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Is the C-reactive protein-to-albumin ratio the most remarkable simple inflammatory marker showing active disease in patients with axial spondyloarthritis, psoriatic arthritis, and rheumatoid arthritis?

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Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objective

To learn which of the simple inflammation markers obtained from routine laboratory tests showed active disease best.

Methods

The study included 256 patients (102 patients with axial spondyloarthritis [axSpA], 54 with psoriatic arthritis [PsA], and 100 with rheumatoid arthritis [RA]). The results of the routine laboratory tests requested during the outpatient clinic visits of the patients were noted. Inflammation-related ratio/indices were then calculated from these laboratory tests. Active and inactive diseases were defined according to the disease activity scores for each disease. Logistic regression and receiver operating characteristic (ROC) analyses were performed to determine the best laboratory marker(s) showing active disease and its cutoff value for all three diseases.

Results

C-reactive protein to albumin ratio (CAR) was significantly higher in patients with active axSpA, PsA, and RA diseases than those with inactive diseases (p < 0.001, p = 0.006, and p < 0.001, respectively). In the logistic regression analysis, the CAR was the most important predictor of active disease in patients with axSpA, PsA, and RA. CAR had also showed the active disease at an acceptable level in axSpA and PsA and very well in RA. The cutoff values for active disease in axSpA, PsA, and RA were 0.75, 0.92, and 0.89, respectively.

Conclusion

CAR may be a promising simple laboratory marker to distinguish active disease in patients with axSpA, PsA, and RA.

Key Points

• Acute phase reactants and circulating blood cells have become an important target because of the search for a disease activity marker that can be used cheaply and quickly in the daily outpatient routine.

• One or more of these simple markers have been previously discussed in various studies with different hypotheses.

• We aimed to determine which of the inflammation markers obtained from routine laboratory tests showed active disease and to determine a cutoff value for this/these marker(s).

• CAR was the most important simple laboratory marker to distinguish active disease in patients with axSpA, PsA, and RA. In addition, CAR showed the active disease at an acceptable level in axSpA and PsA, and very well in RA.

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References

  1. Michelsen B, Fiane R, Diamantopoulos AP, Soldal DM, Hansen IJW, Sokka T et al (2015) A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. PloS One 10(4):e0123582. https://doi.org/10.1371/journal.pone.0123582

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Taha SI, Samaan SF, Ibrahim RA, Moustafa NM, El-Sehsah EM, Youssef MK (2022) Can complete blood count picture tell us more about the activity of rheumatological diseases? Clin Med Insights Arthritis Musculoskelet Disord 15:11795441221089182. https://doi.org/10.1177/11795441221089182

    Article  PubMed  PubMed Central  Google Scholar 

  3. Šućur A, Jajić Z, Ikić Matijašević M, Stipić Marković A, Flegar D, Lukač N et al (2020) Combined manual and automated immunophenotypisation identified disease-specific peripheral blood immune subpopulations in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Clin Exp Rheumatol 38(5):903–916

    PubMed  Google Scholar 

  4. Mease PJ, Liu M, Rebello S, Kang H, Yi E, Park Y et al (2019) Comparative disease burden in patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis: data from two Corrona registries. Rheumatol Ther 6(4):529–542. https://doi.org/10.1007/s40744-019-00172-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tymms K, Littlejohn G, Griffiths H, de Jager J, Bird P, Joshua F et al (2018) Treatment patterns among patients with rheumatic disease (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated arthritis (UnA)) treated with subcutaneous TNF inhibitors. Clin Rheumatol 37(6):1617–1623. https://doi.org/10.1007/s10067-018-4105-3

    Article  PubMed  Google Scholar 

  6. Inciarte-Mundo J, Ramirez J, Hernández MV, Ruiz-Esquide V, Cuervo A, Cabrera-Villalba SR et al (2018) Calprotectin strongly and independently predicts relapse in rheumatoid arthritis and polyarticular psoriatic arthritis patients treated with tumor necrosis factor inhibitors: a 1-year prospective cohort study. Arthritis Res Ther 20(1):1–11. https://doi.org/10.1186/s13075-018-1764-z

