Top

Published in:

01-12-2021 | Systemic Sclerosis | Original Article

Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study

Authors: Eleni Pagkopoulou, Stergios Soulaidopoulos, Eva Triantafyllidou, Alexandra Arvanitaki, Niki Katsiki, Chalarampos Loutradis, Asterios Karagiannis, Michael Doumas, Alexandros Garyfallos, George D. Kitas, Theodoros Dimitroulas

Published in: Clinical Rheumatology | Issue 12/2021

Abstract

Introduction

Microvascular dysfunction is the key element in the pathogenesis of systemic sclerosis (SSc), whereas the contribution of large and medium size vessel abnormalities is yet to be established. The aim of the present study is to assess the association between micro- and macrovascular function by utilizing a broad spectrum of assessments of vascular performance.

Methods

We included consecutive, consenting SSc patients who underwent nailfold video capillaroscopy (NVC) for microcirculation evaluation. Peripheral and central systolic and diastolic blood pressure, carotid intima-media thickness (cIMT), aortic augmentation index (AIx) corrected for a heart rate of 75 beats per minute (AIx-75), and carotid-femoral pulse wave velocity (PWV) were also performed to assess macrovascular function. Cardiovascular risk disease (CVD) algorithms were also calculated and included in the analysis.

Results

A total of 81 patients (6 males) were studied with mean age 55.44 ± 13.40 years. Reduced capillary density was inversely correlated with arterial stiffness (Alx-75) and augmentation pressure (r = − 0.262, p = 0.018, and r = − 0.249, p = 0.025 respectively). Alx was significantly lower in the early compared to late pattern (28.24 ± 11.75 vs 35.63 ± 10.47, p = 0.036). A significant trend was found among NVC patterns with Alx-75 values being higher with the progression of microangiopathy towards the “late” group (26.36 ± 10.90 vs 30.81 ± 11.59 vs 35.21 ± 7.90, p = 0.027 for trend). Similarly, Framingham risk score and Atherosclerotic Cardiovascular Disease score were progressively higher across the worsening NVC patterns (4.10 ± 4.13 vs 2.99 ± 2.72 vs 6.36 ± 5.65, p = 0.023, and 6.99 ± 7.18 vs 5.63 ± 4.41 vs 12.09 ± 9.90, p = 0.019, respectively, for trends). Finally, QRISK3 (10-year cardiovascular disease risk) and ASCVD (Atherosclerotic Cardiovascular Disease) scores were inversely correlated with the number of capillaries (r = − 0.231, p = 0.048, and r = − 0.260, p = 0.038 respectively).

Conclusion

These data suggest that CVD risk scores and macrovascular parameters are strongly correlated with microvasculopathy in patients with SSc.

Key Points

• Microangiopathy is the hallmark of SSc, but the relationship between subclinical atherosclerosis and small vessel disease remains unknown.

• Arterial stiffening and CVD risk scores are positively associated with the degree of progression of peripheral microvasculopathy assessed with NVC.

• The results of the study suggest an association between NVC abnormalities and higher CVD risk in SSc patients.

Available only for authorised users

Denton CP, Khanna D (2017) Systemic sclerosis. Lancet 390(10103):1685–1699. https://doi.org/10.1016/s0140-6736(17)30933-9CrossRefPubMed

Poudel DR, Jayakumar D, Danve A, Sehra ST, Derk CT (2018) Determinants of mortality in systemic sclerosis: a focused review. Rheumatol Int 38(10):1847–1858. https://doi.org/10.1007/s00296-017-3826-yCrossRefPubMed

Tyndall AJ, Bannert B, Vonk M et al (2010) Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis 69(10):1809–1815. https://doi.org/10.1136/ard.2009.114264CrossRefPubMed

Derk CT, Jimenez SA (2003) Systemic sclerosis: current views of its pathogenesis. Autoimmun Rev 2(4):181–191. https://doi.org/10.1016/s1568-9972(03)00005-3CrossRefPubMed

Pagkopoulou E, Poutakidou M, Garyfallos A, Kitas G, Dimitroulas T (2017) Cardiovascular risk in systemic sclerosis: micro- and macro-vascular involvement. Indian Journal of Rheumatology 12(6):211–217. https://doi.org/10.4103/0973-3698.219080CrossRef

