| 1. |
- Jacobsson, Lennart, et al.
(author)
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Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort
- 2014
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In: Clinical Rheumatology. - London : Springer Science and Business Media LLC. - 0770-3198 .- 1434-9949. ; 33:11, s. 1649-1656
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Journal article (peer-reviewed)abstract
- Anxiety and depression are common among patients with rheumatic diseases. This study aims to explore which factors are associated with self-reported anxiety and depression in a well-defined cohort of spondyloarthritis (SpA) patients. In 2009, 3,711 patients from the SpAScania cohort were sent a postal questionnaire to assess health-related quality of life (HRQoL) and physical and mental functioning. The Hospital Anxiety and Depression Scale measured anxiety (HADS-A) and depression (HADS-D), subscales 0-21, best-worst. HADS a parts per thousand yen8 indicates possible cases of anxiety or depression. One-way ANOVA (p < 0.05) tested for differences among the SpA subtypes in HADS scores. Linear regression analysis adjusted for age, gender, and disease duration was used to test for associations between HADS and independent variables. In total, 2,167 (58 %) patients (52 % females, mean age 55.4 years) returned the questionnaire. In total, 683 (32 %) cases were classified as "possible anxiety" and 305 (14 %) as "possible depression" cases with mean (SD) HADS-A 5.9 (4.3) and HADS-D 4.4 (3.6). There were no differences among the SpA subtypes in HADS-A and HADS-D. HADS-A and HADS-D were associated with lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL, lower level of functioning, higher disease activity, and lower self-efficacy. Associations with anxiety and/or depression appear multifactorial in patients with SpA including both personal and disease-related factors. Since these comorbidities are increased in SpA and treatable, they should be screened for in clinical practice, possibly with instruments like the HADS.
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| 2. |
- Bergman, Stefan, 1959-, et al.
(author)
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Chronic widespread pain: A three year followup of pain distribution and risk factors
- 2002
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In: Journal of Rheumatology. - Toronto : Journal of Rheumatology Publishing Co. Ltd.. - 0315-162X .- 1499-2752. ; 29:4, s. 818-825
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Journal article (peer-reviewed)abstract
- Objective. To describe the change of pain reports over time in 3 cohorts derived from the general population: (1) no chronic pain (NCP, n = 1156); (2) chronic regional pain (CRP n = 502) and (3) chronic widespread pain (CWP; n = 242). To identify risk factors that predict the development or persistence of chronic widespread pain. Methods. A 3-year followup from 1995 to 1998 with postal questionnaire to 2425 subjects of both sexes aged 20-74 years on the west coast of Sweden. Results. At followup, a larger proportion of subjects with initial CRP compared to initial NCP reported CWP (16.4 and 2.2%, respectively; p < 0.001). The majority of subjects (56.9%) who primarily reported CWP remained in that group at followup, but 26.8% had changed status to CRP and 16.3% to NCP. The number of painful regions (7-12 vs 0 regions) reported at baseline was the strongest predictor for the development of CWP with an odds ratio (OR) of 12,13 (95% CI 4.47-32.88). The development of CWP was also predicted by higher age (OR = 3.13, 95% CI 1.47-6.69, age-group 59-74 years vs age-group 20-34 years), and a family history of chronic pain (OR = 1.87, 95% CI 1.14-3.07). A habit of drinking alcohol weekly (OR = 0.42, 95% Cl 0.21-0.85) compared to the habit of never or seldom drinking alcohol was protective, as well as having personal social support (OR = 0.49, 95% CI 0.28-0.85). The persistence of CWP was predicted by the number of painful regions (13-18 vs 1-6 regions) at baseline (OR = 7.56, 95% CI 2.17-26.30), and being an immigrant (OR 3.22, 95% CI 1.33-7.77). Conclusion. Although the overall prevalence of CWP was stable over a 3-year period there was a considerable variation on an individual basis. This variability in expressing CWP was moderately predicted by a combination of risk factors. the most important being the number of painful regions at baseline. Future research will need to show how useful the identified factors are in clinical practice and whether intervention aimed at changing these factors will improve pain outcome.
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| 3. |
- Bergman, Stefan, 1959-, et al.
