Skip to main content
Top
Published in: Rheumatology International 6/2016

Open Access 01-06-2016 | Imaging

Musculoskeletal ultrasonography in routine rheumatology practice: data from Central and Eastern European countries

Authors: Peter Mandl, Asta Baranauskaite, Nemanja Damjanov, Maja Hojnik, Reka Kurucz, Orsolya Nagy, Petr Nemec, Dora Niedermayer, Porin Perić, Tzvetanka Petranova, Andres Pille, Simona Rednic, Violeta Vlad, Martin Zlnay, Peter V. Balint

Published in: Rheumatology International | Issue 6/2016

Login to get access

Abstract

The main aim was to gain structured insight into the use of musculoskeletal ultrasonography (MSUS) in routine rheumatology practices in Central and Eastern European (CEE) countries. In a cross-sectional, observational, international, multicenter survey, a questionnaire was sent to investigational sites in CEE countries. Data on all subsequent routine MSUS examinations, site characteristics, MSUS equipment, and investigators were collected over 6 months or up to 100 examinations per center. A total of 95 physicians at 44 sites in 9 countries provided information on a total of 2810 MSUS examinations. The most frequent diagnoses were rheumatoid arthritis (RA) and spondyloarthritis (34.8 and 14.9 % of cases, respectively). Mean number of joints examined was 6.8. MSUS was most frequently performed for diagnostic purposes (58 %), particularly in patients with undifferentiated arthritis, suspected soft tissue disorders, or osteoarthritis (73.0–85.3 %). In RA patients, 56.3 % of examinations were conducted to monitor disease activity. Nearly all investigations (99 %) had clinical implications, while the results of 78.6 % of examinations (51.6–99.0 %) were deemed useful for patient education. This first standardized multicountry survey performed in CEEs provided a structured documentation of the routine MSUS use in participating countries. The majority of MSUS examinations were performed for diagnostic purposes, whereas one-third was conducted to monitor disease activity in RA. A majority of examinations had an impact on clinical decision making and were also found to be useful for patient education.
Appendix
Available only for authorised users
Literature
1.
go back to reference Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, Hensor E, Wakefield RJ, O’Connor PJ, Emery P (2008) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58:2958–2967CrossRefPubMed Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, Hensor E, Wakefield RJ, O’Connor PJ, Emery P (2008) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58:2958–2967CrossRefPubMed
2.
go back to reference Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, Wakefield RJ, O’Connor PJ, Emery P (2006) Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying anti-rheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 54:3761–3773CrossRefPubMed Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, Wakefield RJ, O’Connor PJ, Emery P (2006) Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying anti-rheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 54:3761–3773CrossRefPubMed
3.
go back to reference Balsa A, de Miguel E, Castillo C, Peiteado D, Martín-Mola E (2010) Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology [Oxford] 49:683–690CrossRef Balsa A, de Miguel E, Castillo C, Peiteado D, Martín-Mola E (2010) Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology [Oxford] 49:683–690CrossRef
4.
go back to reference Saleem B, Brown AK, Keen H, Nizam S, Freeston J, Wakefield R, Karim Z, Quinn MA, Hensor E, Conaghan PG, Emery P (2011) Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments. Ann Rheum Dis 70:792–798CrossRefPubMed Saleem B, Brown AK, Keen H, Nizam S, Freeston J, Wakefield R, Karim Z, Quinn MA, Hensor E, Conaghan PG, Emery P (2011) Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments. Ann Rheum Dis 70:792–798CrossRefPubMed