    Article  CAS  Google Scholar 

  7. Zong H-x, Xu S-q, Wang J-x, Chu Y-r, Chen K-m, Wang C et al (2022) Presence of subclinical inflammation in axial spondyloarthritis patients with NSAID/anti-TNF-α drug-induced clinical remission. Clin Rheumatol 41(5):1403–1412. https://doi.org/10.1007/s10067-021-06018-6

    Article  PubMed  Google Scholar 

  8. Brown A, Conaghan P, Karim Z, Quinn M, Ikeda K, Peterfy C et al (2022) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58(10):2958–2967. https://doi.org/10.1002/art.23945

    Article  Google Scholar 

  9. Alivernini S, Tolusso B, Petricca L, Bui L, Di Sante G, Peluso G et al (2017) Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission? Ann Rheum Dis 76(7):1228–1236. https://doi.org/10.1136/annrheumdis-2016-210424

    Article  CAS  PubMed  Google Scholar 

  10. Chen C-H, Chen H-A, Liao H-T, Liu C-H, Tsai C-Y, Chou C-T (2015) The clinical usefulness of ESR, CRP, and disease duration in ankylosing spondylitis: the product of these acute-phase reactants and disease duration is associated with patient’s poor physical mobility. Rheumatol Int 35(7):1263–1267. https://doi.org/10.1007/s00296-015-3214-4

    Article  CAS  PubMed  Google Scholar 

  11. Mease PJ (2011) Psoriatic arthritis: update on pathophysiology, assessment and management. Ann Rheum Dis 70(Suppl 1):i77–i84. https://doi.org/10.1136/ard.2010.140582

    Article  PubMed  Google Scholar 

  12. Aletaha D, Smolen JS (2018) Diagnosis and management of rheumatoid arthritis: a review. JAMA 320(13):1360–1372. https://doi.org/10.1001/jama.2018.13103

    Article  PubMed  Google Scholar 

  13. Jarlborg M, Courvoisier DS, Lamacchia C, Martinez Prat L, Mahler M, Bentow C et al (2020) Serum calprotectin: a promising biomarker in rheumatoid arthritis and axial spondyloarthritis. Arthritis Res Ther 22(1):105. https://doi.org/10.1186/s13075-020-02190-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Zochling J (2011) Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken) 63(Suppl 11):47–58. https://doi.org/10.1002/acr.20575

    Article  Google Scholar 

  15. Greenmyer JR, Stacy JM, Sahmoun AE, Beal JR, Diri E (2020) DAS28-CRP cutoffs for high disease activity and remission are lower than DAS28-ESR in rheumatoid arthritis. ACR Open Rheumatol 2(9):507–511. https://doi.org/10.1002/acr2.11171

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schoels MM, Aletaha D, Alasti F, Smolen JS (2016) Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis 75(5):811–818. https://doi.org/10.1136/annrheumdis-2015-207507

    Article  PubMed  Google Scholar 

  17. Pamukcu M, Duran TI (2021) Could C-reactive protein/Albumin Ratio be an indicator of activation in Axial Spondyloarthritis. J Coll Physicians Surg Pak 30(5):537–541. https://doi.org/10.29271/jcpsp.2021.05.537

    Article  PubMed  Google Scholar 

  18. Sunar I, Ataman Ş (2020) Serum C-Reactive Protein/Albumin ratio in rheumatoid arthritis and its relationship with disease activity, physical function, and quality of life. Arch Rheumatol 35(2):247–253. https://doi.org/10.46497/ArchRheumatol.2020.7456

    Article  PubMed  PubMed Central  Google Scholar 

  19. Xue L, Tao L, Sun H, Wang Y, Zhang Y, Lei N et al (2022) Association Between Blood PLT and RBC Related Indices and Disease Activity in Patients with Rheumatoid Arthritis. Int J Gen Med 15:573–581. https://doi.org/10.2147/IJGM.S351505

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Yıldırım A, Karabiber M, Sürücü GD, Türkbeyler İH, Karakoyun A, Selkuc MY et al (2015) The changes of mean platelet volume and platelet distribution width in patients with rheumatoid arthritis and their correlation with disease activity. Acta Medica Mediterranea 31(5):1105–1111

