroscopy was most frequently performed by the physician him/herself, using different types of equipment relating to availability. Most rheumatologists reported high levels of appropriateness for NVC in both clinical and research settings for global assessment and differential diagnosis of Rp. Other techniques were less used. Of all the different techniques, nailfold capillaroscopy was the one most used in both clinical and research settings by adult physicians, the majority of whom use NVC in their everyday practice. The low proportion of clinicians using other techniques suggests that these are currently mainly research tools, available only in specialist centres.

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Acknowledgements

SUrvey on non-iNvaSive tecHniques to assess the mIcrocirculation in patients with RayNaud’s phEnomenon (SUNSHINE) study group: Carlos Abud Mendoza, Departamento de Reumatología y Patología, Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis, Mexico; Everardo Alvarez Hernández, Servicio de Reumatología, Hospital General de México, Mexico D.F., Mexico; Amina Abdessemed, Rheumatology Department, EPH Benaknoun, Algiers, Algeria; Jonathan Akikusa, Murdoch Childrens Research Institute and Royal Children’s Hospital, Parkville, Victoria, Australia; Nuray Aktay Ayaz, Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey; Lidia Ananyeva, Rheumatology Department, Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russia; Codrina Ancuta, Gr. T. Popa University of Medicine and Pharmacy, Rehabilitation Hospital, Iasi, Romania; Marcelo J Audisio, Hospital Nacional de Clínicas, Córdoba, Argentina; Alexandra Balbir-Gurman, The B. Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Haifa, Israel; Asta Baranauskaite, Lithuanian University of Health Sciences, Kaunas, Lithuania; Marko Barešić, Division of Clinical Immunology and Rheumatology, Internal Medicine Department, University Hospital Center Zagreb, Zagreb, Croatia; Radim Bečvář, Institute of Rheumatology and Department of Rheumatology of the First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Mike Becker, Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Laura Belloli, S.C. Reumatologica, A.O. Ospedale Niguarda Ca’ Granda, Milan, Italy; Susa Benseler, Department of Pediatrics, Alberta Children’s Hospital Research Institute Faculty of Medicine, University of Calgary, Calgary, Canada; Lorenzo Beretta, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Chiara Bertolazzi, Rheumatology department, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Blanca E Bica, Rheumatology Unit, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Francesco Boin, Department of Medicine, Division of Rheumatology, University of California, San Francisco, USA; Yolanda Braun-Moscovici, The B. Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Haifa, Israel; Paola Caramaschi, Rheumatology Unit, Policlinico G.B. Rossi, University of Verona, Verona, Italy; Carlo Chizzolini, Immunollogy & Allergy, University Hospital and School of Medicine, Geneva, Switzerland; Rolando Cimaz, Department of Pediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital and University of Florence, Italy; Jean-Luc Cracowski, Université Grenoble-Alpes, HP2, Grenoble, France; Megan Curran, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA; Thomas Daikeler, Rheumatology, University Hospital, Basel, Switzerland; Rossella De Angelis, Rheumatology Department, Polytechnic University of the Marche, Jesi, Italy; Daniel B De Araujo, Rheumatology Department, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil; Carlos De la Puente, Servicio de Reumatología, Hospital Ramon Y Cajal, Madrid, Spain; Beata Derfalvi, Dalhousie University, IWK Health Centre, Halifax, Canada; Oliver Distler, Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland; Hristo Dobrev, Department of Dermatology and Venereology, Medical University, Plovdiv, Bulgaria; Rucsandra Dobrota, Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland; Ellen De Langhe, Department of Rheumatology, University Hospital Leuven, Leuven, Belgium; Eric Hachulla, Service de Médecine Interne, Centre National de Référence des Maladies Autoimmunes, Hôpital Claude Huriez CHRU, Lille, France; Nihal Fathi, Department of Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt; Hilda Fragoso Loyo, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México; Tracy Frech, Division of Rheumatology, Department of Internal Medicine, University of Utah, Salt Lake City, USA; Paloma García de la Peña Lefebvre, Servicio de Reumatología, Hospitales Universitarios Grupo Madrid, Madrid, Spain; Serena Guiducci, Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy; Marwin Gutierrez, Division of Musculoskeletal Diseases, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico; Paul Hasler, Department of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland; Walter Hermann, Internal Medicine & Rheumatology Department, Justus-Liebig-University Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany; Gabriela Hernandez Molina, Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Roger Hesselstrand, Rheumatology Department, Lund University, Lund, Sweden; Adrian Hij, Département de Médecine Interne et Pathologie Vasculaire, Hôpital Saint Louis, Université Paris 7, APHP, Paris, France.; Markus Hufnagel, Division of Pediatric Infectious Diseases and Rheumatology, University Medical Center Freiburg, Freiburg, Germany; Michael Hughes, Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Claudia Ickinger, Division of Rheumatology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa; Murat Inanç, Internal Medicine Department, Division of Rheumatology, Istanbul University, Istanbul, Turkey; Rosaria Irace, Rheumatology Unit, Department of Internal and Experimental Medicine, Second University of Naples, Naples, Italy; Iustina Janta, Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Cristiane Kayser, Rheumatology Division, Universidade Federal de São Paulo, São Paulo, Brazil; Kariem Khan Ajaz, Khyber Medical Institute Srinagar, India; Dinesh Khanna, Division