5.
go back to reference Del Cura JL (2008) Ultrasound-guided therapeutic procedures in the musculoskeletal system. Curr Probl Diagn Radiol 37:203–218CrossRefPubMed Del Cura JL (2008) Ultrasound-guided therapeutic procedures in the musculoskeletal system. Curr Probl Diagn Radiol 37:203–218CrossRefPubMed
6.
go back to reference Mandl P, Naredo E, Conaghan PG, D’Agostino MA, Wakefield RJ, Bachta A, Backhaus M, Hammer HB, Bruyn GA, Damjanov N, Filippucci E, Grassi W, Iagnocco A, Jousse-Joulin S, Kane D, Koski JM, Möller I, De Miguel E, Schmidt WA, Swen WA, Szkudlarek M, Terslev L, Ziswiler HR, Ostergaard M, Balint PV (2012) Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford) 51:184–190CrossRef Mandl P, Naredo E, Conaghan PG, D’Agostino MA, Wakefield RJ, Bachta A, Backhaus M, Hammer HB, Bruyn GA, Damjanov N, Filippucci E, Grassi W, Iagnocco A, Jousse-Joulin S, Kane D, Koski JM, Möller I, De Miguel E, Schmidt WA, Swen WA, Szkudlarek M, Terslev L, Ziswiler HR, Ostergaard M, Balint PV (2012) Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford) 51:184–190CrossRef
7.
go back to reference Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, Proudman S, Emery P (2004) Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 63:382–385CrossRefPubMedPubMedCentral Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, Proudman S, Emery P (2004) Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 63:382–385CrossRefPubMedPubMedCentral
8.
go back to reference D’Agostino MA, Ayral X, Baron G, Ravaud P, Breban M, Dougados M (2005) Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind-, and mid-foot in chronic inflammatory diseases. Arthritis Rheum 53:284–292CrossRefPubMed D’Agostino MA, Ayral X, Baron G, Ravaud P, Breban M, Dougados M (2005) Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind-, and mid-foot in chronic inflammatory diseases. Arthritis Rheum 53:284–292CrossRefPubMed
9.
go back to reference Naredo E, D’Agostino MA, Conaghan PG, Backhaus M, Balint P, Bruyn GA, Filippucci E, Grassi W, Hammer HB, Iagnocco A, Kane D, Koski JM, Szkudlarek M, Terslev L, Wakefield RJ, Ziswiler HR, Schmidt WA (2010) Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford) 49:2438–2443CrossRef Naredo E, D’Agostino MA, Conaghan PG, Backhaus M, Balint P, Bruyn GA, Filippucci E, Grassi W, Hammer HB, Iagnocco A, Kane D, Koski JM, Szkudlarek M, Terslev L, Wakefield RJ, Ziswiler HR, Schmidt WA (2010) Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford) 49:2438–2443CrossRef
10.
go back to reference Naredo E, Bijlsma JW, Conaghan PG, Acebes C, Balint P, Berner-Hammer H, Bruyn GA, Collado P, D’Agostino MA, de Agustin JJ, de Miguel E, Filippucci E, Grassi W, Iagnocco A, Kane D, Koski JM, Manger B, Mayordomo L, Möller I, Moragues C, Rejón E, Szkudlarek M, Terslev L, Uson J, Wakefield RJ, Schmidt WA (2008) Recommendations for the content and conduct of EULAR musculoskeletal ultrasound courses. Ann Rheum Dis 67:1017–1022CrossRefPubMedPubMedCentral Naredo E, Bijlsma JW, Conaghan PG, Acebes C, Balint P, Berner-Hammer H, Bruyn GA, Collado P, D’Agostino MA, de Agustin JJ, de Miguel E, Filippucci E, Grassi W, Iagnocco A, Kane D, Koski JM, Manger B, Mayordomo L, Möller I, Moragues C, Rejón E, Szkudlarek M, Terslev L, Uson J, Wakefield RJ, Schmidt WA (2008) Recommendations for the content and conduct of EULAR musculoskeletal ultrasound courses. Ann Rheum Dis 67:1017–1022CrossRefPubMedPubMedCentral
11.
go back to reference Terslev L, Hammer HB, Torp Pedersen S, Szkudlarek M, Iagnocco A, D’Agostino MA, Schmidt WA, Uson J, Bruyn GA, Filippucci E, Möller I, Balint P, Wakefield R, Naredo E (2013) EFSUMB minimum training requirements for rheumatologists performing musculoskeletal ultrasound. Ultraschall Med 34:475–477CrossRefPubMed Terslev L, Hammer HB, Torp Pedersen S, Szkudlarek M, Iagnocco A, D’Agostino MA, Schmidt WA, Uson J, Bruyn GA, Filippucci E, Möller I, Balint P, Wakefield R, Naredo E (2013) EFSUMB minimum training requirements for rheumatologists performing musculoskeletal ultrasound. Ultraschall Med 34:475–477CrossRefPubMed