(author)
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Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: a 3-year follow up study in the general population
- 2004
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In: Pain. - Philadelphia : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 108:1-2, s. 115-123
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Journal article (peer-reviewed)abstract
- The SF-36 is a well-validated health status instrument measuring eight different health concepts. One aim of this study was to compare health status as measured by SF-36 in subjects from the general population with no chronic pain (NCP), chronic regional pain (CRP), and chronic widespread pain (CWP). A second aim was to assess if SF-36 could reflect changes in pain status over time. A third aim was to study if health status at baseline, measured by SF-36, could predict pain status 3 years later. The study was designed as a 3-year follow up with a postal questionnaire, including the SF-36 health survey, to 2357 subjects from the general population aged 20-74 years. The results were controlled for age, sex, co-morbidity, and socio-economic status. At baseline, all eight health concepts of SF-36 discriminated between subgroups with NCP, CRP and CWP. Changes in SF-36 over the 3-year follow up time coincided with improvement or deterioration of pain status. Baseline SF-36 scores predicted pain outcome 3 years later. These results support that both physical and mental aspects of health status as measured by SF-36 are affected by the burden of musculoskeletal pain, are sensitive to changes in pain status, and also predict the further development of pain. (C) 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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| 4. |
- Bremander, Ann, et al.
(author)
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Smoking is associated with a worse self-reported health status in patients with psoriatic arthritis: data from a Swedish population-based cohort
- 2015
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In: Clinical Rheumatology. - London : Springer Science and Business Media LLC. - 0770-3198 .- 1434-9949. ; 34:3, s. 579-583
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Journal article (peer-reviewed)abstract
- The aim was to study possible associations between smoking habits and self-reported clinical features in a large population-based cohort of patients with psoriatic arthritis (PsA). All subjects with PsA who had sought health care in the period 2003-2007 were identified using a regional health-care register. In 2009, all those identified who were 18 years of age or more (n = 2,003) were sent a questionnaire with questions on smoking, health-related quality of life [EuroQol five-dimension (EQ-5D)questionnaire], function [Health Assessment Questionnaire (HAQ)], pain, fatigue, and global health. We performed age- and sex-adjusted regression analysis to compare health status outcomes in never and ever smokers. Altogether, 1,185 subjects (59 %) returned the questionnaire. Mean age was 57 years (SD 13.5), and 58 % were women; 38 % were never smokers and 62 % were ever smokers. Mean age at disease onset was 38.2 years (SD 13.2) and 41.2 years (SD 13.6), respectively (p = 0.001). In age- and sex-adjusted data, ever smokers reported worse EQ-5D (p = 0.009); worse reports of global health (p = 0.01), pain (p = 0.01), and fatigue (p = 0.04); and a higher number of painful body regions (p = 0.04) compared to never smokers. In this population-based PsA cohort, patients who were ever smokers reported worse health status than never smokers. Besides being a possible result of a worse PsA in ever smokers, impaired health status could also be an effect of unstudied comorbidities. Further longitudinal studies are needed to gain a better understanding of cause and effect. However, smoking cessation should be recommended because of general health considerations as well as disease-specific issues.
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| 5. |
- Haglund, Emma, 1970-, et al.
(author)
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Differences in physical activity patterns in patients with spondylarthritis
- 2012
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In: Arthritis Care and Research. - Hoboken : John Wiley & Sons. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 64:12, s. 1886-1894
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To study patient-reported physical activity in patients with spondylarthritis (SpA) and possible differences in physical activity patterns between the SpA subtypes and sexes.METHODS: In 2009, a questionnaire including inquiries concerning physical activity was sent to patients with a SpA diagnosis (n = 3,711). The World Health Organization (WHO) global recommendations of physical activity for health requiring 150 minutes of moderate-intensity physical activity (MI-PA) or 75 minutes of vigorous-intensity physical activity (VI-PA) per week were used as recommended levels. Standardized risk ratios (RRs) were calculated by using physical activity data from the Swedish population. The association within the SpA group between sex, age, disease-related variables, anxiety, and depression and meeting recommended levels of MI-PA and VI-PA (dependent variables) was studied with multivariate analysis.RESULTS: A total of 2,167 patients with SpA (48% men, mean ± SD age 55 ± 14 years) responded to the questionnaire. Sixty-eight percent of the patients met the WHO recommendations, more frequently in women than in men (70% versus 66%). The recommendations were more often met in the SpA group (RR 1.09, 95% confidence interval [95% CI] 1.04-1.15) compared with the Swedish population. There was a tendency for young women to meet the WHO recommendations less often than the Swedish population (RR 0.94, 95% CI 0.63-1.25). Different factors were found to influence whether the patients were exercising with a moderate or vigorous intensity.CONCLUSION: Seven of 10 patients with SpA met the WHO recommendations of physical activity for health, but we found sex and disease subtype differences. This information can be useful in clinical practice when coaching patients to have a healthier lifestyle. © 2012 by the American College of Rheumatology.