Frech T, Walker AE, Barrett-O’Keefe Z, Hopkins PN, Richardson RS, Wray DW, Donato AJ (2015) Systemic sclerosis induces pronounced peripheral vascular dysfunction characterized by blunted peripheral vasoreactivity and endothelial dysfunction. Clin Rheumatol 34(5):905–913. https://doi.org/10.1007/s10067-014-2834-5CrossRefPubMed

Aviña-Zubieta JA, Man A, Yurkovich M, Huang K, Sayre EC, Choi HK (2016) Early cardiovascular disease after the diagnosis of systemic sclerosis. Am J Med 129(3):324–331. https://doi.org/10.1016/j.amjmed.2015.10.037CrossRefPubMed

Piccione MC, Bagnato G, Zito C, Di Bella G, Caliri A, Catalano M, Longordo C, Oreto G, Bagnato G, Carerj S (2011) Early identification of vascular damage in patients with systemic sclerosis. Angiology 62(4):338–343. https://doi.org/10.1177/0003319710387918CrossRefPubMed

Liu J, Zhang Y, Cao TS, Duan YY, Yuan LJ, Yang YL, Li Y, Yao L (2011) Preferential macrovasculopathy in systemic sclerosis detected by regional pulse wave velocity from wave intensity analysis: comparisons of local and regional arterial stiffness parameters in cases and controls. Arthritis Care Res (Hoboken) 63(4):579–587. https://doi.org/10.1002/acr.20306CrossRef

10.

Au K, Singh MK, Bodukam V, Bae S, Maranian P, Ogawa R, Spiegel B, McMahon M, Hahn B, Khanna D (2011) Atherosclerosis in systemic sclerosis: a systematic review and meta-analysis. Arthritis Rheum 63(7):2078–2090. https://doi.org/10.1002/art.30380CrossRefPubMedPubMedCentral

11.

Panopoulos S, Tektonidou M, Drosos AA et al (2018) Prevalence of comorbidities in systemic sclerosis versus rheumatoid arthritis: a comparative, multicenter, matched-cohort study. Arthritis Res Ther 20(1):267. https://doi.org/10.1186/s13075-018-1771-0CrossRefPubMedPubMedCentral

12.

Dimitroulas T, Baniotopoulos P, Pagkopoulou E, Soulaidopoulos S, Nightingale P, Sandoo A, Karagiannis A, Douglas K, Sachinidis A, Garyfallos A, Kitas G (2020) Subclinical atherosclerosis in systemic sclerosis and rheumatoid arthritis: a comparative matched-cohort study. Rheumatol Int 40(12):1997–2004. https://doi.org/10.1007/s00296-020-04677-3CrossRefPubMed

13.

Etehad Tavakol M, Fatemi A, Karbalaie A, Emrani Z, Erlandsson BE (2015) Nailfold capillaroscopy in rheumatic diseases: which parameters should be evaluated? Biomed Res Int 2015:974530. https://doi.org/10.1155/2015/974530CrossRefPubMedPubMedCentral

14.

Bernardino V, Rodrigues A, Lladó A, Panarra A (2020) Nailfold capillaroscopy and autoimmune connective tissue diseases in patients from a Portuguese nailfold capillaroscopy clinic. Rheumatol Int 40(2):295–301. https://doi.org/10.1007/s00296-019-04427-0CrossRefPubMed

15.

van den Hoogen F, Khanna D, Fransen J et al (2013) 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 72(11):1747–1755. https://doi.org/10.1136/annrheumdis-2013-204424CrossRefPubMed

16.

Maricq HR, LeRoy EC (1973) Patterns of finger capillary abnormalities in connective tissue disease by “wide-field” microscopy. Arthritis Rheum 16(5):619–628. https://doi.org/10.1002/art.1780160506CrossRefPubMed

17.

Soulaidopoulos S, Triantafyllidou E, Garyfallos A, Kitas GD, Dimitroulas T (2017) The role of nailfold capillaroscopy in the assessment of internal organ involvement in systemic sclerosis: a critical review. Autoimmun Rev 16(8):787–795. https://doi.org/10.1016/j.autrev.2017.05.019CrossRefPubMed

18.

