Development and validation of a risk score for serious infection in patients with rheumatoid arthritis
Identifieur interne : 002715 ( Istex/Corpus ); précédent : 002714; suivant : 002716Development and validation of a risk score for serious infection in patients with rheumatoid arthritis
Auteurs : Cynthia S. Crowson ; Deana D. Hoganson ; Patrick D. Fitz-Gibbon ; Eric L. MattesonSource :
- Arthritis & Rheumatism [ 0004-3591 ] ; 2012-09.
English descriptors
- Teeft :
- Arthritis, Arthritis rheum, Biologic, Biologic agents, Biologic therapy, Biologic treatment, British society, Cardiovascular comorbidities, Chronic lung disease, Cohort, Comorbidities, Comorbidity, Coronary heart disease, Corticosteroid, Crowson, Decile, Diabetes mellitus, Disease activity, Disease characteristics, Erythrocyte sedimentation rate, Extraarticular, Extraarticular manifestations, First infection, Followup, Heart failure, Infection, Infection risk, Intravenous antibiotics, Leukopenia, Lymphopenia, Matteson, Mayo clinic, Mellitus, Multivariable, Multivariable model, Neutropenia, Next year, Nonlinear effects, Olmsted county, Original cohort, Past year, Potential predictors, Predictor, Previous infection, Previous infections, Referent, Rheum, Rheumatoid, Rheumatoid arthritis, Rheumatoid arthritis patients, Rheumatoid factor, Rheumatoid lung disease, Rheumatoid vasculitis, Rheumatology, Rheumatology biologics, Risk factors, Risk score, Rochester epidemiology project, Serious infection, Serious infections, Statistic, Statistical significance, Validation, Validation cohort.
Abstract
Objective: Infection risk is increased in patients with rheumatoid arthritis (RA), and accurate assessment of the risk of infection could inform clinical decision‐making. This study was undertaken to develop and validate a score to predict the 1‐year risk of serious infection in patients with RA. Methods: We studied a population‐based cohort of Olmsted County, Minnesota residents with incident RA ascertained in 1955–1994 whose members were followed up longitudinally, via complete medical records, until January 2000. The validation cohort included residents with incident RA ascertained in 1995–2007. The outcome measure included all serious infections (requiring hospitalization or intravenous antibiotics). Potential predictors were examined using multivariable Cox models. The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic. Results: Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80). Conclusion: RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.
Url:
DOI: 10.1002/art.34530
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ISTEX:903C6C44346E1B88F99ADDE5112894440FEF4997Le document en format XML
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This study was undertaken to develop and validate a score to predict the 1‐year risk of serious infection in patients with RA. Methods: We studied a population‐based cohort of Olmsted County, Minnesota residents with incident RA ascertained in 1955–1994 whose members were followed up longitudinally, via complete medical records, until January 2000. The validation cohort included residents with incident RA ascertained in 1995–2007. The outcome measure included all serious infections (requiring hospitalization or intravenous antibiotics). Potential predictors were examined using multivariable Cox models. The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic. Results: Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80). Conclusion: RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>cohort</json:string><json:string>rheumatoid</json:string><json:string>serious infection</json:string><json:string>risk score</json:string><json:string>validation cohort</json:string><json:string>original cohort</json:string><json:string>predictor</json:string><json:string>rheumatoid arthritis</json:string><json:string>corticosteroid</json:string><json:string>validation</json:string><json:string>crowson</json:string><json:string>infection risk</json:string><json:string>lymphopenia</json:string><json:string>comorbidities</json:string><json:string>followup</json:string><json:string>serious infections</json:string><json:string>mellitus</json:string><json:string>extraarticular</json:string><json:string>arthritis rheum</json:string><json:string>decile</json:string><json:string>infection</json:string><json:string>rheum</json:string><json:string>biologic</json:string><json:string>comorbidity</json:string><json:string>leukopenia</json:string><json:string>diabetes mellitus</json:string><json:string>rheumatology</json:string><json:string>arthritis</json:string><json:string>statistic</json:string><json:string>multivariable</json:string><json:string>previous infections</json:string><json:string>biologic agents</json:string><json:string>matteson</json:string><json:string>neutropenia</json:string><json:string>biologic treatment</json:string><json:string>coronary heart disease</json:string><json:string>multivariable model</json:string><json:string>chronic lung disease</json:string><json:string>heart failure</json:string><json:string>potential predictors</json:string><json:string>extraarticular manifestations</json:string><json:string>risk factors</json:string><json:string>referent</json:string><json:string>rheumatoid lung disease</json:string><json:string>rheumatoid arthritis patients</json:string><json:string>disease activity</json:string><json:string>erythrocyte sedimentation rate</json:string><json:string>next year</json:string><json:string>disease characteristics</json:string><json:string>rochester epidemiology project</json:string><json:string>rheumatoid vasculitis</json:string><json:string>past year</json:string><json:string>biologic therapy</json:string><json:string>first infection</json:string><json:string>rheumatoid factor</json:string><json:string>previous infection</json:string><json:string>statistical significance</json:string><json:string>cardiovascular comorbidities</json:string><json:string>nonlinear effects</json:string><json:string>mayo clinic</json:string><json:string>intravenous antibiotics</json:string><json:string>olmsted county</json:string><json:string>british society</json:string><json:string>rheumatology biologics</json:string></teeft></keywords><author><json:item><name>Cynthia S. Crowson</name><affiliations><json:string>Mayo Clinic, Rochester, Minnesota</json:string><json:string>E-mail: crowson@mayo.edu</json:string><json:string>Correspondence address: Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905</json:string></affiliations></json:item><json:item><name>Deana D. Hoganson</name><affiliations><json:string>Mayo Clinic, Rochester, Minnesota</json:string></affiliations></json:item><json:item><name>Patrick D. Fitz‐Gibbon</name><affiliations><json:string>Mayo Clinic, Rochester, Minnesota</json:string></affiliations></json:item><json:item><name>Eric L. Matteson</name><affiliations><json:string>Mayo Clinic, Rochester, Minnesota</json:string></affiliations></json:item></author><articleId><json:string>ART34530</json:string></articleId><arkIstex>ark:/67375/WNG-4M6F56D9-7</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Objective: Infection risk is increased in patients with rheumatoid arthritis (RA), and accurate assessment of the risk of infection could inform clinical decision‐making. This study was undertaken to develop and validate a score to predict the 1‐year risk of serious infection in patients with RA. Methods: We studied a population‐based cohort of Olmsted County, Minnesota residents with incident RA ascertained in 1955–1994 whose members were followed up longitudinally, via complete medical records, until January 2000. The validation cohort included residents with incident RA ascertained in 1995–2007. The outcome measure included all serious infections (requiring hospitalization or intravenous antibiotics). Potential predictors were examined using multivariable Cox models. The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic. Results: Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80). Conclusion: RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.</abstract><qualityIndicators><score>10</score><pdfWordCount>6013</pdfWordCount><pdfCharCount>38880</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>9</pdfPageCount><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><pdfWordsPerPage>668</pdfWordsPerPage><pdfText>true</pdfText><refBibsNative>true</refBibsNative><abstractWordCount>253</abstractWordCount><abstractCharCount>1818</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Development and validation of a risk score for serious infection in patients with rheumatoid arthritis</title><pmid><json:string>22576809</json:string></pmid><genre><json:string>article</json:string></genre><host><title>Arthritis & Rheumatism</title><language><json:string>unknown</json:string></language><doi><json:string>10.1002/(ISSN)1529-0131</json:string></doi><issn><json:string>0004-3591</json:string></issn><eissn><json:string>1529-0131</json:string></eissn><publisherId><json:string>ART</json:string></publisherId><volume>64</volume><issue>9</issue><pages><first>2847</first><last>2855</last><total>9</total></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Rheumatoid Arthritis</value></json:item><json:item><value>Rheumatoid Arthritis</value></json:item></subject></host><namedEntities><unitex><date><json:string>2000</json:string><json:string>2012</json:string><json:string>1987</json:string><json:string>1955</json:string><json:string>1995</json:string></date><geogName></geogName><orgName><json:string>Consortium of Rheumatology Researchers of North America</json:string><json:string>National Institute of Arthritis</json:string><json:string>National Institute on Aging</json:string><json:string>Genentech</json:string><json:string>British Society for Rheumatology Biologics Register</json:string><json:string>Department of Health Sciences Research, Mayo Clinic</json:string><json:string>ACR</json:string><json:string>Olmsted Medical Center</json:string><json:string>American College of Rheumatology</json:string><json:string>BSR Biologics Register</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Crowson</json:string><json:string>Our</json:string><json:string>Genentech</json:string><json:string>Eric L. 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Crowson</json:string></persName><placeName><json:string>Rochester</json:string><json:string>MN</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Smitten et al</json:string><json:string>through January 1, 2000</json:string><json:string>Franklin et al</json:string><json:string>Doran et al</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/WNG-4M6F56D9-7</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - rheumatology</json:string></wos><scienceMetrix></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Pharmacology (medical)</json:string><json:string>1 - Life Sciences</json:string><json:string>2 - Immunology and Microbiology</json:string><json:string>3 - Immunology</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Rheumatology</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - 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The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic.</p><head>Results</head><p>Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80).</p><head>Conclusion</head><p>RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.</p></abstract><textClass><keywords rend="articleCategory"><term>Rheumatoid Arthritis</term></keywords><keywords rend="tocHeading1"><term>Rheumatoid Arthritis</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc><revisionDesc><change when="2019-12-20" who="#istex" xml:id="pub2tei">formatting</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-4M6F56D9-7/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" 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registered="yes">10.1002/art.34530</doi><idGroup><id type="unit" value="ART34530"></id></idGroup><countGroup><count type="pageTotal" number="9"></count></countGroup><titleGroup><title type="articleCategory">Rheumatoid Arthritis</title><title type="tocHeading1">Rheumatoid Arthritis</title></titleGroup><copyright ownership="thirdParty">Copyright © 2012 by the American College of Rheumatology</copyright><eventGroup><event type="manuscriptReceived" date="2011-05-08"></event><event type="manuscriptAccepted" date="2012-04-26"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:3.1.9 mode:FullText mathml2tex" date="2012-10-18"></event><event type="publishedOnlineAccepted" date="2012-05-10"></event><event type="publishedOnlineFinalForm" date="2012-08-27"></event><event type="firstOnline" date="2012-08-27"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-05"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.3.7 mode:FullText" date="2015-03-24"></event></eventGroup><numberingGroup><numbering type="pageFirst">2847</numbering><numbering type="pageLast">2855</numbering></numberingGroup><correspondenceTo>Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:ART.ART34530.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="4"></count><count type="referenceTotal" number="36"></count><count type="wordTotal" number="6985"></count></countGroup><titleGroup><title type="main" xml:lang="en">Development and validation of a risk score for serious infection in patients with rheumatoid arthritis</title><title type="short" xml:lang="en">Infection Risk in RA</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Cynthia S.</givenNames><familyName>Crowson</familyName></personName><contactDetails><email>crowson@mayo.edu</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Deana D.</givenNames><familyName>Hoganson</familyName></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Patrick D.</givenNames><familyName>Fitz‐Gibbon</familyName></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1" noteRef="#fn1"><personName><givenNames>Eric L.</givenNames><familyName>Matteson</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Mayo Clinic, Rochester, Minnesota</unparsedAffiliation></affiliation></affiliationGroup><fundingInfo><fundingAgency>Genentech</fundingAgency></fundingInfo><fundingInfo><fundingAgency>NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases)</fundingAgency><fundingNumber>R01‐AR‐46849</fundingNumber></fundingInfo><fundingInfo><fundingAgency>National Institute on Aging</fundingAgency><fundingNumber>R01‐AG‐034676</fundingNumber></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><section xml:id="abs1-1"><title type="main">Objective</title><p>Infection risk is increased in patients with rheumatoid arthritis (RA), and accurate assessment of the risk of infection could inform clinical decision‐making. This study was undertaken to develop and validate a score to predict the 1‐year risk of serious infection in patients with RA.</p></section><section xml:id="abs1-2"><title type="main">Methods</title><p>We studied a population‐based cohort of Olmsted County, Minnesota residents with incident RA ascertained in 1955–1994 whose members were followed up longitudinally, via complete medical records, until January 2000. The validation cohort included residents with incident RA ascertained in 1995–2007. The outcome measure included all serious infections (requiring hospitalization or intravenous antibiotics). Potential predictors were examined using multivariable Cox models. The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic.</p></section><section xml:id="abs1-3"><title type="main">Results</title><p>Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80).</p></section><section xml:id="abs1-4"><title type="main">Conclusion</title><p>RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.</p></section></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Dr. Matteson has received research grants from Centocor, Genentech, Human Genome Sciences, Pfizer, Novartis, and UCB.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Development and validation of a risk score for serious infection in patients with rheumatoid arthritis</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Infection Risk in RA</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Development and validation of a risk score for serious infection in patients with rheumatoid arthritis</title></titleInfo><name type="personal"><namePart type="given">Cynthia S.