    Google Scholar 

  21. Yang W-m, Zhang W-h, Ying H-q, Xu Y-m, Zhang J, Min Q-h et al (2018) Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: albumin to fibrinogen ratio and C-reactive protein to albumin ratio. Int Immunopharmacol 62:293–298. https://doi.org/10.1016/j.intimp.2018.07.007

    Article  CAS  PubMed  Google Scholar 

  22. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD (2019) The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 39(4):345–357. https://doi.org/10.3343/alm.2019.39.4.345

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Garcia-Magallón B, Castro-Villegas C, Rosello-Pardo R, Salvador-Oliván JA, Navarro-Compán V (2020) Is the new ASDAS nomenclature in agreement with therapeutic decision making in patients with axial spondyloarthritis? Semin Arthritis Rheum 50(5):854–857. https://doi.org/10.1016/j.semarthrit.2020.07.010

    Article  PubMed  Google Scholar 

  24. Thomas K, Lazarini A, Kaltsonoudis E, Drosos A, Papalopoulos I, Sidiropoulos P et al (2020) Treatment patterns and achievement of the treat-to-target goals in a real-life rheumatoid arthritis patient cohort: data from 1317 patients. Ther Adv Musculoskelet Dis 12. https://doi.org/10.1177/1759720X20937132

  25. Kneepkens E, Krieckaert C, Van der Kleij D, Nurmohamed M, van Der Horst-Bruinsma I, Rispens T et al (2015) Lower etanercept levels are associated with high disease activity in ankylosing spondylitis patients at 24 weeks of follow-up. Ann Rheum Dis 74(10):1825–1829. https://doi.org/10.1136/annrheumdis-2014-205213

    Article  CAS  PubMed  Google Scholar 

  26. Gazitt T, Elhija MA, Haddad A, Lavi I, Elias M, Zisman D (2021) Implementation of the treat-to-target concept in evaluation of psoriatic arthritis patients. J Clin Med 10(23):5659. https://doi.org/10.3390/jcm10235659

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Lee S-W, Park M-C, Park Y-B, Lee S-K (2007) Measurement of the serum leptin level could assist disease activity monitoring in rheumatoid arthritis. Rheumatol Int 27(6):537–540. https://doi.org/10.1007/s00296-006-0253-x

    Article  CAS  PubMed  Google Scholar 

  28. Bonek K, Kuca Warnawin E, Kornatka A, Plebańczyk M, Burakowski T, Maśliński W et al (2022) Circulating miRNA correlates with lipid profile and disease activity in psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis patients. Biomedicines 10(4):893. https://doi.org/10.3390/biomedicines10040893

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R et al (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68(Suppl 2):ii1–ii44. https://doi.org/10.1136/ard.2008.104018

    Article  PubMed  Google Scholar 

  30. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54(8):2665–2673. https://doi.org/10.1002/art.21972

    Article  PubMed  Google Scholar 

  31. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62(9):2569–2581. https://doi.org/10.1002/art.27584

    Article  PubMed  Google Scholar 

  32. Gezer O, Batmaz İ, Sariyildiz MA, Sula B, Ucmak D, Bozkurt M et al (2017) Sleep quality in patients with psoriatic arthritis. Int J Rheum Dis 20(9):1212–1218. https://doi.org/10.1111/1756-185X.12505

    Article  CAS  PubMed  Google Scholar 

  33. Rosa Neto NS, De Carvalho JF, Shoenfeld Y (2009) Screening tests for inflammatory activity: applications in rheumatology. Mod Rheumatol 19(5):469–477. https://doi.org/10.1007/s10165-009-0211-z

    Article  PubMed  Google Scholar 

  34. Rosa Neto NS, Carvalho JF (2009) The use of inflammatory laboratory tests in rheumatology. Rev Bras Reumatol 49(4):413–430. https://doi.org/10.1590/S0482-50042009000400008