Rollando D, Bezante GP, Sulli A, Balbi M, Panico N, Pizzorni C, Negrini S, Brunelli C, Barsotti A, Cutolo M, Indiveri F, Ghio M (2010) Brachial artery endothelial-dependent flow-mediated dilation identifies early-stage endothelial dysfunction in systemic sclerosis and correlates with nailfold microvascular impairment. J Rheumatol 37(6):1168–1173. https://doi.org/10.3899/jrheum.091116CrossRefPubMed

19.

Jung KH, Lim MJ, Kwon SR, Kim D, Joo K, Park W (2015) Nailfold capillary microscopic changes and arterial stiffness in Korean systemic sclerosis patients. Mod Rheumatol 25(2):328–331. https://doi.org/10.3109/14397595.2014.881955CrossRefPubMed

20.

Soulaidopoulos S, Pagkopoulou E, Katsiki N, Triantafyllidou E, Karagiannis A, Garyfallos A, Kitas GD, Dimitroulas T (2019) Arterial stiffness correlates with progressive nailfold capillary microscopic changes in systemic sclerosis: results from a cross-sectional study. Arthritis Res Ther 21(1):253. https://doi.org/10.1186/s13075-019-2051-3CrossRefPubMedPubMedCentral

21.

Colaci M, Dal Bosco Y, Schinocca C, Ronsivalle G, Guggino G, De Andres I, Russo AA, Sambataro D, Sambataro G, Malatino L (2020) Aortic root dilation in associated with the reduction in capillary density observed at nailfold capillaroscopy in SSc patients. Clin Rheumatol. https://doi.org/10.1007/s10067-020-05201-5CrossRefPubMedPubMedCentral

22.

D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117(6):743–753. https://doi.org/10.1161/circulationaha.107.699579CrossRefPubMed

23.

Hippisley-Cox J, Coupland C, Brindle P (2017) Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ 357:j2099. https://doi.org/10.1136/bmj.j2099CrossRefPubMedPubMedCentral

24.

Goff DC Jr, Lloyd-Jones DM, Bennett G et al (2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129(25 Suppl 2):S49-73. https://doi.org/10.1161/01.cir.0000437741.48606.98CrossRefPubMed

25.

Williams B, Mancia G, Spiering W et al (2018) 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 36(10):1953–2041. https://doi.org/10.1097/hjh.0000000000001940CrossRefPubMed

26.

Frech TM, Penrod J, Battistone MJ, Sawitzke AD, Stults BM (2012) The prevalence and clinical correlates of an auscultatory gap in systemic sclerosis patients. Int J Rheumatol 2012:590845. https://doi.org/10.1155/2012/590845CrossRefPubMedPubMedCentral

27.

Saito K, Hishiki Y, Takahashi H (2020) Validation of the Omron HBP-1320 for professional use according to the ANSI/AAMI/ISO 81060–2: 2013 protocol and the 2010 revision of the European Society of Hypertension International Protocol. Blood Press Monit 25(3):162–166. https://doi.org/10.1097/mbp.0000000000000437CrossRefPubMed

28.

Cutolo M, Sulli A, Smith V (2010) Assessing microvascular changes in systemic sclerosis diagnosis and management. Nat Rev Rheumatol 6(10):578–587. https://doi.org/10.1038/nrrheum.2010.104CrossRefPubMed

29.

Cutolo M, Sulli A, Pizzorni C, Accardo S (2000) Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol 27(1):155–160PubMed

30.

Smith V, Vanhaecke A, Herrick AL et al (2019) Fast track algorithm: how to differentiate a “scleroderma pattern” from a “non-scleroderma pattern.” Autoimmun Rev 18(11):102394. https://doi.org/10.1016/j.autrev.2019.102394CrossRefPubMed

31.

Caramaschi P, Canestrini S, Martinelli N, Volpe A, Pieropan S, Ferrari M, Bambara LM, Carletto A, Biasi D (2007) Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity. Rheumatology (Oxford) 46(10):1566–1569. https://doi.org/10.1093/rheumatology/kem190CrossRef

32.