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| 6. |
- Haglund, Emma, et al.
(author)
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Prevalence of spondyloarthritis and its subtypes in southern Sweden
- 2011
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In: Annals of the Rheumatic Diseases. - London : BMJ. - 1468-2060 .- 0003-4967. ; 70, s. 943-948
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To estimate the prevalence of spondyloarthritis and its subtypes. METHODS: The Swedish healthcare organisation comprises a system where all inpatient and outpatient care is registered by a personal identifier. For the calendar years 2003-7, all residents aged ≥15 years in the southernmost county of Sweden (1.2 million inhabitants) diagnosed by a physician with spondyloarthritis (ankylosing spondylitis (AS), psoriatic arthritis (PsA), inflammatory arthritis associated with inflammatory bowel disease (Aa-IBD) or undifferentiated spondylarthritis (USpA)) were identified. To obtain valid point estimates of prevalence by the end of 2007, identification numbers were cross-referenced with the population register to exclude patients who had died or relocated. RESULTS: The authors estimated the prevalence of spondyloarthritis (not including chronic reactive arthritis) as 0.45% (95% CI 0.44% to 0.47%). The mean (SD) age of patients with prevalent spondyloarthritis by the end of 2007 was 53 (15) years. Among the component subtypes, PsA accounted for 54% of cases, AS 21.4%, USpA 17.8% and Aa-IBD 2.3% with a prevalence of 0.25%, 0.12%, 0.10% and 0.015%, respectively. The remaining 6.4% had some form of combination of spondyloarthritis diagnoses. The prevalence of spondyloarthritis at large was about the same in men and women. However, the subtype PsA was more prevalent in women and AS was more prevalent in men. CONCLUSION: In Sweden the prevalence of spondyloarthritis leading to a doctor consultation is not much lower than rheumatoid arthritis. PsA was the most frequent subtype followed by AS and USpA, and the two most frequent subtypes PsA and AS also display some distinct sex patterns.
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| 7. |
- Haglund, Emma, et al.
(author)
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Work productivity in a population-based cohort of patients with spondyloarthritis
- 2013
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In: Rheumatology. - Oxford : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 52:9, s. 1708-1714
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Journal article (peer-reviewed)abstract
- Objective. To assess work productivity and associated factors in patients with SpA. Methods. This cross-sectional postal survey included 1773 patients with SpA identified in a regional health care register. Items on presenteeism (reduced productivity at work, 0-100%, 0 = no reduction) were answered by 1447 individuals. Absenteeism was defined as register-based sick leave using data from a national register. Disease duration, disease activity (BASDAI), physical function (BASFI), health-related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy [Arthritis Self-efficacy Scale (ASES) pain and symptom], physical activity and education were also measured. Results. Forty-five per cent reported reduced productivity at work with a mean reduction of 20% (95% CI 18, 21) and women reported a higher mean reduction than men (mean 23% vs 17%, P < 0.001). Worse quality of life, disease activity, physical function and anxiety all correlated with reduced productivity (r = 0.52-0.66, P < 0.001), while sick leave did not. Worse outcomes on the EQ-5D (beta-est -9.6, P < 0.001), BASDAI (beta-est 7.8, P < 0.001), BASFI (beta-est 7.3, P < 0.001), ASES pain (beta-est -0.5, P < 0.001) and HAD-d (beta-est 3.4, P < 0.001) were associated with reduced productivity at work in patients with SpA regardless of age, gender and disease subgroup. ASES symptoms, HAD-a and education level < 12 years were associated with reduced productivity but were not significant in all strata for age, gender and disease subgroup. Conclusion. Work productivity was reduced in patients with SpA and more so in women. Worse quality of life, disease activity, physical function, self-efficacy and depression were all associated with reduced productivity at work in patients with SpA.
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| 8. |
- Lindström, Ulf, et al.
