The Barriers and Enhancers to Trust in a Just Culture in Hospital Settings: A Systematic Review.

Objectives: Healthcare workers wanting to report errors often encounter a culture of fear or blame. A just culture can improve patient safety by promoting safe and open communication, trust is hereby essential. We defined trust in a just culture when healthcare professionals believe that error communication is honest, safe, and reliable.

Pilot Mental Health, Negative Life Events, and Improving Safety with Peer Support and a Just Culture.

Background: In the last 35 yr, 17 commercial aviation accidents and incidents, with 576 fatalities, could likely have been attributed to mental disease of a pilot. Screening tools for mental health risks in airline pilots are needed. There is growing interest in pilot peer-support programs and how to incorporate them in a just culture, meaning that pilots can report mental health complaints without a risk of job or income loss.

Genetic Factors for the Severity of ACPA-negative Rheumatoid Arthritis in 2 Cohorts of Early Disease: A Genome-wide Study.

Objective: Rheumatoid arthritis (RA) that is negative for anticitrullinated protein antibodies (ACPA) is a subentity of RA, characterized by less severe disease. At the individual level, however, considerable differences in the severity of joint destruction occur. We performed a study on genetic factors underlying the differences in joint destruction in ACPA-negative patients.

A genetic variant in osteoprotegerin is associated with progression of joint destruction in rheumatoid arthritis.

Introduction: Progression of joint destruction in rheumatoid arthritis (RA) is partly heritably; 45 to 58% of the variance in joint destruction is estimated to be explained by genetic factors. The binding of RANKL (Receptor Activator for Nuclear Factor κ B Ligand) to RANK results in the activation of TRAF6 (tumor necrosis factor (TNF) receptor associated factor-6), and osteoclast formation ultimately leading to enhanced bone resorption. This bone resorption is inhibited by osteoprotegerin (OPG) which prevents RANKL-RANK interactions.

Identification of a genetic variant for joint damage progression in autoantibody-positive rheumatoid arthritis.

Background: Joint destruction is a hallmark of autoantibody-positive rheumatoid arthritis (RA), though the severity is highly variable between patients. The processes underlying these interindividual differences are incompletely understood.

Methods: We performed a genome-wide association study on the radiological progression rate in 384 autoantibody-positive patients with RA.

Associations between APOE genotypes and disease susceptibility, joint damage and lipid levels in patients with rheumatoid arthritis.

Objective: Apolipoprotein E (APOE) genotypes are associated with cardiovascular disease (CVD) and lipid levels. In rheumatoid arthritis (RA), an association has been found with disease activity. We examined the associations between APOE genotypes and disease susceptibility and markers of disease severity in RA, including radiographic joint damage, inflammatory markers, lipid levels and cardiovascular markers.

Genetic studies on components of the Wnt signalling pathway and the severity of joint destruction in rheumatoid arthritis.

Background: Progression of joint destruction in rheumatoid arthritis (RA) is partly heritable; knowledge of genetic factors may increase our understanding of the mechanisms underlying joint destruction. The activity of the Wnt/β-catenin pathway influences osteoblast differentiation. Dickkopf-1 (Dkk-1) and sclerostin (Sost) are negative regulators and lipoprotein receptor-related protein-5 (LRP-5) and Kremen-1 are transmembrane receptors involved in this pathway.

Reasons for medical help-seeking behaviour of patients with recent-onset arthralgia.

Objective: Patient delay in seeking medical help may cause suboptimal use of the therapeutic window in rheumatoid arthritis. We aimed to assess the motivations and the urgency with which patients with arthralgia seek medical help.

Methods: 612 patients with arthralgia-visiting two Dutch Early Arthritis Recognition Clinics-were studied.

Loss of metacarpal bone density predicts RA development in recent-onset arthritis.

Objective: Serum samples taken before the onset of RA suggest that one of the first features of RA is BMD loss. We determined the ability of radiographic BMD loss to predict RA development and arthritis persistency in patients with early undifferentiated arthritis (UA).

Methods: Five hundred and seventeen patients with early UA, included in the Leiden Early Arthritis Clinic, were assessed.

Can anti-cyclic citrullinated peptide antibody-negative RA be subdivided into clinical subphenotypes?

Introduction: Studies investigating genetic risk factors for susceptibility to rheumatoid arthritis (RA) studied anti-citrullinated peptide antibody (CCP)-positive RA more frequently than anti-CCP-negative RA. One of the reasons for this is the perception that anti-CCP-negative RA may include patients that fulfilled criteria for RA but belong to a wide range of diagnoses. We aimed to evaluate the validity of this notion and explored whether clinical subphenotypes can be discerned within anti-CCP-negative RA.

Predicting arthritis outcomes--what can be learned from the Leiden Early Arthritis Clinic?

Objectives: In order to allow personalized medicine, adequate prediction of disease outcome is required. In early undifferentiated arthritis (UA), prediction of the development of RA is crucial, and in case of RA predicting the severity of the disease course may guide individualized treatment decisions.

Methods: A total of 570 UA patients and 676 RA patients included in the Leiden Early Arthritis Clinic cohort were studied for baseline characteristics.