Hofstee HM, Serné EH, Roberts C, Hesselstrand R, Scheja A, Moore TL, Wildt M, Manning JB, Vonk Noordegraaf A, Voskuyl AE, Herrick AL (2012) A multicentre study on the reliability of qualitative and quantitative nail-fold videocapillaroscopy assessment. Rheumatology (Oxford) 51(4):749–755. https://doi.org/10.1093/rheumatology/ker403CrossRef

33.

Roman MJ, Naqvi TZ, Gardin JM, Gerhard-Herman M, Jaff M, Mohler E (2006) Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr 19(8):943–954. https://doi.org/10.1016/j.echo.2006.04.020CrossRefPubMed

34.

DeLoach SS, Townsend RR (2008) Vascular stiffness: its measurement and significance for epidemiologic and outcome studies. Clin J Am Soc Nephrol 3(1):184–192. https://doi.org/10.2215/cjn.03340807CrossRefPubMed

35.

Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T (2015) Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension 66(3):698–722. https://doi.org/10.1161/hyp.0000000000000033CrossRefPubMed

36.

Dimitroulas T, Giannakoulas G, Karvounis H, Garyfallos A, Settas L, Kitas GD (2014) Micro- and macrovascular treatment targets in scleroderma heart disease. Curr Pharm Des 20(4):536–544. https://doi.org/10.2174/13816128113199990555CrossRefPubMed

37.

Kavian N, Batteux F (2015) Macro- and microvascular disease in systemic sclerosis. Vascul Pharmacol 71:16–23. https://doi.org/10.1016/j.vph.2015.05.015CrossRefPubMed

38.

Zanatta E, Famoso G, Boscain F, Montisci R, Pigatto E, Polito P, Schiavon F, Iliceto S, Cozzi F, Doria A, Tona F (2019) Nailfold avascular score and coronary microvascular dysfunction in systemic sclerosis: a newsworthy association. Autoimmun Rev 18(2):177–183. https://doi.org/10.1016/j.autrev.2018.09.002CrossRefPubMed

39.

Rosato E, Gigante A, Barbano B, Cianci R, Molinaro I, Pisarri S, Salsano F (2011) In systemic sclerosis macrovascular damage of hands digital arteries correlates with microvascular damage. Microvasc Res 82(3):410–415. https://doi.org/10.1016/j.mvr.2011.07.009CrossRefPubMed

40.

Ruaro B, Sulli A, Alessandri E, Pizzorni C, Ferrari G, Cutolo M (2014) Laser speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis 73(6):1181–1185. https://doi.org/10.1136/annrheumdis-2013-203514CrossRefPubMed

41.

Bartoloni E, Pucci G, Cannarile F, Battista F, Alunno A, Giuliani M, Cafaro G, Gerli R, Schillaci G (2016) Central hemodynamics and arterial stiffness in systemic sclerosis. Hypertension 68(6):1504–1511. https://doi.org/10.1161/hypertensionaha.116.08345CrossRefPubMed

42.

Cypiene A, Laucevicius A, Venalis A, Dadoniene J, Ryliskyte L, Petrulioniene Z, Kovaite M, Gintautas J (2008) The impact of systemic sclerosis on arterial wall stiffness parameters and endothelial function. Clin Rheumatol 27(12):1517–1522. https://doi.org/10.1007/s10067-008-0958-1CrossRefPubMed

43.

Muiesan ML, Salvetti M, Rizzoni D, Paini A, Agabiti-Rosei C, Aggiusti C, Bertacchini F, Stassaldi D, Gavazzi A, Porteri E, De Ciuceis C, Agabiti-Rosei E (2013) Pulsatile hemodynamics and microcirculation: evidence for a close relationship in hypertensive patients. Hypertension 61(1):130–136. https://doi.org/10.1161/hypertensionaha.111.00006CrossRefPubMed

44.

van Sloten TT, Czernichow S, Houben AJ et al (2015) Association between arterial stiffness and skin microvascular function: the SUVIMAX2 Study and The Maastricht Study. Am J Hypertens 28(7):868–876. https://doi.org/10.1093/ajh/hpu246CrossRefPubMed

45.