</namePart><namePart type="family">Crowson</namePart><affiliation>Mayo Clinic, Rochester, Minnesota</affiliation><affiliation>E-mail: crowson@mayo.edu</affiliation><affiliation>Correspondence address: Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Deana D.</namePart><namePart type="family">Hoganson</namePart><affiliation>Mayo Clinic, Rochester, Minnesota</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Patrick D.</namePart><namePart type="family">Fitz‐Gibbon</namePart><affiliation>Mayo Clinic, Rochester, Minnesota</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Eric L.</namePart><namePart type="family">Matteson</namePart><affiliation>Mayo Clinic, Rochester, Minnesota</affiliation><description>Dr. Matteson has received research grants from Centocor, Genentech, Human Genome Sciences, Pfizer, Novartis, and UCB.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2012-09</dateIssued><dateCaptured encoding="w3cdtf">2011-05-08</dateCaptured><dateValid encoding="w3cdtf">2012-04-26</dateValid><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">2</extent><extent unit="tables">4</extent><extent unit="references">36</extent><extent unit="words">6985</extent></physicalDescription><abstract lang="en">Objective: Infection risk is increased in patients with rheumatoid arthritis (RA), and accurate assessment of the risk of infection could inform clinical decision‐making. This study was undertaken to develop and validate a score to predict the 1‐year risk of serious infection in patients with RA. Methods: We studied a population‐based cohort of Olmsted County, Minnesota residents with incident RA ascertained in 1955–1994 whose members were followed up longitudinally, via complete medical records, until January 2000. The validation cohort included residents with incident RA ascertained in 1995–2007. The outcome measure included all serious infections (requiring hospitalization or intravenous antibiotics). Potential predictors were examined using multivariable Cox models. The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic. Results: Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80). Conclusion: RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.</abstract><note type="funding">Genentech</note><note type="funding">NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases) - No. R01‐AR‐46849; </note><note type="funding">National Institute on Aging - No. R01‐AG‐034676; </note><relatedItem type="host"><titleInfo><title>Arthritis & Rheumatism</title></titleInfo><titleInfo type="abbreviated"><title>Arthritis & Rheumatism</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>article-category</genre><topic>Rheumatoid Arthritis</topic><topic>Rheumatoid Arthritis</topic></subject><identifier type="ISSN">0004-3591</identifier><identifier type="eISSN">1529-0131</identifier><identifier type="DOI">10.1002/(ISSN)1529-0131</identifier><identifier type="PublisherID">ART</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>64</number></detail><detail type="issue"><caption>no.</caption><number>9</number></detail><extent unit="pages"><start>2847</start><end>2855</end><total>9</total></extent></part></relatedItem><relatedItem type="references" displayLabel="cit1"><titleInfo><title>The widening mortality gap between rheumatoid arthritis patients and the general population</title></titleInfo><name type="personal"><namePart type="given">A</namePart><namePart type="family">Gonzalez</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H</namePart><namePart type="family">Maradit Kremers</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">CS</namePart><namePart type="family">Crowson</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">PJ</namePart><namePart type="family">Nicola</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">JM</namePart><namePart type="family">Davis III</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">TM</namePart><namePart type="family">Therneau</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal-article</genre><note type="citation/reference">Gonzalez A, Maradit Kremers H, Crowson CS, Nicola PJ, Davis JM III, Therneau TM, et al. 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Arthritis Res Ther 2005; 7: R796–806.</note><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>7</number></detail><extent unit="pages"><start>R796</start><end>806</end></extent></part><relatedItem type="host"><titleInfo><title>Arthritis Res Ther</title></titleInfo><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>7</number></detail><extent unit="pages"><start>R796</start><end>806</end></extent></part></relatedItem></relatedItem><identifier type="istex">903C6C44346E1B88F99ADDE5112894440FEF4997</identifier><identifier type="ark">ark:/67375/WNG-4M6F56D9-7</identifier><identifier type="DOI">10.1002/art.34530</identifier><identifier type="ArticleID">ART34530</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2012 by the American College of Rheumatology</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-L0C46X92-X">wiley</recordContentSource><recordOrigin>Converted from (version ) to MODS version 3.6.</recordOrigin><recordCreationDate encoding="w3cdtf">2019-11-13</recordCreationDate></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-4M6F56D9-7/record.json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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