12.
go back to reference Iagnocco A, Porta F, Cuomo G, Delle Sedie A, Filippucci E, Grassi W, Sakellariou G, Epis O, Adinolfi A, Ceccarelli F, De Lucia O, Di Geso L, Di Sabatino V, Gabba A, Gattamelata A, Gutierrez M, Massaro L, Massarotti M, Perricone C, Picerno V, Ravagnani V, Riente L, Scioscia C, Naredo E, Filippou G, Musculoskeletal Ultrasound Study Group of the Italian Society of Rheumatology (2014) The Italian MSUS Study Group recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology. Rheumatology (Oxford) 53:367–373CrossRef Iagnocco A, Porta F, Cuomo G, Delle Sedie A, Filippucci E, Grassi W, Sakellariou G, Epis O, Adinolfi A, Ceccarelli F, De Lucia O, Di Geso L, Di Sabatino V, Gabba A, Gattamelata A, Gutierrez M, Massaro L, Massarotti M, Perricone C, Picerno V, Ravagnani V, Riente L, Scioscia C, Naredo E, Filippou G, Musculoskeletal Ultrasound Study Group of the Italian Society of Rheumatology (2014) The Italian MSUS Study Group recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology. Rheumatology (Oxford) 53:367–373CrossRef
13.
go back to reference Kane D, Balint PV, Sturrock R, Grassi W (2004) Musculoskeletal ultrasound—a state of the art review in rheumatology. Part 1: current controversies and issues in the development of musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 43:823–828CrossRef Kane D, Balint PV, Sturrock R, Grassi W (2004) Musculoskeletal ultrasound—a state of the art review in rheumatology. Part 1: current controversies and issues in the development of musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 43:823–828CrossRef
14.
go back to reference Wakefield RJ, Goh E, Conaghan PG, Karim Z, Emery P (2003) Musculoskeletal ultrasonography in Europe: results of a rheumatologist-based survey at a EULAR meeting. Rheumatology (Oxford) 42:1251–1253CrossRef Wakefield RJ, Goh E, Conaghan PG, Karim Z, Emery P (2003) Musculoskeletal ultrasonography in Europe: results of a rheumatologist-based survey at a EULAR meeting. Rheumatology (Oxford) 42:1251–1253CrossRef
15.
go back to reference Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M (2001) Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 44:2018–2023CrossRefPubMed Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M (2001) Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 44:2018–2023CrossRefPubMed
16.
go back to reference Weiner SM, Jurenz S, Uhl M, Lange-Nolde A, Warnatz K, Peter HH, Walker UA (2008) Ultrasonography in the assessment of peripheral joint involvement in psoriatic arthritis: a comparison with radiography, MRI and scintigraphy. Clin Rheumatol 27:983–989CrossRefPubMed Weiner SM, Jurenz S, Uhl M, Lange-Nolde A, Warnatz K, Peter HH, Walker UA (2008) Ultrasonography in the assessment of peripheral joint involvement in psoriatic arthritis: a comparison with radiography, MRI and scintigraphy. Clin Rheumatol 27:983–989CrossRefPubMed
17.
go back to reference Mandl P, Balint PV, Brault Y, Backhaus M, D’Agostino MA, Grassi W, van der Heijde D, de Miguel E, Wakefield RJ, Logeart I, Dougados M (2012) Metrologic properties of ultrasound versus clinical evaluation of synovitis in rheumatoid arthritis: results of a multicenter, randomized study. Arthritis Rheum 64:1272–1282CrossRefPubMed Mandl P, Balint PV, Brault Y, Backhaus M, D’Agostino MA, Grassi W, van der Heijde D, de Miguel E, Wakefield RJ, Logeart I, Dougados M (2012) Metrologic properties of ultrasound versus clinical evaluation of synovitis in rheumatoid arthritis: results of a multicenter, randomized study. Arthritis Rheum 64:1272–1282CrossRefPubMed
18.
go back to reference Mandl P, Naredo E, Wakefield RJ, Conaghan PG, D’Agostino MA (2011) A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. J Rheumatol 38:2055–2062CrossRefPubMed Mandl P, Naredo E, Wakefield RJ, Conaghan PG, D’Agostino MA (2011) A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. J Rheumatol 38:2055–2062CrossRefPubMed
19.
go back to reference Iagnocco A, Conaghan PG, Aegerter P, Möller I, Bruyn GA, Chary-Valckenaere I, Filippucci E, Gandjbakhch F, Loeuille D, Naredo E, D’Agostino MA (2012) The reliability of musculoskeletal ultrasound in the detection of cartilage abnormalities at the metacarpo-phalangeal joints. Osteoarthr Cartil 20:1142–1146CrossRefPubMed Iagnocco A, Conaghan PG, Aegerter P, Möller I, Bruyn GA, Chary-Valckenaere I, Filippucci E, Gandjbakhch F, Loeuille D, Naredo E, D’Agostino MA (2012) The reliability of musculoskeletal ultrasound in the detection of cartilage abnormalities at the metacarpo-phalangeal joints. Osteoarthr Cartil 20:1142–1146CrossRefPubMed
20.
go back to reference Colebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint PV, D’Agostino MA, Forslind K, Grassi W, Haavardsholm EA, Haugeberg G, Jurik AG, Landewé RB, Naredo E, O’Connor PJ, Ostendorf B, Potocki K, Schmidt WA, Smolen JS, Sokolovic S, Watt I, Conaghan PG (2013) EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 72:804–814CrossRefPubMed Colebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint PV, D’Agostino MA, Forslind K, Grassi W, Haavardsholm EA, Haugeberg G, Jurik AG, Landewé RB, Naredo E, O’Connor PJ, Ostendorf B, Potocki K, Schmidt WA, Smolen JS, Sokolovic S, Watt I, Conaghan PG (2013) EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 72:804–814CrossRefPubMed
21.
go back to reference Mandl P, Navarro-Compán V, Terslev L, Aegerter P, van der Heijde D, D’Agostino MA, Baraliakos X, Pedersen SJ, Jurik AG, Naredo E, Schueller-Weidekamm C, Weber U, Wick MC, Bakker PA, Filippucci E, Conaghan PG, Rudwaleit M, Schett G, Sieper J, Tarp S, Marzo-Ortega H, Østergaard M (2015) EULAR recommendations for the use of imaging in spondyloarthritis in clinical practice. Ann Rheum Dis 74:1327–1339CrossRefPubMed Mandl P, Navarro-Compán V, Terslev L, Aegerter P, van der Heijde D, D’Agostino MA, Baraliakos X, Pedersen SJ, Jurik AG, Naredo E, Schueller-Weidekamm C, Weber U, Wick MC, Bakker PA, Filippucci E, Conaghan PG, Rudwaleit M, Schett G, Sieper J, Tarp S, Marzo-Ortega H, Østergaard M (2015) EULAR recommendations for the use of imaging in spondyloarthritis in clinical practice. Ann Rheum Dis 74:1327–1339CrossRefPubMed
22.
go back to reference McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M et al (2012) American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken) 64:1625–1640CrossRef McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M et al (2012) American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken) 64:1625–1640CrossRef
23.
go back to reference Samuels J, Abramson SB, Kaeley GS (2010) The use of musculoskeletal ultrasound by rheumatologists in the United States. Bull NYU Hosp Joint Dis 68:292–298 Samuels J, Abramson SB, Kaeley GS (2010) The use of musculoskeletal ultrasound by rheumatologists in the United States. Bull NYU Hosp Joint Dis 68:292–298
24.
go back to reference Brown AK, Roberts TE, Wakefield RJ, Karim Z, Hensor E, O’Connor PJ et al (2007) The challenges of integrating ultrasonography into routine rheumatology practice: addressing the needs of clinical rheumatologists. Rheumatology 46:821–829CrossRefPubMed Brown AK, Roberts TE, Wakefield RJ, Karim Z, Hensor E, O’Connor PJ et al (2007) The challenges of integrating ultrasonography into routine rheumatology practice: addressing the needs of clinical rheumatologists. Rheumatology 46:821–829CrossRefPubMed
25.
go back to reference Cunnington J, Platt P, Raftery G, Kane D (2007) Attitudes of United Kingdom rheumatologists to musculoskeletal ultrasound practice and training. Ann Rheum Dis 66:1381–1383CrossRefPubMedPubMedCentral Cunnington J, Platt P, Raftery G, Kane D (2007) Attitudes of United Kingdom rheumatologists to musculoskeletal ultrasound practice and training. Ann Rheum Dis 66:1381–1383CrossRefPubMedPubMedCentral
26.
go back to reference Iagnocco A, Ceccarelli F, Cuomo G, Delle Sedie A, Filippou G, Filippucci E, Grassi W, Porta F, Sakellariou G (2013) Diffusion and applications of musculoskeletal ultrasound in Italian Rheumatology Units. Reumatismo 65:46–47CrossRefPubMed Iagnocco A, Ceccarelli F, Cuomo G, Delle Sedie A, Filippou G, Filippucci E, Grassi W, Porta F, Sakellariou G (2013) Diffusion and applications of musculoskeletal ultrasound in Italian Rheumatology Units. Reumatismo 65:46–47CrossRefPubMed
27.
go back to reference Tamas MM, Fodor D, Rednic N, Rednic S (2011) Musculoskeletal ultrasonography in Romania—results from a specific questionnaire. Med Ultrason 13:10–14PubMed Tamas MM, Fodor D, Rednic N, Rednic S (2011) Musculoskeletal ultrasonography in Romania—results from a specific questionnaire. Med Ultrason 13:10–14PubMed
28.
go back to reference De Miguel E, Andreu JL, Naredo E, Möller I, Grupo de Trabajo de Ecografía de la Sociedad Española de Reumatología (ECOSER) (2012) Situation of Spanish echography in Spanish rheumatology 2012. Reumatol Clin 8:310–314CrossRefPubMed De Miguel E, Andreu JL, Naredo E, Möller I, Grupo de Trabajo de Ecografía de la Sociedad Española de Reumatología (ECOSER) (2012) Situation of Spanish echography in Spanish rheumatology 2012. Reumatol Clin 8:310–314CrossRefPubMed
29.
go back to reference Pineda C, Filippucci E, Chávez-López M, Hernández-Díaz C, Moya C, Ventura L, Grassi W (2008) Ultrasound in rheumatology. The Mexican experience. Clin Exp Rheumatol 26:929–932PubMed Pineda C, Filippucci E, Chávez-López M, Hernández-Díaz C, Moya C, Ventura L, Grassi W (2008) Ultrasound in rheumatology. The Mexican experience. Clin Exp Rheumatol 26:929–932PubMed
30.
go back to reference Filippou G, Frediani B, Gallo A, Menza L, Falsetti P, Baldi F, Acciai C, Lorenzini S, Galeazzi M, Marcolongo R (2007) A “new” technique for the diagnosis of chondrocalcinosis of the knee: sensitivity and specificity of high-frequency ultrasonography. Ann Rheum Dis 66:1126–1128CrossRefPubMedPubMedCentral Filippou G, Frediani B, Gallo A, Menza L, Falsetti P, Baldi F, Acciai C, Lorenzini S, Galeazzi M, Marcolongo R (2007) A “new” technique for the diagnosis of chondrocalcinosis of the knee: sensitivity and specificity of high-frequency ultrasonography. Ann Rheum Dis 66:1126–1128CrossRefPubMedPubMedCentral
31.
go back to reference Frediani B, Filippou G, Falsetti P, Lorenzini S, Baldi F, Acciai C, Siagkri C, Marotto D, Galeazzi M, Marcolongo R (2005) Diagnosis of calcium pyrophosphate dehydrate crystal deposition disease: ultrasonographic criteria proposed. Ann Rheum Dis 64:638–640CrossRefPubMedPubMedCentral Frediani B, Filippou G, Falsetti P, Lorenzini S, Baldi F, Acciai C, Siagkri C, Marotto D, Galeazzi M, Marcolongo R (2005) Diagnosis of calcium pyrophosphate dehydrate crystal deposition disease: ultrasonographic criteria proposed. Ann Rheum Dis 64:638–640CrossRefPubMedPubMedCentral
Metadata
Title
Musculoskeletal ultrasonography in routine rheumatology practice: data from Central and Eastern European countries
Authors
Peter Mandl
Asta Baranauskaite
Nemanja Damjanov
Maja Hojnik
Reka Kurucz
Orsolya Nagy
Petr Nemec
Dora Niedermayer
Porin Perić
Tzvetanka Petranova
Andres Pille
Simona Rednic
Violeta Vlad
Martin Zlnay
Peter V. Balint
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Rheumatology International / Issue 6/2016
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-016-3442-2

Other articles of this Issue 6/2016

Rheumatology International 6/2016 Go to the issue