Schoina M, Loutradis C, Theodorakopoulou M, Dimitroulas T, Triantafillidou E, Doumas M, Karagiannis A, Garyfallos A, Papagianni A, Sarafidis P (2021) The presence of diabetes mellitus further impairs structural and functional capillary density in patients with chronic kidney disease. Microcirculation 28(2):e12665. https://doi.org/10.1111/micc.12665CrossRefPubMed

46.

Dalbeni A, Ciccarese C, Bevilacqua M et al (2018) Effects of antiangiogenetic drugs on microcirculation and macrocirculation in patients with advanced-stage renal cancer. Cancers (Basel) 11(1):30. https://doi.org/10.3390/cancers11010030CrossRef

47.

Arvanitaki A, Giannakoulas G, Triantafyllidou E, Feloukidis C, Boutou AK, Garyfallos A, Karvounis H, Dimitroulas T (2021) Peripheral microangiopathy in precapillary pulmonary hypertension: a nailfold video capillaroscopy prospective study. Respir Res 22(1):27. https://doi.org/10.1186/s12931-021-01622-1CrossRefPubMedPubMedCentral

48.

Arvanitaki A, Giannakoulas G, Triantafyllidou E, Karvounis H, Dimitroulas T (2020) Peripheral microangiopathy in patients with precapillary pulmonary hypertension: correlation with cardiac function and patients’ functional capacity. Study Design and Rationale. Mediterr J Rheumatol 31(3):369–373. https://doi.org/10.31138/mjr.31.3.369CrossRefPubMedPubMedCentral

49.

Lisco G, Cicco G, Cignarelli A, Garruti G, Laviola L, Giorgino F (2018) Computerized video-capillaroscopy alteration related to diabetes mellitus and its complications. Adv Exp Med Biol 1072:363–368. https://doi.org/10.1007/978-3-319-91287-5_58CrossRefPubMed

50.

Lambova S, Müller-Ladner U (2013) Capillaroscopic pattern in paraneoplastic Raynaud’s phenomenon. Rheumatol Int 33(6):1597–1599. https://doi.org/10.1007/s00296-010-1715-8CrossRefPubMed

51.

Wibetoe G, Sexton J, Ikdahl E et al (2020) Prediction of cardiovascular events in rheumatoid arthritis using risk age calculations: evaluation of concordance across risk age models. Arthritis Res Ther 22(1):90. https://doi.org/10.1186/s13075-020-02178-zCrossRefPubMedPubMedCentral

52.

Ozen G, Inanc N, Unal AU, Korkmaz F, Sunbul M, Ozmen M, Akar S, Deniz R, Donmez S, Pamuk ON, Atagunduz P, Tigen K, Direskeneli H (2016) Subclinical atherosclerosis in systemic sclerosis: not less frequent than rheumatoid arthritis and not detected with cardiovascular risk indices. Arthritis Care Res (Hoboken) 68(10):1538–1546. https://doi.org/10.1002/acr.22852CrossRef

53.

Smith V, Herrick AL, Ingegnoli F et al (2020) Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis. Autoimmun Rev 19(3):102458. https://doi.org/10.1016/j.autrev.2020.102458CrossRefPubMed

Title: Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study
Authors: Eleni Pagkopoulou
Stergios Soulaidopoulos
Eva Triantafyllidou
Alexandra Arvanitaki
Niki Katsiki
Chalarampos Loutradis
Asterios Karagiannis
Michael Doumas
Alexandros Garyfallos
George D. Kitas
Theodoros Dimitroulas
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Systemic Sclerosis
Arterial Occlusive Disease
Published in: Clinical Rheumatology / Issue 12/2021
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-021-05795-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2021

Correction to: Measuring treatment effect on psoriatic arthritis-related domains: insights from the SPIRIT-H2H study at weeks 24 and 52

Frailty as a novel predictor of achieving comprehensive disease control (CDC) in rheumatoid arthritis

Madarosis in acute Kawasaki disease—an uncustomary accompaniment

Characterisation of first metatarsophalangeal joint osteoarthritis using magnetic resonance imaging

Real-world data on MTX tolerance with regimens used in children versus adults

Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage