Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Experimental and Therapeutic Medicine
Join Editorial Board Propose a Special Issue
Print ISSN: 1792-0981 Online ISSN: 1792-1015
Journal Cover
January-2021 Volume 21 Issue 1

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
January-2021 Volume 21 Issue 1

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Article

Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study

  • Authors:
    • Liliana Catan
    • Marius Boariu
    • Elena Amaricai
    • Daniel Popa
    • George Puenea
    • Mihai Drăgoi
    • Ștefan Stratul
    • Răzvan Gabriel Drăgoi
  • View Affiliations / Copyright

    Affiliations: Department of Balneology, Medical Rehabilitation and Rheumatology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania, Department of Endodontics, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania, Department of Periodontology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
  • Article Number: 89
    |
    Published online on: November 26, 2020
       https://doi.org/10.3892/etm.2020.9521
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:



Abstract

This prospective study explored the link between values of C‑reactive protein (CRP) in patients with SpA (ankylosing spondylitis, psoriatic arthritis, reactive arthritis, or arthritis‑related inflammatory bowel disease) and functional disability in order to derive an algorithm that may predict functional disability based on disease activity. Patients diagnosed with Spa were classified into five groups based on the type of therapy and they were followed up for 3 years. Group 1: Symptomatic medication alone; Group 2: Disease‑modifying antirheumatic drugs (DMARDs); Group 3: DMARDs and 30 rehabilitation sessions twice a year; Group 4: Group 3 therapy and biologic anti‑tumor necrosis factor‑alpha (anti‑TNF‑α) drugs; and Group 5: Group 4 therapy and, in addition, a daily home‑adapted kinesiotherapy program. CRP, modified Health Assessment Questionnaire (mHAQ‑S), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and T‑score of the patients were recorded. Correlation and multivariate regression analyses were conducted using demographic data, CRP, and mHAQ‑S scores to derive the CRP-mHAQ‑S correlation algorithm. Statistical analysis included the chi‑square, Mann‑Whitney, and multiple regression tests and repeated measures analysis of variance. A total of 144 patients were enrolled, all of whom completed the study. The best predictive model (P<0.001) provided the algorithm mHAQ‑S36=17.14+0.12xCRP0-0.24xCRP12-0.15xCRP36 (CRP0, CRP12, and CRP36 correspond to CRP levels at baseline, 12, and 36 months, respectively, and mHAQ‑S36 to mHAQ‑S score at 36 months). This derived algorithm based on objective CRP assessment may have implications in the prediction of functional disability evolution in patients with SpA.
View Figures
View References

1 

Bevan S: Spondyloarthropathy and Work. A Review of UK Evidence. The Work Foundation, London, 2010.

2 

Dougados M and Baeten D: Spondyloarthritis. Lancet. 377:2127–2137. 2011.PubMed/NCBI View Article : Google Scholar

3 

Bakland G and Nossent HC: Epidemiology of spondyloarthritis: A review. Curr Rheumatol Rep. 15(351)2013.PubMed/NCBI View Article : Google Scholar

4 

Arumugam R and McHugh NJ: Mortality and causes of death in psoriatic arthritis. J Rheumatol Suppl. 89:32–35. 2012.PubMed/NCBI View Article : Google Scholar

5 

Bakland G, Gran JT and Nossent JC: Increased mortality in ankylosing spondylitis is related to disease activity. Ann Rheum Dis. 70:1921–1925. 2011.PubMed/NCBI View Article : Google Scholar

6 

Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, et al: 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 70:896–904. 2011.PubMed/NCBI View Article : Google Scholar

7 

Gossec L, Smolen JS, Gaujoux-Viala C, Ash Z, Marzo-Ortega H, van der Heijde D, FitzGerald O, Aletaha D, Balint P, Boumpas D, et al: European league against rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis. 71:4–12. 2012.PubMed/NCBI View Article : Google Scholar

8 

Palazzi C, Olivieri I, D'Amico E, Pennese E and Petricca A: Management of reactive arthritis. Expert Opin Pharmacother. 5:61–70. 2004.PubMed/NCBI View Article : Google Scholar

9 

Kwiatkowska B and Filipowicz-Sosnowska A: Reactive arthritis. Pol Arch Med Wewn. 119:60–65. 2009.PubMed/NCBI

10 

Orchard TR: Management of arthritis in patients with inflammatory bowel disease. Gastroenterol Hepatol (NY). 8:327–329. 2012.PubMed/NCBI

11 

Arvikar SL and Fisher MC: Inflammatory bowel disease associated arthropathy. Curr Rev Musculoskelet Med. 4:123–131. 2011.PubMed/NCBI View Article : Google Scholar

12 

Smolen JS, Braun J, Dougados M, Emery P, Fitzgerald O, Helliwell P, Kavanaugh A, Kvien TK, Landewé R, Luger T, et al: Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: Recommendations of an international task force. Ann Rheum Dis. 73:6–16. 2014.PubMed/NCBI View Article : Google Scholar

13 

Braun J, Kiltz U, Baraliakos X and van der Heijde D: Optimisation of rheumatology assessments - the actual situation in axial spondyloarthritis including ankylosing spondylitis. Clin Exp Rheumatol. 32 (Suppl 85):S96–S104. 2014.PubMed/NCBI

14 

Salaffi F, Ciapetti A, Carotti M, Gasparini S and Gutierrez M: Disease activity in psoriatic arthritis: Comparison of the discriminative capacity and construct validity of six composite indices in a real world. BioMed Res Int. 2014(528105)2014.PubMed/NCBI View Article : Google Scholar

15 

Eberl G, Studnicka-Benke A, Hitzelhammer H, Gschnait F and Smolen JS: Development of a disease activity index for the assessment of reactive arthritis (DAREA). Rheumatology (Oxford). 39:148–155. 2000.PubMed/NCBI View Article : Google Scholar

16 

van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, Braun J and Landewé R: Assessment of SpondyloArthritis international Society (ASAS): ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis. 68:1811–1818. 2009.PubMed/NCBI View Article : Google Scholar

17 

Helliwell PS, FitzGerald O, Fransen J, Gladman DD, Kreuger GG, Callis-Duffin K, McHugh N, Mease PJ, Strand V, Waxman R, et al: The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann Rheum Dis. 72:986–991. 2013.PubMed/NCBI View Article : Google Scholar

18 

Zochling J: Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 63 (Suppl 11):S47–S58. 2011.PubMed/NCBI View Article : Google Scholar

19 

Gladman DD, Mease PJ, Healy P, Helliwell PS, Fitzgerald O, Cauli A, Lubrano E, Krueger GG, van der Heijde D, Veale DJ, et al: Outcome measures in psoriatic arthritis. J Rheumatol. 34:1159–1166. 2007.PubMed/NCBI

20 

Rohekar S and Pope J: Assessment of work disability in seronegative spondyloarthritis. Clin Exp Rheumatol. 28:35–40. 2010.PubMed/NCBI

21 

Daltroy LH, Larson MG, Roberts NW and Liang MH: A modification of the Health Assessment Questionnaire for the spondyloarthropathies. J Rheumatol. 17:946–950. 1990.PubMed/NCBI

22 

Bruce B and Fries JF: The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 23 (Suppl 39):S14–S18. 2005.PubMed/NCBI

23 

Kotsis K, Voulgari PV, Drosos AA, Carvalho AF and Hyphantis T: Health-related quality of life in patients with ankylosing spondylitis: A comprehensive review. Expert Rev Pharmacoecon Outcomes Res. 14:857–872. 2014.PubMed/NCBI View Article : Google Scholar

24 

Kifley A, Heller GZ, Beath KJ, Bulger D, Ma J and Gebski V: Multilevel latent variable models for global health-related quality of life assessment. Stat Med. 31:1249–1264. 2012.PubMed/NCBI View Article : Google Scholar

25 

Machado P and van der Heijde D: How to measure disease activity in axial spondyloarthritis? Curr Opin Rheumatol. 23:339–345. 2011.PubMed/NCBI View Article : Google Scholar

26 

Singh HJ, Nimarpreet K, Ashima Das S, Kumar A and Prakash S: Study of bone mineral density in patients with ankylosing spondylitis. J Clin Diagn Res. 7:2832–2835. 2013.PubMed/NCBI View Article : Google Scholar

27 

Caruntu C, Boda D, Dumitrascu G, Constantin C and Neagu M: Proteomics focusing on immune markers in psoriatic arthritis. Biomarkers Med. 9:513–528. 2015.PubMed/NCBI View Article : Google Scholar

28 

Berthelot JM, Le Goff B and Maugars Y: The Hawthorne effect: Stronger than the placebo effect? Joint Bone Spine. 78:335–336. 2011.PubMed/NCBI View Article : Google Scholar

29 

Landewé R, Dougados M, Mielants H, van der Tempel H and van der Heijde D: Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis. 68:863–867. 2009.PubMed/NCBI View Article : Google Scholar

30 

Tillett W, Shaddick G, Askari A, Cooper A, Creamer P, Clunie G, Helliwell PS, Kay L, Korendowych E, Lane S, et al: Factors influencing work disability in psoriatic arthritis: First results from a large UK multicentre study. Rheumatology (Oxford). 54:157–162. 2015.PubMed/NCBI View Article : Google Scholar

31 

Boda D, Negrei C, Nicolescu F and Badalau C: Assessment of some oxidative stress parameters in methotrexate treated psoriasis patients. Farmacia. 62:704–710. 2014.

32 

Weiss A, Song IH, Haibel H, Listing J and Sieper J: Good correlation between changes in objective and subjective signs of inflammation in short- but not long-diseased patients with axial spondyloarthritis treated with tumor necrosis factor-blockers. Arthritis Res Ther. 16(R35)2014.PubMed/NCBI View Article : Google Scholar

33 

Saber TP, Ng CT, Renard G, Lynch BM, Pontifex E, Walsh CA, Grier A, Molloy M, Bresnihan B, Fitzgerald O, et al: Remission in psoriatic arthritis: Is it possible and how can it be predicted? Arthritis Res Ther. 12(R94)2010.PubMed/NCBI View Article : Google Scholar

34 

O'Dwyer T, O'Shea F and Wilson F: Exercise therapy for spondyloarthritis: A systematic review. Rheumatol Int. 34:887–902. 2014.PubMed/NCBI View Article : Google Scholar

35 

Mesquita C, Lopes S, Excelsa Moreira M, Lopes P, Carneiro A, Silva D, Neves I, Araújo F and Vitorino A: A2.8 Effect of home exercise program in quality of life in patients with ankylosing spondylitis. Ann Rheum Dis. 73 (Suppl 1)(A41)2014.

36 

van den Berg R, Baraliakos X, Braun J and van der Heijde D: First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs: A systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Rheumatology (Oxford). 51:1388–1396. 2012.PubMed/NCBI View Article : Google Scholar

37 

Husted JA, Tom BD, Farewell VT, Schentag CT and Gladman DD: A longitudinal study of the effect of disease activity and clinical damage on physical function over the course of psoriatic arthritis: Does the effect change over time? Arthritis Rheum. 56:840–849. 2007.PubMed/NCBI View Article : Google Scholar

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Catan L, Boariu M, Amaricai E, Popa D, Puenea G, Drăgoi M, Stratul Ș and Drăgoi RG: Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study. Exp Ther Med 21: 89, 2021.
APA
Catan, L., Boariu, M., Amaricai, E., Popa, D., Puenea, G., Drăgoi, M. ... Drăgoi, R.G. (2021). Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study. Experimental and Therapeutic Medicine, 21, 89. https://doi.org/10.3892/etm.2020.9521
MLA
Catan, L., Boariu, M., Amaricai, E., Popa, D., Puenea, G., Drăgoi, M., Stratul, Ș., Drăgoi, R. G."Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study". Experimental and Therapeutic Medicine 21.1 (2021): 89.
Chicago
Catan, L., Boariu, M., Amaricai, E., Popa, D., Puenea, G., Drăgoi, M., Stratul, Ș., Drăgoi, R. G."Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study". Experimental and Therapeutic Medicine 21, no. 1 (2021): 89. https://doi.org/10.3892/etm.2020.9521
Copy and paste a formatted citation
x
Spandidos Publications style
Catan L, Boariu M, Amaricai E, Popa D, Puenea G, Drăgoi M, Stratul Ș and Drăgoi RG: Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study. Exp Ther Med 21: 89, 2021.
APA
Catan, L., Boariu, M., Amaricai, E., Popa, D., Puenea, G., Drăgoi, M. ... Drăgoi, R.G. (2021). Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study. Experimental and Therapeutic Medicine, 21, 89. https://doi.org/10.3892/etm.2020.9521
MLA
Catan, L., Boariu, M., Amaricai, E., Popa, D., Puenea, G., Drăgoi, M., Stratul, Ș., Drăgoi, R. G."Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study". Experimental and Therapeutic Medicine 21.1 (2021): 89.
Chicago
Catan, L., Boariu, M., Amaricai, E., Popa, D., Puenea, G., Drăgoi, M., Stratul, Ș., Drăgoi, R. G."Predicting functional disability in patients with spondyloarthritis using a CRP‑based algorithm: A 3‑year prospective study". Experimental and Therapeutic Medicine 21, no. 1 (2021): 89. https://doi.org/10.3892/etm.2020.9521
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team