Nicola Waldron
Royal National Hospital for Rheumatic Diseases
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Rheumatology | 2013
Laura C. Coates; William Tillett; David Chandler; Philip S. Helliwell; Eleanor Korendowych; Stuart Kyle; Iain B. McInnes; Susan Oliver; A.D. Ormerod; Catherine Smith; Deborah Symmons; Nicola Waldron; Neil McHugh
The last British Society of Rheumatology (BSR) guidelines for the treatment of PsA were published in 2005 when antiTNF therapy was not widely available. At that time only one of the anti-TNF therapies was licensed for the treatment of PsA. Since then, their use in PsA has become more widespread, with multiple anti-TNF drugs licensed for the treatment of PsA and approved for therapy by the National Institute for Health and Clinical Excellence (NICE). However, despite these advances, there are still patients
The Journal of Rheumatology | 2010
Caitriona Buckley; Charlotte Cavill; Gordon Taylor; Hazel Kay; Nicola Waldron; Eleanor Korendowych; Neil McHugh
Objective. To determine whether the mortality in a cohort of patients with psoriatic arthritis (PsA) from a single center in the UK is significantly different from the general UK population. Methods. Patients who were entered onto the PsA database at the Royal National Hospital for Rheumatic Diseases, Bath, between 1985 and 2007 were included in this study. Information on patient deaths was collected retrospectively. The National Health Service (NHS) Strategic Tracing Service was used to establish which patients were alive and which had died. Date and cause of death were confirmed by death certificates from the Registry of Births, Marriages and Deaths. A standardized mortality ratio (SMR) was calculated by matching the patient data to single-year, 5-year age-banded England and Wales data from the Office of National Statistics. Results. In this cohort of 453 patients with PsA (232 men, 221 women), there were 37 deaths. Sixteen men and 21 women died. The SMR for the men was 67.87% (95% CI 38.79, 110.22), and for the women, 97.01% (95% CI 60.05, 148.92) and the overall SMR for the PsA cohort was 81.82% (95% CI 57.61, 112.78). The leading causes of death in this cohort were cardiovascular disease (38%), diseases of the respiratory system (27%), and malignancy (14%). Conclusion. These results suggest that mortality in our single-center PsA cohort is not significantly different from the general UK population. No increased risk of death was observed in this cohort.
Rheumatology | 2013
Deepak Jadon; William Tillett; Dinny Wallis; Charlotte Cavill; John Bowes; Nicola Waldron; Anna Dixon; Raj Sengupta; Anne Barton; Eleanor Korendowych; Neil McHugh
OBJECTIVE To ascertain whether AS-associated polymorphisms of ERAP1, IL23R and IL12B genes associate with subphenotypes of PsA, particularly axial radiographic disease once stratified by HLA-B27 and HLA-Cw*0602 status. METHODS rs30187 (ERAP1 gene), rs6887695 (IL12B gene), rs11209026 and rs7530511 (IL23R gene) single nucleotide polymorphisms were genotyped in 263 PsA cases from a prospective cohort and compared with data from healthy controls (n = 3266-5422). ERAP1 results were stratified according to HLA-B27 and HLA-Cw*0602 status. Investigation of association with age at onset of psoriasis/PsA, arthritic joint count, axial radiographic disease, peripheral radiographic erosions, Psoriasis Area Severity Index, nail score and HAQ was made. RESULTS There was a strong association between rs6887595 (IL12B) and PsA, with homozygosity for the major allele being more frequent in PsA than controls (odds ratio 1.70; 95% CI 1.3, 2.2; P < 0.001). A trend was demonstrated for the minor allele of rs11209026 (IL23R) to be less frequent in patients with erosive joint disease than in those without erosions or controls (7%, 14% and 12%, respectively). None of the polymorphisms associated with the presence of axial radiographic disease or other clinical parameters. CONCLUSION We have confirmed a strong association between rs6887595 (IL12B) and PsA. A trend has been demonstrated between an IL23R variant and peripheral erosive disease. ERAP1 was not associated with axial radiographic disease in PsA. Spinal involvement in PsA may be genetically different from that in AS, which is in keeping with previous observations that the clinical and radiographic pattern of axial disease also differs.
The Journal of Rheumatology | 2015
Deepak Jadon; Gavin Shaddick; William Tillett; Eleanor Korendowych; Graham Robinson; Nicola Waldron; Charlotte Cavill; Neil McHugh
Objective. (1) To compare clinical characteristics of patients with psoriatic arthritis (PsA) with PsA mutilans (PAM) and without PAM, and (2) to determine the rate of PAM radiographic progression. Methods. A retrospective cohort study was conducted of all patients with PsA attending a teaching hospital. The most recent hand and feet radiographs were screened for PAM. Serial radiographs (earliest to most recent) were quantitatively scored for osteolysis, erosion, joint space narrowing, and osteoproliferation. Results. Out of the 610 cases, 36 PsA cases had PAM (5.9%). PAM cases were younger at diagnosis of PsA than non-PAM cases (p = 0.04), had more prevalent psoriatic nail dystrophy (OR 5.43, p < 0.001), and worse health assessment questionnaire score (1.25 vs 0.63, p < 0.04). Radiographic axial disease (OR 2.31, adjusted p = 0.03) and especially radiographic sacroiliitis (OR 2.99, adjusted p = 0.01) were more prevalent in PAM. PAM were more likely than non-PAM cases to have used a disease-modifying antirheumatic drug (DMARD; OR 16.36, p < 0.001). Out of 33 cases, 29 PAM cases had initiated a synthetic DMARD and 4/13 had initiated anti-tumor necrosis factor (anti-TNF) prior to first demonstration of PAM. A median 5 radiographs were scored for each PAM case (interquartile range 3–7). PAM progressed from monoarticular (60%) to polyarticular (80%) involvement. Osteolysis was initially rapid and progressive in the hands and feet, tapering later during disease course. Nail dystrophy predicted more severe osteolysis (p = 0.03). Conclusion. Compared with non-PAM cases, PAM cases have earlier age at PsA diagnosis, poorer function, more prevalent nail dystrophy, and more radiographic axial disease/sacroiliitis. The rate of osteolysis is higher in earlier disease, and more severe in those with nail dystrophy. DMARD and anti-TNF therapy appear not to prevent PAM occurrence.
The Journal of Rheumatology | 2013
Dinny Wallis; Nicola Waldron; Eleanor Korendowych
To the Editor: Ustekinumab is a human monoclonal antibody that targets the p40 subunit of both interleukin 12 (IL-12) and IL-23 and inhibits their activity. IL-12 and IL-23 have a key role in the differentiation and proliferation of Th1 and Th17 cell subsets. The efficacy of ustekinumab in psoriasis has been demonstrated in randomized controlled trials and it is currently licensed for the treatment of severe psoriasis. Ustekinumab was shown to have modest efficacy in a multicenter phase II study in patients with psoriatic arthritis (PsA)1, although the American College of Rheumatology20 scores were lower than in comparable studies of tumor necrosis factor (TNF) inhibitors2. Some reports … Address correspondence to Dr. D. Wallis, Department of Rheumatology, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. E-mail: dwallis{at}uhnresearch.ca
Annals of the Rheumatic Diseases | 2018
Richard Holland; William Tillett; Eleanor Korendowych; Charlotte Cavill; Nicola Waldron; Melanie Brooke; Neil McHugh
Objectives The Psoriatic Arthritis Impact of Disease (PsAID) Questionnaire is a recently developed patient-reported outcome measure (PROM) of disease impact in psoriatic arthritis (PsA). We set out to assess the validity in an independent cohort of patients, estimate the minimally important difference for improvement and explore the potential of individual components of the PsAID in clinical practice. Methods Data were collected prospectively for a single-centre cohort of patients with PsA. Construct validity was assessed by Spearman correlation with other PROMs and reliability by intraclass correlation coefficient (ICC) at 1 week. Sensitivity to change at 3 months was determined by the standardised response mean (SRM) in those patients with active disease requiring a change in treatment. Results A total of 129 patients (mean ±SD age 52.1±13.3, 57% women, disease duration 10.2±8 years) completed the baseline questionnaires and assessments. The mean baseline PsAID12 score was 3.92±2.26 with an ICC of 0.91 (95%CI 0.87 to 0.94). The SE of measurement was 0.51 and the minimal detectable change was 1.41. There was strong correlation (r≥0.70) with most of the PROMs studied and moderate correlation with clinical outcomes (r=0.40–0.57). The SRM of the PsAID12 was 0.74 (95%CI 0.45 to 0.97). There was strong correlation with individual PsAID items and their corresponding PROM questionnaires (r≥0.67). Conclusion The PsAID is a reliable, feasible and discriminative measure in patients with PsA. The good responsiveness of the PsAID and strong correlation of individual items with other PROMS represent an opportunity to reduce questionnaire burden for patients in studies and clinical practice.
Musculoskeletal Care | 2011
Nicola Waldron; Sue Brown; Sarah Hewlett; Barbara Elliott; Neil McHugh; Candy S. McCabe
Musculoskeletal Care | 2012
Nicola Waldron; Sue Brown; Sarah Hewlett; Barbara Elliott; Neil McHugh; Candy S. McCabe
Annals of the Rheumatic Diseases | 2013
Dinny Wallis; Deepak Jadon; William Tillett; Nicola Waldron; Charlotte Cavill; Neil McHugh; E. Korendowych
Rheumatology | 2010
Sam Norton; John Done; Amanda Sacker; Adam Young; Nigel Cox; Gareth J. Treharne; Zoe C. McGavock; Anna Tonks; Sarah A. Kafka; Elizabeth D. Hale; George D. Kitas; Debbie Fletcher; Tessa Sanderson; Gillian Baker; Phil Street; Sarah Hewlett; Siobhán Stynes; George Peat; Helen Myers; Peter Croft; Ailsa Bosworth; Diane Crake; Michael Hurley; Anita Patel; Nicola Walsh; H. Mitchell; Kanta Kumar; Chandrika Gordhan; Deva Situnayake; Karim Raza