    Article  Google Scholar 

  35. Orr CK, Najm A, Young F, McGarry T, Biniecka M, Fearon U et al (2018) The utility and limitations of CRP, ESR and DAS28-CRP in appraising disease activity in rheumatoid arthritis. Front Med (Lausanne) 5:185. https://doi.org/10.3389/fmed.2018.00185

    Article  PubMed  Google Scholar 

  36. Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Shibuya N, Kubota K (2016) Clinical significance of the C-reactive protein to albumin ratio for survival after surgery for colorectal cancer. Ann Surg Oncol 23(3):900–907. https://doi.org/10.1245/s10434-015-4948-7

    Article  PubMed  Google Scholar 

  37. Hizli O, Cayir S, Coluk Y, Kayabasi S, Yildirim G (2021) The novel indicators of moderate to severe sleep apnea: fibrinogen to albumin ratio vs. CRP to albumin ratio. Eur Arch Otorhinolaryngol 278(3):851–855. https://doi.org/10.1007/s00405-019-05770-5

    Article  PubMed  Google Scholar 

  38. Uğur S (2022) C-reactive protein to albumin ratio, albumin to globulin ratio and platelet to lymphocyte ratio in patients with spondyloarthritis. Turk J Health S 3(1):1–4. https://doi.org/10.29228/tjhealthsport.55675

    Article  Google Scholar 

  39. Moeller M, Pink C, Endlich N, Endlich K, Grabe H-J, Völzke H et al (2017) Mortality is associated with inflammation, anemia, specific diseases and treatments, and molecular markers. PLoS One 12(4):e0175909. https://doi.org/10.1371/journal.pone.0175909

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Li L, Shen Q, Rao S (2022) Association of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes: A Cross-Sectional Study. Ther Clin Risk Manag 18:1157–1166. https://doi.org/10.2147/TCRM.S393135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Zhong Z, Huang Y, Liu Y, Chen J, Liu M, Huang Q et al (2021) Correlation between C-reactive protein to albumin ratio and disease activity in patients with axial spondyloarthritis. Dis Markers 2021:6642486. https://doi.org/10.1155/2021/6642486

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kemeriz F, Tuǧrul B, Tuncer SÇ (2020) C-reactive protein to albumin ratio: Is a new parameter for the disease severity in patients with psoriasis vulgaris? Dermatol Sin 38:199–204. https://doi.org/10.4103/ds.ds_42_20

    Article  Google Scholar 

  43. Izci Duran T, Pamukcu M (2022) Relationship between disease impact scores and C-reactive protein/albumin ratio in patients with psoriatic arthritis. Croat Med J 63(2):141–147. https://doi.org/10.3325/cmj.2022.63.141

    Article  CAS  Google Scholar 

  44. Onder ME, Orucoglu N, Omar F, Canataroglu A (2021) C-Reactive protein-to-Albumin ratio: A novel inflammatory marker and disease activity sign in early rheumatoid arthritis. Akt Rheumatol 47:239–247. https://doi.org/10.1055/a-1653-1172

    Article  Google Scholar 

  45. Afifi N, M Medhat B, Abdelghani AM, Mohamedalihassan HGE, Behiry ME (2020) Value of albumin-fibrinogen ratio and CRP-albumin ratio as predictor marker of disease activity in Egyptian RA patients, correlated with musculoskeletal sonography. Open Access Rheumatol 12:241–248. https://doi.org/10.2147/OARRR.S268668

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Wang J, Su J, Yuan Y, Jin X, Shen B, Lu G (2021) The role of lymphocyte-monocyte ratio on axial spondyloarthritis diagnosis and sacroiliitis staging. BMC Musculoskelet Disord 22(1):86. https://doi.org/10.1186/s12891-021-03973-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Wu J, Yan L, Chai K (2021) Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal 35(9):e23964. https://doi.org/10.1002/jcla.23964

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Elfitouri AOK (2022) Neutrophil-Lymphocyte Ratio and Platelat-Lymphocyte Ratio as Potential Markers of Disease Activity in Patients with Axial Spondyloarthritis. Egypt J Hosp Med 89(2):7383–7387. https://doi.org/10.21608/ejhm.2022.274802