of Rheumatology, Internal Medicine Department, University of Michigan, Ann Arbor, USA; Dorota Krasowska, Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Poland; Satoshi Kubo, The First Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan; Laura Lewandowski, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA. Francisco J Longo, Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Sevdalina Lambova, Department of Propedeutics in Internal Medicine, Medical University, Plovdiv, Bulgaria; David Launay, Département de Médecine Interne et Immunologie Clinique, Lille University, Lille, France; Rodrigo Lima, Serviço de Reumatologia, Hospital de Base do Distrito Federal, Brasília, Brasil; Esthela Loyo, Servicio de Reumatología e Inmunología Clinica HRUJMCB, Jefe de Servicio, Santiago, Rep. Dominicana; Ulf Müller Ladner, Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik, Justus-Liebig University Giessen, Bad Nauheim, Germany; Ashima Makol, Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, USA; Marta N Mamani, Servicio de Reumatología, Hospital Bernardino Rivadavia, Buenos Aires, Argentina; Dušanka M Kaliterna, Division of Rheumatology and Clinical Immunology, University Hospital Center of Split, Split, Croatia; Małgorzata Michalska Jakubus, Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland; Carina Mihai, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Marcin Milchert, Department of Rheumatology and Internal Medicine of Pomeranian Medical University, Szczec, Poland; Tünde Minier, Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary; Maria J Molina, Rheumatology Department, Hospital Central de San Isidro, Buenos Aires, Argentina; Fontes Maria F Moraes, Unidade de Doenças Auto-imunes, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Gianluca Moroncini, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche & Clinica Medica, Ospedali Riuniti Ancona, Ancona, Italy; Esperanza Naredo, Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Nieto-Gonzàlez Juan Carlos Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Alejandro Nitsche, Servicio de Reumatología, Hospital Alemán, Buenos Aires, Argentina; Predrag Ostojic, Institute of Rheumatology, University of Belgrade, Belgrade, Serbia; Clare Pain, Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; Pamuk N Ömer, Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey; John Pauling, Royal National Hospital for Rheumatic Diseases, Bath, UK; Sarah Payne-Poff, Greenville Health Systems Pediatric Rheumatology, Greenville, USA; Mykolas Petraitis, Hospital of Lithuanian, University of Health Sciences Kaunas Clinics, Kaunas, Lithuania; Ross Petty, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada; Serghei Popa, Department of Rheumatology, Republican Clinical Hospital, Chisinau, Republic of Moldova; Mariusz Puszczewicz, Department of Rheumatology and Internal Disease, University of medical Sciences,Poznan University of Medical Science, Poznan, Poland; Valeria Riccieri, Department of Internal Medicine and Medical Specialities, University of Rome La Sapienza, Rome, Italy; Gabriela Riemekasten, Clinic for Rheumatology, University of Lübeck, Lübeck, Germany; Simona Rednic, Department of Rheumatology, Clinical County Emergency Hospital, Cluj-Napoca, Romania; Reyna S Tatiana Rodríguez, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Katarzyna Romanowska Próchnicka, Department of General and Experimental Pathology, Warsaw Medical University, Warsaw, Poland; Edoardo Rosato, Department of Clinical Medicine, Clinical Immunology Unit, Sapienza University of Rome, Italy; Kelly Rouster Stevens, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, USA; Saketkoo Lesley A, New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Tulane University Lung Center, New Orleans, USA; Oliver Sander, Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Germany; Lelita Santos, Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Tim Schmeiser, Krankenhaus St. Josef Hospital, Wuppertal, Germany; Belén Serrano Benavente, Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Tatzana Shevtsova; Kamal Solanki, Rheumatology Department, Waikato Hospital, Hamilton, New Zealand; Jorge Sotoca Fernàndez, Servicio de Pediatría, Mälarsjukhuset, Eskilstuna, Sweden; Betul Sozeri, Department of Pediatric Rheumatology, Ege University Faculty of Medicine, Izmir, Turkey; Bojana Stamenkovic, Institute for Prevention, Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases, Niska Banja, Serbia and Montenegro; Simon Stebbings, Department of Medicine, University of Otago, Dunedin, New Zealand; Alberto Sulli, Research Laboratory and Academic Division of Clinical Rheumatology,University of Genova, Genova, Italy; Cord Sunderkotter, Department of Dermatology, University Hospital, Münster, Germany; Flavio Sztajnbok, Division of Pediatric Rheumatology, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Gabriella Szucs, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary; Maria T Terreri, Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Sao Paulo, Brazil; Yosef Uziel, Meir Medical center, Tel Aviv University, Tel Aviv, Israel; Alessandra Vacca, Rheumatology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy; Antonia Valenzuela, Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, USA; Frank van den Hoogen, Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands; Angelica Vargas, National Institute of Cardiology Ignacio Chavez, Department of Rheumatology, Mexico City, Mexico; Douglas Veale, The Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St. Vincent’s University Hospital, Dublin, Ireland; Verônica Vilela, Department of Rheumatology, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil; Carlos von Muhlen, Brazilian Society of Autoimmunity; Ulrich Walker, Rheumatology Department, University Hospital Basel, Basel, Switzerland; Karol Wierzba, Clinic of Internal Medicine, Connective Tissue Diseases and Geriatrics, Gdańsk, Poland; Sule Yavuz, Istanbul Bilim University, Istanbul, Turkey; Zenone Thierry, Department of Internal Medicine, Centre Hospitalier, Valence, France.

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Authors and Affiliations

  1. Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, P.zza Cardinal Ferrari 1, 20122, Milan, Italy

    Francesca Ingegnoli & Nicola Ughi

  2. Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    Graham Dinsdale & Ariane L. Herrick

  3. Laboratory of Medical Statistics, Epidemiology and Biometry G.A. Maccacaro, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Annalisa Orenti & Patrizia Boracchi

  4. Paris Descartes University and Cochin Hospital, AP-HP, Paris, France

    Yannick Allanore

  5. Hamburger Zentrum für Kinder- und Jugend Rheumatologie, Klinikum Eilbek, Hamburg, Germany

    Ivan Foeldvari

  6. Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy

    Alberto Sulli & Maurizio Cutolo

  7. Department of Rheumatology, Ghent University Hospital, Ghent, Ghent University, Ghent, Belgium

    Vanessa Smith

  8. NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    Ariane L. Herrick

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  1. Francesca Ingegnoli
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  2. Nicola Ughi
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  3. Graham Dinsdale
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  4. Annalisa Orenti
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  5. Patrizia Boracchi
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  6. Yannick Allanore
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  7. Ivan Foeldvari
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  8. Alberto Sulli
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  9. Maurizio Cutolo
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  10. Vanessa Smith
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  11. Ariane L. Herrick
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Consortia

