Minimal disease activity for rheumatoid arthritis : A preliminary definition
Identifieur interne : 00A551 ( Main/Exploration ); précédent : 00A550; suivant : 00A552Minimal disease activity for rheumatoid arthritis : A preliminary definition
Auteurs : George A. Wells [Canada, États-Unis, Pays-Bas, Australie, Royaume-Uni] ; Maarten Boers ; Beverley Shea [Canada] ; Peter M. Brooks [Australie] ; Lee S. Simon ; C. Vibeke Strand ; Daniel Aletaha [Autriche] ; Jennifer J. Anderson [États-Unis] ; Claire Bombardier [Canada] ; Maxime Dougados [France] ; Paul Emery [Royaume-Uni] ; David T. Felson [États-Unis] ; Jaap Fransen [Pays-Bas] ; Dan E. Furst ; Johanna M. W. Hazes ; Kent R. Johnson ; John R. Kirwan ; Robert B. M. Landewe ; Marissa N. D. Lassere ; Kaleb Michaud ; Maria Suarez-Almazor ; Alan J. Silman ; Josef S. Smolen ; Desiree M. F. M. Van Der Heijde ; Piet L. C. M. Van Riel ; Fred Wolfe ; Peter S. TugwellSource :
- Journal of rheumatology [ 0315-162X ] ; 2005.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Agreement on response criteria in rheumatoid arthritis (RA) has allowed better standardization and interpretation of clinical trial reports. With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. The threshold for MDA is between high disease activity and remission and, by definition, anyone in remission will also be in MDA. True remission is still rare in RA; in addition, the American College of Rheumatology definition is difficult to apply in the context of trials. Participants at OMERACT 6 in 2002 agreed on a conceptual definition of minimal disease activity (MDA): "that state of disease activity deemed a useful target of treatment by both the patient and the physician, given current treatment possibilities and limitations." To prepare for a preliminary operational definition of MDA for use in clinical trials, we asked rheumatologists to assess 60 patient profiles describing real RA patients seen in routine clinical practice. Based on their responses, several candidate definitions for MDA were designed and discussed at the OMERACT 7 in 2004. Feedback from participants and additional on-site analyses in a cross-sectional database allowed the formulation of 2 preliminary, equivalent definitions of MDA: one based on the Disease Activity Score 28 (DAS28) index, and one based on meeting cutpoints in 5 out the 7 WHO/ILAR core set measures. Researchers applying these definitions first need to choose whether to use the DAS28 or the core set definition, because although each selects a similar proportion in a population, these are not always the same patients. In both MDA definitions, an initial decision node places all patients in MDA who have a tender joint count of 0 and a swollen joint count of 0, and an erythrocyte sedimentation rate (ESR) no greater than 10 mm. If this condition is not met: ● The DAS28 definition places patients in MDA when DAS28 < 2.85 ● The core set definition places patients in MDA when they meet 5 of 7 criteria: (1) Pain (0-10) ≤ 2; (2) Swollen joint count (0-28) ≤ 1; (3) Tender joint count (0-28) ≤ 1; (4) Health Assessment Questionnaire (HAQ, 0-3) ≤ 0.5; (5) Physician global assessment of disease activity (0-10) ≤ 1.5; (6) Patient global assessment of disease activity (0-10) ≤ 2; (7) ESR ≤ 20. This set of 2 definitions gained approval of 73% of the attendees. These (and other) definitions will now be subject to further validation in other databases.
Affiliations:
- Australie, Autriche, Canada, France, Pays-Bas, Royaume-Uni, États-Unis
- Angleterre, Californie, Grand Manchester, Hollande-Méridionale, Massachusetts, Nouvelle-Galles du Sud, Ontario, Texas, Vienne (Autriche), Yorkshire-et-Humber, Île-de-France
- Boston, Houston, Leeds, Los Angeles, Manchester, Paris, Rotterdam, Sydney, Toronto, Vienne (Autriche)
- Université de Leeds, Université de Manchester, Université de Toronto
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Hazes</name></author><author><name sortKey="Johnson, Kent R" sort="Johnson, Kent R" uniqKey="Johnson K" first="Kent R." last="Johnson">Kent R. Johnson</name></author><author><name sortKey="Kirwan, John R" sort="Kirwan, John R" uniqKey="Kirwan J" first="John R." last="Kirwan">John R. Kirwan</name></author><author><name sortKey="Landewe, Robert B M" sort="Landewe, Robert B M" uniqKey="Landewe R" first="Robert B. M." last="Landewe">Robert B. M. Landewe</name></author><author><name sortKey="Lassere, Marissa N D" sort="Lassere, Marissa N D" uniqKey="Lassere M" first="Marissa N. D." last="Lassere">Marissa N. D. Lassere</name></author><author><name sortKey="Michaud, Kaleb" sort="Michaud, Kaleb" uniqKey="Michaud K" first="Kaleb" last="Michaud">Kaleb Michaud</name></author><author><name sortKey="Suarez Almazor, Maria" sort="Suarez Almazor, Maria" uniqKey="Suarez Almazor M" first="Maria" last="Suarez-Almazor">Maria Suarez-Almazor</name></author><author><name sortKey="Silman, Alan J" sort="Silman, Alan J" uniqKey="Silman A" first="Alan J." last="Silman">Alan J. Silman</name></author><author><name sortKey="Smolen, Josef S" sort="Smolen, Josef S" uniqKey="Smolen J" first="Josef S." last="Smolen">Josef S. Smolen</name></author><author><name sortKey="Van Der Heijde, Desiree M F M" sort="Van Der Heijde, Desiree M F M" uniqKey="Van Der Heijde D" first="Desiree M. F. M." last="Van Der Heijde">Desiree M. F. M. Van Der Heijde</name></author><author><name sortKey="Van Riel, Piet L C M" sort="Van Riel, Piet L C M" uniqKey="Van Riel P" first="Piet L. C. M." last="Van Riel">Piet L. C. M. 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Wells</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Epidemiology and Community Medicine, University of Ottawa</s1><s2>Ottawa</s2><s3>CAN</s3><sZ>1 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Ottawa</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>David Geffen School of Medicine, UCLA</s1><s2>Los Angeles</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Los Angeles</settlement><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="12"><s1>Erasmus University Medical Center</s1><s2>Rotterdam</s2><s3>NLD</s3></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Mater Hospital, University of Newcastle</s1><s2>Newcastle</s2><s3>AUS</s3></inist:fA14><country>Australie</country><wicri:noRegion>Newcastle</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>University of Bristol, Bristol Royal Infirmary</s1><s2>Bristol</s2><s3>GBR</s3></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Bristol</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>University Hospital Maastricht</s1><s2>Maastricht</s2><s3>NLD</s3></inist:fA14><country>Pays-Bas</country><wicri:noRegion>University Hospital Maastricht</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="16"><s1>Department of Rheumatology, St. George Hospital</s1><s2>Sydney</s2><s3>AUS</s3></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>National Data Bank for Rheumatic Diseases</s1><s2>Wichita</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><wicri:noRegion>National Data Bank for Rheumatic Diseases</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="18"><s1>Baylor College of Medicine and Michael E. De Bakey VAMC</s1><s2>Houston</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Houston</settlement><region type="state">Texas</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="19"><s1>University of Manchester</s1><s2>Manchester</s2><s3>GBR</s3></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region><settlement type="city">Manchester</settlement></placeName><orgName type="university">Université de Manchester</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="20"><s1>Harvard Medical School, Beth Israel Deaconess Medical Center</s1><s2>Boston</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="21"><s1>Stanford University School of Medicine</s1><s2>Stanford</s2><s3>USA</s3></inist:fA14><country>États-Unis</country><wicri:noRegion>Stanford University School of Medicine</wicri:noRegion></affiliation></author><author><name sortKey="Boers, Maarten" sort="Boers, Maarten" uniqKey="Boers M" first="Maarten" last="Boers">Maarten Boers</name></author><author><name sortKey="Shea, Beverley" sort="Shea, Beverley" uniqKey="Shea B" first="Beverley" last="Shea">Beverley Shea</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Institution of Population Health</s1><s2>Ottawa</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Institution of Population Health</wicri:noRegion></affiliation></author><author><name sortKey="Brooks, Peter M" sort="Brooks, Peter M" uniqKey="Brooks P" first="Peter M." last="Brooks">Peter M. Brooks</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Queensland, Royal Brisbane Hospital</s1><s2>Brisbane</s2><s3>AUS</s3><sZ>4 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author><author><name sortKey="Simon, Lee S" sort="Simon, Lee S" uniqKey="Simon L" first="Lee S." last="Simon">Lee S. Simon</name></author><author><name sortKey="Strand, C Vibeke" sort="Strand, C Vibeke" uniqKey="Strand C" first="C. Vibeke" last="Strand">C. Vibeke Strand</name></author><author><name sortKey="Aletaha, Daniel" sort="Aletaha, Daniel" uniqKey="Aletaha D" first="Daniel" last="Aletaha">Daniel Aletaha</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Medical University Vienna</s1><s2>Vienna</s2><s3>AUT</s3><sZ>7 aut.</sZ></inist:fA14><country>Autriche</country><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author><author><name sortKey="Anderson, Jennifer J" sort="Anderson, Jennifer J" uniqKey="Anderson J" first="Jennifer J." last="Anderson">Jennifer J. Anderson</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Boston University School of Public Health</s1><s2>Boston</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bombardier, Claire" sort="Bombardier, Claire" uniqKey="Bombardier C" first="Claire" last="Bombardier">Claire Bombardier</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Institution of Work and Health, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Dougados, Maxime" sort="Dougados, Maxime" uniqKey="Dougados M" first="Maxime" last="Dougados">Maxime Dougados</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Hopital Cochin. Rene Descartes University</s1><s2>Paris</s2><s3>FRA</s3><sZ>10 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Emery, Paul" sort="Emery, Paul" uniqKey="Emery P" first="Paul" last="Emery">Paul Emery</name><affiliation wicri:level="4"><inist:fA14 i1="08"><s1>University of Leeds</s1><s2>Leeds</s2><s3>GBR</s3><sZ>11 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName><orgName type="university">Université de Leeds</orgName></affiliation></author><author><name sortKey="Felson, David T" sort="Felson, David T" uniqKey="Felson D" first="David T." last="Felson">David T. Felson</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>School of Medicine</s1><s2>Boston</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Fransen, Jaap" sort="Fransen, Jaap" uniqKey="Fransen J" first="Jaap" last="Fransen">Jaap Fransen</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Rheumatology, University Hospital Nijmegen</s1><s3>NLD</s3><sZ>13 aut.</sZ></inist:fA14><country>Pays-Bas</country><wicri:noRegion>Department of Rheumatology, University Hospital Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Furst, Dan E" sort="Furst, Dan E" uniqKey="Furst D" first="Dan E." last="Furst">Dan E. Furst</name></author><author><name sortKey="Hazes, Johanna M W" sort="Hazes, Johanna M W" uniqKey="Hazes J" first="Johanna M. W." last="Hazes">Johanna M. W. Hazes</name></author><author><name sortKey="Johnson, Kent R" sort="Johnson, Kent R" uniqKey="Johnson K" first="Kent R." last="Johnson">Kent R. Johnson</name></author><author><name sortKey="Kirwan, John R" sort="Kirwan, John R" uniqKey="Kirwan J" first="John R." last="Kirwan">John R. Kirwan</name></author><author><name sortKey="Landewe, Robert B M" sort="Landewe, Robert B M" uniqKey="Landewe R" first="Robert B. M." last="Landewe">Robert B. M. Landewe</name></author><author><name sortKey="Lassere, Marissa N D" sort="Lassere, Marissa N D" uniqKey="Lassere M" first="Marissa N. D." last="Lassere">Marissa N. D. Lassere</name></author><author><name sortKey="Michaud, Kaleb" sort="Michaud, Kaleb" uniqKey="Michaud K" first="Kaleb" last="Michaud">Kaleb Michaud</name></author><author><name sortKey="Suarez Almazor, Maria" sort="Suarez Almazor, Maria" uniqKey="Suarez Almazor M" first="Maria" last="Suarez-Almazor">Maria Suarez-Almazor</name></author><author><name sortKey="Silman, Alan J" sort="Silman, Alan J" uniqKey="Silman A" first="Alan J." last="Silman">Alan J. Silman</name></author><author><name sortKey="Smolen, Josef S" sort="Smolen, Josef S" uniqKey="Smolen J" first="Josef S." last="Smolen">Josef S. Smolen</name></author><author><name sortKey="Van Der Heijde, Desiree M F M" sort="Van Der Heijde, Desiree M F M" uniqKey="Van Der Heijde D" first="Desiree M. F. M." last="Van Der Heijde">Desiree M. F. M. Van Der Heijde</name></author><author><name sortKey="Van Riel, Piet L C M" sort="Van Riel, Piet L C M" uniqKey="Van Riel P" first="Piet L. C. M." last="Van Riel">Piet L. C. M. Van Riel</name></author><author><name sortKey="Wolfe, Fred" sort="Wolfe, Fred" uniqKey="Wolfe F" first="Fred" last="Wolfe">Fred Wolfe</name></author><author><name sortKey="Tugwell, Peter S" sort="Tugwell, Peter S" uniqKey="Tugwell P" first="Peter S." last="Tugwell">Peter S. Tugwell</name></author></analytic><series><title level="j" type="main">Journal of rheumatology</title><title level="j" type="abbreviated">J. rheumatol.</title><idno type="ISSN">0315-162X</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of rheumatology</title><title level="j" type="abbreviated">J. rheumatol.</title><idno type="ISSN">0315-162X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Chronic</term><term>Clinical trial</term><term>Definition</term><term>Joint</term><term>Pain</term><term>Prognosis</term><term>Rheumatoid arthritis</term><term>Rheumatology</term><term>Survey</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Polyarthrite rhumatoïde</term><term>Définition</term><term>Pronostic</term><term>Essai clinique</term><term>Enquête</term><term>Articulation</term><term>Douleur</term><term>Rhumatologie</term><term>Chronique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Agreement on response criteria in rheumatoid arthritis (RA) has allowed better standardization and interpretation of clinical trial reports. With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. The threshold for MDA is between high disease activity and remission and, by definition, anyone in remission will also be in MDA. True remission is still rare in RA; in addition, the American College of Rheumatology definition is difficult to apply in the context of trials. Participants at OMERACT 6 in 2002 agreed on a conceptual definition of minimal disease activity (MDA): "that state of disease activity deemed a useful target of treatment by both the patient and the physician, given current treatment possibilities and limitations." To prepare for a preliminary operational definition of MDA for use in clinical trials, we asked rheumatologists to assess 60 patient profiles describing real RA patients seen in routine clinical practice. Based on their responses, several candidate definitions for MDA were designed and discussed at the OMERACT 7 in 2004. Feedback from participants and additional on-site analyses in a cross-sectional database allowed the formulation of 2 preliminary, equivalent definitions of MDA: one based on the Disease Activity Score 28 (DAS28) index, and one based on meeting cutpoints in 5 out the 7 WHO/ILAR core set measures. Researchers applying these definitions first need to choose whether to use the DAS28 or the core set definition, because although each selects a similar proportion in a population, these are not always the same patients. In both MDA definitions, an initial decision node places all patients in MDA who have a tender joint count of 0 and a swollen joint count of 0, and an erythrocyte sedimentation rate (ESR) no greater than 10 mm. If this condition is not met: ● The DAS28 definition places patients in MDA when DAS28 < 2.85 ● The core set definition places patients in MDA when they meet 5 of 7 criteria: (1) Pain (0-10) ≤ 2; (2) Swollen joint count (0-28) ≤ 1; (3) Tender joint count (0-28) ≤ 1; (4) Health Assessment Questionnaire (HAQ, 0-3) ≤ 0.5; (5) Physician global assessment of disease activity (0-10) ≤ 1.5; (6) Patient global assessment of disease activity (0-10) ≤ 2; (7) ESR ≤ 20. This set of 2 definitions gained approval of 73% of the attendees. These (and other) definitions will now be subject to further validation in other databases.