Kong Christian X's Gigthospital

This book addresses the special relationship from the perspective of post-Second World War British governments. It argues that Britain's foreign policy challenges the dominant idea that its power has been waning and that it sees itself as the junior partner to the hegemonic US. The book also shows how at moments of international crisis successive British governments have attempted to re-play the same foreign policy role within the special relationship. It discusses the power of a profoundly antagonistic relationship between Mark Twain and Walter Scott. The book demonstrates Stowe's mis-reading and mis-representation of the Highland Clearances. It explains how Our Nig, the work of a Northern free black, also provides a working-class portrait of New England farm life, removed from the frontier that dominates accounts of American agrarian life. Telegraphy - which transformed transatlantic relations in the middle of the century- was used by spiritualists as a metaphor for the ways in which communications from the other world could be understood. The story of the Bolton Whitman Fellowship is discussed. Beside Sarah Orne Jewett's desk was a small copy of the well-known Raeburn portrait of Sir Walter Scott. Henry James and George Eliot shared a transatlantic literary network which embodied an easy flow of mutual interest and appreciation between their two milieux. In her autobiography, Gertrude Stein assigns to her lifelong companion the repeated comment that she has met three geniuses in her life: Stein, Picasso, and Alfred North Whitehead.

To assess reliability, feasibility, and responsiveness of Hip Inflammation Magnetic resonance imaging Scoring System (HIMRISS) for bone marrow lesions (BML) in hip osteoarthritis (OA). HIMRISS was scored by 8 readers in 360 hips of 90 patients imaged pre/post-hip steroid injection. Pre-scoring, new readers trained online to achieve intraclass correlation coefficient (ICC) > 0.80 versus experts. HIMRISS reliability was excellent for BML status (ICC 0.83-0.92). Despite small changes post-injection, reliability of BML change scores was high in femur (0.76-0.81) and moderate in acetabulum (0.42-0.56). HIMRISS should be a priority for further assessment of hip BML in OA, and evaluated for use in other arthropathies.

Whether using magnetic resonance imaging (MRI) to guide treatment in patients with rheumatoid arthritis (RA) improves disease activity and slows joint damage progression is unknown. To determine whether an MRI-guided treat-to-target strategy vs a conventional clinical treat-to-target strategy improves outcomes in patients with RA in clinical remission. Two-year, randomized, multicenter trial conducted at 9 hospitals in Denmark. Two hundred patients with RA in clinical remission (disease activity score in 28 joints-C-reactive protein [DAS28-CRP] <3.2 and no swollen joints) were enrolled between April 2012 and June 2015. The final follow-up visit was April 2017. Patients were randomly allocated (1:1) to an MRI-guided vs a conventional treat-to-target strategy. In the MRI-guided group, the treatment goal was absence of MRI bone marrow edema combined with clinical remission, defined as DAS28-CRP of 3.2 or less and no swollen joints. In the conventional group, the treatment goal was clinical remission. Co-primary outcomes were proportions of patients achieving DAS28-CRP remission (DAS28-CRP <2.6) and with no radiographic progression (no increase in total van der Heijde-modified Sharp score) at 24 months. Significance testing for the primary outcome was based on 1-sided testing. Secondary outcomes were clinical and MRI measures of disease activity, physical function, and quality of life. Of 200 patients randomized (133 women [67%]; mean [SD] age, 61.6 [10.5] years; median baseline DAS28-CRP, 1.9 [interquartile range, 1.7-2.2]; van der Heijde-modified Sharp score, 18.0 [interquartile range, 7.0-42.5]), 76 patients (76%) in the MRI-guided group and 95 (95%) in the conventional group completed the study. Of these, 64 (85%) vs 83 (88%), respectively, reached the primary clinical end point (risk difference, -4.8% [1-sided 95% CI, -13.6% to + ∞; 1-sided P = .19]) and 49 (66%) vs 58 (62%), respectively, reached the primary radiographic end point (risk difference, 4.7% [1-sided 95% CI, -7.0% to + ∞; 1-sided P = .25). Of 10 key secondary end points, 8 were null and 2 showed statistically significant benefit for the MRI treat-to-target group. Seventeen patients (17%) in the MRI-guided treat-to-target group and 6 patients (6%) in the conventional treat-to-target group experienced serious adverse events. Among patients with RA in clinical remission, an MRI-guided treat-to-target strategy compared with a conventional treat-to-target strategy did not result in improved disease activity remission rates or reduce radiographic progression. These findings do not support the use of an MRI-guided strategy for treating patients with RA. ClinicalTrials.gov Identifier: NCT01656278.

Objective: To investigate the clinical and radiographic status, and to identify baseline predictors of functional status and erosive progression at 11 years’ follow-up of early rheumatoid arthritis (RA) patients.Methods: Patients enrolled in the Danish investigator-initiated randomized controlled CIMESTRA trial, which investigated a 2 year treat-to-target intervention with methotrexate and intra-articular glucocorticoids with or without cyclosporine, were followed up. The 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) score, and total Sharp van der Heijde score (TSS) were assessed at baseline and 11 years. Baseline magnetic resonance imaging (MRI) of unilateral wrists was scored (OMERACT RAMRIS). Multivariable linear regression analyses of baseline variables [TSS, HAQ, DAS28, age, anti-cyclic citrullinated peptide (anti-CCP) status, gender, MRI erosion score, MRI synovitis score, MRI bone marrow oedema score] were performed in 96 patients with HAQ11yrs and ∆TSS0–11yrs as dependent variables. Since outcomes were similar in the two treatment arms, data were pooled.Results: In total, 120 of 160 patients completed 11 years’ follow-up. They were 63 (55–72) years old, 68% were in DAS28 remission (≤ 2.4), HAQ11yrs was 0.25 (0–0.75), mean ∆TSS0–11yrs was 0.96 ± 1.52 units/year; 53%, 20%, and 27% received conventional treatment, biologics, and no treatment, respectively; and 34% had not progressed radiographically since baseline. Increased DAS28 (p = 0.02) and anti-CCP (p = 0.03) predicted HAQ11yrs, whereas anti-CCP (p = 0.03) and MRI bone marrow oedema (p = 0.01) predicted ∆TSS0–11yrs in multivariable analyses.Conclusions: Early and strict synovitis suppression with methotrexate and intra-articular glucocorticoids led to persistently high remission rates and limited erosive progression at 11 years. In this well-treated cohort, baseline anti-CCP status, DAS28, and MRI bone marrow oedema predicted functional status and/or erosive progression.

To summarize recent advances and challenges of using MRI toward early recognition of axial spondyloarthritis (SpA). Low-grade bone marrow edema (BME) on sacroiliac joint (SIJ) MRI is nonspecific and may be misleading in recognition of axial SpA. Structural features on SIJ MRI along with BME may not only facilitate recognition of early disease, but also enhance specificity. Structural lesions on MRI and low-dose computed tomography are highly concordant, adding to criterion validity of SIJ MRI. There is accumulating evidence that SIJ MRI due to superior reliability of structural lesions may supplant the traditional imaging approach by pelvic radiographs in healthcare settings in which MRI is readily available. Pilot initiatives exploring the bone remodeling cascade in SIJs showed early reparative response upon biological treatment. Methodological challenges regarding evaluation and data processing of imaging examinations need to be addressed to enhance reproducibility and specificity of imaging in SpA. Evaluation of SIJ MRI is contextual incorporating structural lesions and BME. MRI is but one element in pattern recognition toward diagnosis. An unmet need is dissemination of advances in imaging in SpA to the broad community of rheumatologists and radiologists.

BackgroundSacroiliitis detected by MRI plays a central role in the ASAS (Assessment of Spondyloarthritis International Society) classification criteria for axial spondyloarthritis (axSpA)1. However, both false positives and false negatives have been reported. We have little knowledge of the best MRI approach to separate AxSpA from other conditions that may appear like sacroiliitis.ObjectivesTo assess the value of different types of MRI SIJ lesions to differentiate axSpA from other conditions.MethodsIn this prospective cross-sectional study, the MASH study, 204 participants, age ≤45 years were enrolled. All participants with pain should have VAS pain >2 (on a scale 0–10) for ≥2 months. Women with and without pain after pregnancy, patients with disc herniation and all participants without pain were not allowed to have any clinical SpA features or rheumatologic conditions. Information on HLA-B27 and CRP were not available until after the study. The study included 41 patients with axSpA, 46 women with and 14 without pain respectively related to pregnancy/labour≤12 months, 25 patients with lumbar disc herniation, 26 persons with hard physical jobs (cleaning assistants), 23 long-distance runners (≥30 km/week) and 29 healthy men. All participants underwent clinical, laboratory and MRI examination including STIR and T1-weighted sequences of the SIJs. MRIs were evaluated in random order according to the Spondyloarthritis Research Consortium of Canada SIJ MRI scores for inflammation2 and structural lesions3 by two experienced readers blinded to all clinical data.ResultsThe 204 participants comprised 41.2% males, had a mean (min-max) age of 33.2 (19; 45) years, and 22% were HLA-B27 positive. The table 1 below shows the clinical characteristics within each participant group, and the preliminary MRI results based on one reader. MRI bone marrow oedema, fat metaplasia and erosions were frequently present in patients with axSpA, but were also seen in the other groups of study participants with and without pain, particularly in women with postpartum pain. MRI backfill and ankylosis were only seen in patients with axSpA.ConclusionsInflammatory lesions, fat metaplasia and erosions were most frequently occurring in patients with axSpA, but also in women with postpartum pain. The SPARCC-scores cannot separate the different groups entirely. Further detailed analysis of lesions may help differentiate axSpA from other conditions.

ObjectivesIn Denmark, patients with rheumatoid arthritis (RA) are registered in the nationwide clinical DANBIO quality register and the Danish National Patient Registry (DNPR). The aim was to study the validity of the RA diagnosis and to estimate the completeness of relevant RA cases in each registry.Study design and settingPatients registered for the first time in 2011 with a diagnosis of RA were identified in DANBIO and DNPR in January 2013. For DNPR, filters were applied to reduce false-positive cases. The diagnosis was verified by a review of patient records. We calculated the positive predictive values (PPVs) of the RA diagnosis registrations in DANBIO and DNPR, and estimated the registry completeness of relevant RA cases for both DANBIO and DNPR. Updated data from 2011 to 2015 from DANBIO were retrieved to identify patients with delayed registration, and the registry completeness and PPV was recalculated.ResultsWe identified 1,678 unique patients in DANBIO or in DNPR. The PPV (2013 dataset) was 92% in DANBIO and 79% in DNPR. PPV for DANBIO on the 2015 update was 96%. The registry completeness of relevant RA cases was 43% in DANBIO, increasing to 91% in the 2015 update and 90% in DNPR.ConclusionDANBIO held a high proportion of true RA cases (96%) and was found to be superior to the DNPR (79%) with regard to the validity of the diagnosis. Both registries were estimated to have a high completeness of RA cases treated in hospital care (~90%).