    Article  Google Scholar 

  49. Al-Osami MH, Awadh NI, Khalid KB, Awadh AI (2020) Neutrophil/lymphocyte and platelet/lymphocyte ratios as potential markers of disease activity in patients with Ankylosing spondylitis: a case-control study. Adv Rheumatol 60(1):13. https://doi.org/10.1186/s42358-020-0113-5

    Article  PubMed  Google Scholar 

  50. Eroğlu DŞ, Torgutalp M, Sezer S, Yayla ME, Özel M, Turgay TM et al (2021) Complete blood count derived haematological parameters do not correlate with disease activity in patients with radiographic axial spondyloarthritis. J Turk Soc Rheumatol 13(1):6–11. https://doi.org/10.4274/raed.galenos.2021.49369

    Article  Google Scholar 

  51. Nguyen HT, Vo LDH, Pham NN (2022) Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory markers in psoriasis: a case-control study. Dermatol Rep 15(1):9516. https://doi.org/10.4081/dr.2022.9516

    Article  Google Scholar 

  52. An I, Ucmak D, Öztürk M, Aksoy M, Yıldız İ, Ucan E (2021) Neutrophil/Iymphocyte ratio, platelet/Iymphocyte ratio, mean platelet volume and C-reactive protein values in psoriatic arthritis patients. Ann Med Res 26(5):894–898. https://doi.org/10.5455/annalsmedres.2019.02.074

    Article  Google Scholar 

  53. Dincer AK, Sezer S (2022) Systemic immune inflammation index as a reliable disease activity marker in psoriatic arthritis. J Coll Physicians Surg Pak 32(6):773–778. https://doi.org/10.29271/jcpsp.2022.06.773

    Article  Google Scholar 

  54. Uslu AU, Küçük A, Şahin A, Ugan Y, Yılmaz R, Güngör T et al (2015) Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis 18(7):731–735. https://doi.org/10.1111/1756-185X.12582

    Article  PubMed  Google Scholar 

  55. Li M, Xie L (2021) Correlation between NLR, PLR, and LMR and disease activity, efficacy assessment in rheumatoid arthritis. Evid Based Complement Alternat Med 2021:4433141. https://doi.org/10.1155/2021/4433141

    Article  PubMed  PubMed Central  Google Scholar 

  56. Satis S (2021) New inflammatory marker associated with disease activity in rheumatoid arthritis: the systemic immune-inflammation index. Curr Health Sci J 47(4):553–557. https://doi.org/10.12865/CHSJ.47.04.11

    Article  PubMed  PubMed Central  Google Scholar 

  57. Kang KY, Jung J-Y, Ju JH, Park S-H, Hong Y-S (2016) Platelet indices are associated with disease activity scores and the severity of sacroiliitis on magnetic resonance imaging in axial spondyloarthritis patients. J Rheum Dis 23(5):288–296. https://doi.org/10.4078/jrd.2016.23.5.288

    Article  Google Scholar 

  58. Canpolat F, Akpınar H, Eskioğlu F (2010) Mean platelet volume in psoriasis and psoriatic arthritis. Clin Rheumatol 29(3):325–328. https://doi.org/10.1007/s10067-009-1323-8

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    Hüseyin Kaplan, Gizem Cengiz & Senem Şaş

  2. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    Yasemin Özden Eldemir

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Contributions

HK, GC, SŞ, and YÖE designed the study. HK, GC, and SŞ acquired the data. HK, GC, and YÖE analyzed and interpreted the data. All authors were involved in writing of the manuscript. The manuscript has been approved by all authors for publication.

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Correspondence to Hüseyin Kaplan.

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This study was approved by the Erciyes University Clinical Research Ethics Committee (Date: 05 May 2021, Approval Number: 2021/343). This study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from all patients.

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Kaplan, H., Cengiz, G., Şaş, S. et al. Is the C-reactive protein-to-albumin ratio the most remarkable simple inflammatory marker showing active disease in patients with axial spondyloarthritis, psoriatic arthritis, and rheumatoid arthritis?. Clin Rheumatol 42, 2959–2969 (2023). https://doi.org/10.1007/s10067-023-06703-8

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