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Autriche</li><li>Canada</li><li>France</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Californie</li><li>Grand Manchester</li><li>Hollande-Méridionale</li><li>Massachusetts</li><li>Nouvelle-Galles du Sud</li><li>Ontario</li><li>Texas</li><li>Vienne (Autriche)</li><li>Yorkshire-et-Humber</li><li>Île-de-France</li></region><settlement><li>Boston</li><li>Houston</li><li>Leeds</li><li>Los Angeles</li><li>Manchester</li><li>Paris</li><li>Rotterdam</li><li>Sydney</li><li>Toronto</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université de Leeds</li><li>Université de Manchester</li><li>Université de Toronto</li></orgName></list><tree><noCountry><name sortKey="Boers, Maarten" sort="Boers, Maarten" uniqKey="Boers M" first="Maarten" last="Boers">Maarten Boers</name><name sortKey="Furst, Dan E" sort="Furst, Dan E" uniqKey="Furst D" first="Dan E." last="Furst">Dan E. Furst</name><name sortKey="Hazes, Johanna M W" sort="Hazes, Johanna M W" uniqKey="Hazes J" first="Johanna M. W." last="Hazes">Johanna M. W. Hazes</name><name sortKey="Johnson, Kent R" sort="Johnson, Kent R" uniqKey="Johnson K" first="Kent R." last="Johnson">Kent R. Johnson</name><name sortKey="Kirwan, John R" sort="Kirwan, John R" uniqKey="Kirwan J" first="John R." last="Kirwan">John R. Kirwan</name><name sortKey="Landewe, Robert B M" sort="Landewe, Robert B M" uniqKey="Landewe R" first="Robert B. M." last="Landewe">Robert B. M. Landewe</name><name sortKey="Lassere, Marissa N D" sort="Lassere, Marissa N D" uniqKey="Lassere M" first="Marissa N. D." last="Lassere">Marissa N. D. Lassere</name><name sortKey="Michaud, Kaleb" sort="Michaud, Kaleb" uniqKey="Michaud K" first="Kaleb" last="Michaud">Kaleb Michaud</name><name sortKey="Silman, Alan J" sort="Silman, Alan J" uniqKey="Silman A" first="Alan J." last="Silman">Alan J. Silman</name><name sortKey="Simon, Lee S" sort="Simon, Lee S" uniqKey="Simon L" first="Lee S." last="Simon">Lee S. Simon</name><name sortKey="Smolen, Josef S" sort="Smolen, Josef S" uniqKey="Smolen J" first="Josef S." last="Smolen">Josef S. Smolen</name><name sortKey="Strand, C Vibeke" sort="Strand, C Vibeke" uniqKey="Strand C" first="C. Vibeke" last="Strand">C. Vibeke Strand</name><name sortKey="Suarez Almazor, Maria" sort="Suarez Almazor, Maria" uniqKey="Suarez Almazor M" first="Maria" last="Suarez-Almazor">Maria Suarez-Almazor</name><name sortKey="Tugwell, Peter S" sort="Tugwell, Peter S" uniqKey="Tugwell P" first="Peter S." last="Tugwell">Peter S. Tugwell</name><name sortKey="Van Der Heijde, Desiree M F M" sort="Van Der Heijde, Desiree M F M" uniqKey="Van Der Heijde D" first="Desiree M. F. M." last="Van Der Heijde">Desiree M. F. M. Van Der Heijde</name><name sortKey="Van Riel, Piet L C M" sort="Van Riel, Piet L C M" uniqKey="Van Riel P" first="Piet L. C. M." last="Van Riel">Piet L. C. M. Van Riel</name><name sortKey="Wolfe, Fred" sort="Wolfe, Fred" uniqKey="Wolfe F" first="Fred" last="Wolfe">Fred Wolfe</name></noCountry><country name="Canada"><noRegion><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></noRegion><name sortKey="Bombardier, Claire" sort="Bombardier, Claire" uniqKey="Bombardier C" first="Claire" last="Bombardier">Claire Bombardier</name><name sortKey="Shea, Beverley" sort="Shea, Beverley" uniqKey="Shea B" first="Beverley" last="Shea">Beverley Shea</name></country><country name="États-Unis"><region name="Californie"><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></region><name sortKey="Anderson, Jennifer J" sort="Anderson, Jennifer J" uniqKey="Anderson J" first="Jennifer J." last="Anderson">Jennifer J. Anderson</name><name sortKey="Felson, David T" sort="Felson, David T" uniqKey="Felson D" first="David T." last="Felson">David T. Felson</name><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></country><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></region><name sortKey="Fransen, Jaap" sort="Fransen, Jaap" uniqKey="Fransen J" first="Jaap" last="Fransen">Jaap Fransen</name><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></country><country name="Australie"><noRegion><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></noRegion><name sortKey="Brooks, Peter M" sort="Brooks, Peter M" uniqKey="Brooks P" first="Peter M." last="Brooks">Peter M. Brooks</name><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></noRegion><name sortKey="Emery, Paul" sort="Emery, Paul" uniqKey="Emery P" first="Paul" last="Emery">Paul Emery</name><name sortKey="Wells, George A" sort="Wells, George A" uniqKey="Wells G" first="George A." last="Wells">George A. Wells</name></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Aletaha, Daniel" sort="Aletaha, Daniel" uniqKey="Aletaha D" first="Daniel" last="Aletaha">Daniel Aletaha</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Dougados, Maxime" sort="Dougados, Maxime" uniqKey="Dougados M" first="Maxime" last="Dougados">Maxime Dougados</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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