(author)
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Back pain and health status in patients with clinically diagnosed ankylosing spondylitis, psoriatic arthritis and other spondyloarthritis: a cross-sectional population-based study
- 2016
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In: Bmc Musculoskeletal Disorders. - London : Springer Science and Business Media LLC. - 1471-2474. ; 17
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Journal article (peer-reviewed)abstract
- Background: In the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA). The objectives of this study were to determine the frequency of current IBP, as a hallmark sign of possible axial SpA, in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other SpA and to compare self-reported health between the groups with current IBP. Methods: Five-thousand seven hundred seventy one patients identified in the regional healthcare register of the most southern county of Sweden, diagnosed at least once by a physician (based on ICD-codes) with any type of SpA in 2003-2007, were sent a postal survey in 2009. Patients with current IBP were identified, based on self-reported back pain >= 3 months in the preceding year and fulfilling the Berlin criteria for IBP. The frequencies of IBP in AS, PsA and other SpA (including the remaining subgroups of SpA) were determined, and the groups were compared with regard to patient reported outcome measures (PROMs). Results: The frequency and proportion of patients with current IBP in AS, PsA and other SpA were 319 (43 %), 409 (31 %) and 282 (39 %) respectively, within the responders to the survey (N = 2785). The proportion was statistically higher in AS, compared to PsA (p < 0.001), but not for AS compared to other SpA (p = 0.112). PsA and other SpA, with current IBP, had similar (BASFI, EQ-5D, patients global assessment, fatigue, spinal pain) or worse (BASDAI) PROMs, compared to AS with current IBP. PsA with current IBP received pharmacological, anti-rheumatic, treatment more frequently than AS with current IBP, while AS and other SpA received treatment to a similar degree. Conclusion: The proportion of patients with current IBP was substantial in all three groups and health reports in the non-AS groups were similar or worse compared to the AS group supporting the severity of IBP in these non-AS SpA groups. These findings may indicate a room for improvement concerning detection of axial disease within different subtypes of non-AS SpA, and possibly also for treatment.
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| 9. |
- Meesters, J. J. L., et al.
(author)
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Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden
- 2018
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In: Scandinavian Journal of Rheumatology. - Abingdon : Informa UK Limited. - 0300-9742 .- 1502-7732. ; 47:3, s. 185-193
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Journal article (peer-reviewed)abstract
- Objectives: Anxiety and depression symptoms are more common in patients with spondyloarthritis (SpA) than in the general population. This study describes prognostic factors for change in self-reported anxiety and depression over 2years in a well-defined SpA cohort.Method: In 2009, 3716 adult patients from the SpAScania cohort received a postal questionnaire to assess quality of life (QoL) and physical and mental functioning. A follow-up survey was performed in 2011. The Hospital Anxiety and Depression Scale indicated no', possible', and probable' cases of anxiety and depression. Transitions between the three different categories were analysed and logistic regression analysis determined prognostic factors (patient-reported outcomes and characteristics) for improvement or deterioration.Results: In total, 1629 SpA patients responded to both surveys (44%) (meanSD age 55.8 +/- 13.1years, disease duration 14.6 +/- 11.7 years); 27% had ankylosing spondylitis, 55% psoriatic arthritis, and 18% undifferentiated SpA. The proportion of patients reporting possible/probable anxiety decreased from 31% to 25% over 2years, while no changes in depression were seen. Factors associated with deterioration or improvement were largely the same for anxiety as for depression: fatigue, general health, QoL, level of functioning, disease activity, and self-efficacy. However, reporting chronic widespread pain (CWP) at baseline increased the risk of becoming depressed and decreased the probability of recovering from anxiety.Conclusion: Self-reported anxiety and depression is common and fairly stable over time in SpA patients. The association between mental health and CWP indicates that both comorbidities need to be acknowledged and treated in the clinic.
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| 10. |
- Strömbeck, Britta, et al.
(author)
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Cost of Illness from the Public Payers' Perspective in Patients with Ankylosing Spondylitis in Rheumatological Care.
- 2010
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In: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 37, s. 2348-2355
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To estimate the incremental costs to public payers for patients with ankylosing spondylitis (AS) of working age compared with reference subjects from the general population. METHODS: We investigated total costs for 3 years (2005-2007) in 116 outpatients under 66 years of age with AS attending rheumatological care in Malmö, Sweden. Mean (SD) age was 46 (11) years and mean (SD) disease duration was 24 (11) years. Two subjects perAS patient matched for age, sex, and residential area were selected from the Population Register to serve as a reference group. We retrieved data concerning sick leave, prescription drugs, and healthcare consumption from Swedish health-cost registers by the unique personal identification numbers. RESULTS: The mean total cost for the 3-year period 2005-2007 was US $37,095 (SD $30,091) for patients with AS, and $11,071 (SD $22,340) for the reference group. The mean indirect cost was $19,618 and $5905, respectively. Mean cost for healthcare was $8998 for the AS patients and $4187 for the reference subjects, and mean cost for drugs was $8479 and $979, respectively. The patients with AS treated with biological therapy constituted 80% of the total drug cost, but just 40% of the cost for disability pension. CONCLUSION: Patients with AS had 3-fold increase in costs compared to reference subjects from the general population, and the drug costs were almost 10 times as high. Production losses (indirect cost) represented more than half of total cost (53%).
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