On behalf of the EULAR Study Group on Microcirculation in RheumaticDiseases

  • Adrian Hij
  • , Alberto Sulli
  • , Alejandro Nitsche
  • , Alessandra Vacca
  • , Alexandra Balbir-Gurman
  • , Amina Abdessemed
  • , Angelica Vargas
  • , Antonia Valenzuela
  • , Ashima Makol
  • , Asta Baranauskaite
  • , Beata Derfalvi
  • , Belén Serrano Benavente
  • , Betul Sozeri
  • , Blanca E. Bica
  • , Bojana Stamenkovic
  • , Carina Mihai
  • , Carlo Chizzolini
  • , Carlos Abud Mendoza
  • , Carlos de la Puente
  • , Carlos von Muhlen
  • , Chiara Bertolazzi
  • , Clare Pain
  • , Claudia Ickinger
  • , Codrina Ancuta
  • , Cord Sunderkotter
  • , Cristiane Kayser
  • , Daniel B. De Araujo
  • , David Launay
  • , Dinesh Khanna
  • , Dorota Krasowska
  • , Douglas Veale
  • , Dušanka M. Kaliterna
  • , Edoardo Rosato
  • , Ellen de Langhe
  • , Eric Hachulla
  • , Esperanza Naredo
  • , Esthela Loyo
  • , Everardo Alvarez Hernández
  • , Flavio Sztajnbok
  • , Francesco Boin
  • , Francisco J. Longo
  • , Frank van den Hoogen
  • , Gabriela Hernandez Molina
  • , Gabriela Riemekasten
  • , Gabriella Szucs
  • , Gianluca Moroncini
  • , Hilda Fragoso Loyo
  • , Hristo Dobrev
  • , Iustina Janta
  • , Jean-Luc Cracowski
  • , John Pauling
  • , Jonathan Akikusa
  • , Jorge Sotoca Fernàndez
  • , Kariem Khan Ajaz
  • , Kamal Solanki
  • , Karol Wierzba
  • , Katarzyna Romanowska Próchnicka
  • , Kelly Rouster Stevens
  • , Laura Belloli
  • , Laura Lewandowski
  • , Lelita Santos
  • , Lesley A. Saketkoo
  • , Lidia Ananyeva
  • , Lorenzo Beretta
  • , Małgorzata Michalska Jakubus
  • , Marcelo J. Audisio
  • , Marcin Milchert
  • , Maria J. Molina
  • , Fontes Maria F. Moraes
  • , Maria T. Terreri
  • , Mariusz Puszczewicz
  • , Marko Barešić
  • , Markus Hufnagel
  • , Marta N. Mamani
  • , Marwin Gutierrez
  • , Megan Curran
  • , Michael Hughes
  • , Mike Becker
  • , Murat Inanç
  • , Mykolas Petraitis
  • , Nieto-Gonzàlez Juan Carlos
  • , Nihal Fathi
  • , Nuray Aktay Ayaz
  • , Oliver Distler
  • , Oliver Sander
  • , Pamuk N. Ömer
  • , Paloma García de la Peña Lefebvre
  • , Paola Caramaschi
  • , Paul Hasler
  • , Predrag Ostojic
  • , Radim Bečvář
  • , Reyna S. Tatiana Rodríguez
  • , Rodrigo Lima
  • , Roger Hesselstrand
  • , Rolando Cimaz
  • , Rosaria Irace
  • , Ross Petty
  • , Rossella de Angelis
  • , Rucsandra Dobrota
  • , Sarah Payne-Poff
  • , Satoshi Kubo
  • , Serena Guiducci
  • , Serghei Popa
  • , Sevdalina Lambova
  • , Simon Stebbings
  • , Simona Rednic
  • , Sule Yavuz
  • , Susa Benseler
  • , Tatzana Shevtsova
  • , Thomas Daikeler
  • , Tim Schmeiser
  • , Tracy Frech
  • , Tünde Minier
  • , Ulf Müller Ladner
  • , Ulrich Walker
  • , Valeria Riccieri
  • , Verônica Vilela
  • , Walter Hermann
  • , Yolanda Braun-Moscovici
  • , Yosef Uziel
  •  & Zenone Thierry

Corresponding author

Correspondence to Francesca Ingegnoli.

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The authors declare that they have no competing interest.

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Additional information

Study group list of co-authors is reported in Acknowledgements section.

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Ingegnoli, F., Ughi, N., Dinsdale, G. et al. An international SUrvey on non-iNvaSive tecHniques to assess the mIcrocirculation in patients with RayNaud’s phEnomenon (SUNSHINE survey). Rheumatol Int 37, 1879–1890 (2017). https://doi.org/10.1007/s00296-017-3808-0

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  • DOI: https://doi.org/10.1007/s00296-017-3808-0

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