| 1. |
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| 2. |
- Ajeganova, S, et al.
(författare)
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HIGHER LEVELS OF NATURAL ANTI-PHOSPHORYLCHOLINE ANTIBODIES ARE ASSOCIATED WITH LOWER RISK OF INCIDENT CARDIOVASCULAR EVENTS IN YOUNGER PATIENTS WITH RHEUMATOID ARTHRITIS
- 2020
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 79, s. 939-939
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The increased cardiovascular (CV) risk in rheumatoid arthritis (RA), especially in seropositive RA, is not fully explained by traditional risk factors. Immuno-inflammatory mechanisms and autoantibodies could be involved in the pathogenesis of atherosclerotic disease. Recent studies have suggested that anti-phosporylcholine antibodies (anti-PC) of IgM subclass counteract the generation of senescent and IL-17+ T-cells, have atheroprotective effects and may play a role in formation and stabilization of atherosclerotic plaque.Objectives:To investigate the association between IgM anti-PC antibodies with cardiovascular (CV) morbidity in patients with RA in age and sex groups and by serostatus.Methods:The study population was derived from the BARFOT early RA cohort, recruited in 1994-1999. The outcome was CV events i.e. AMI, angina pectoris, coronary intervention, ischemic stroke and TIA tracked through the Swedish Hospital Discharge and the National Cause of Death Registries. The RA-disease measures and traditional risk factors were assessed according to the protocol. Sera collected at inclusion and the 2-year visit were analyzed with ELISA to determine levels of anti-PC IgM (Athera CVDefine kit, Athera Biotechnologies AB). The Kaplan-Meier estimates and Cox proportional-hazards regression models were applied. Analysis were stratified by median level of IgM anti-PC and performed within strata of age, sex and RA-autoantibodies.Results:In all, 654 patients with early RA, 68% women, mean (SD) age 55(14.7) years, DAS28 5.2(1.3), 60% RF-positive and 60% ACPA-positive without prevalent CVD were included in this analysis. The level of IgM anti-PC at baseline was median (IQR) of 60.9(36.4-94.9) and at 2 years 56.0(32.3-84.2) U/ml. During follow-up of > 10 years, 141 incident CV events (21.6%) were registered. The levels of anti-PC both at inclusion and after 2 years of observation were lower in participants who experienced CV event than in those who did not, p=0.020 and p=0.012.The CV event-free survival differed between patients with levels of anti-PC above median compared with those with levels below, p=0.003 by log-rank test. The risk for incident CV event showed a 0.6-fold hazard (95% CI, 0.4-0.8) among patients with higher anti-PC levels as compared with those with lower levels, p=0.003. In the age groups, the risk for incident CV event was lower in patients aged <55 years at inclusion than in those who were older, hazard ratio (HR) 0.40 (0.17-0.94), p=0.036. This result persisted when adjusted for sex and all traditional risk factors, HR 0.36 (0.14-0.92), p=0.032. Also, the risk for incident CV events was lower in patients with higher anti-PC levels in females, HR 0.61 (0-39-0.45), and double RF- and ACPA- negative patients, 0.44 (0.21-0.90), in crude analyses.The favourable effect of anti-PC at baseline and the CV outcome was not observed in ages >55 years, males, ACPA+ and RF+ patients. There were no significant association between anti-PC level at 2 years and outcome.Conclusion:These results suggest that higher levels of IgM anti-PC are associated with a lower risk of incident CV events over 10 years in younger patients. The favourable atheroprotective effect of IgM anti-PC may be a part of explanation of lower risk of atherosclerotic disease in younger persons, females and in those with seronegative RA.Acknowledgments :6th Framework Program of the European Union (grant LSHM-CT-2006-037227 CVDIMMUNE)Disclosure of Interests:Sofia Ajeganova: None declared, Maria Andersson: None declared, Johan Frostegård Grant/research support from: Unconditional competitive grant from Amgen, related only to PCSK9, not the topic of this abstract, Ingiäld Hafström: None declared
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| 3. |
- Ajeganova, S, et al.
(författare)
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TEAM-REHABILITATION BENEFITS BODY COMPOSITION AND FUNCTIONAL OUTCOME BEYOND TIME OF THE REHABILITATION PERIOD IN INFLAMMATORY ARTHRITIS, OF WHICH BODY COMPOSITION IS LINKED TO CHANGE IN LEVEL OF CARDIORESPIRATORY FITNESS, WHEREAS MUSCLE MASS AND STRENGTH ARE LINKED TO PHYSICAL FUNCTIONING
- 2020
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 79, s. 1262-1263
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Low physical activity, accumulated disability and disease chronicity contribute to adverse body composition and reduced cardiorespiratory fitness in patients with chronic inflammatory diseases. In the general population, physical exercise improves body composition, muscle strength and aerobic capacity but in inflammatory diseases it is not well established.Objectives:To investigate whether 1) exercise intervention in patients with arthritis affects body composition, physical and aerobic capacity, and whether 2) body composition and physical capacity could explain outcomes as HAQ and aerobic capacity.Methods:Consecutive patients with inflammatory arthritis and a clinical need for rehabilitation, ages 18-80 years, participated in a team-rehabilitation program for 4 weeks. Anthropometry, body composition assessed with bioelectrical impedance analysis, muscle force with hand grip strength and Times sit-to-stand test (TST), activity limitation with the HAQ score and cardiorespiratory fitness with the Åstrand 6-minute cycle test for VO2 max were measured pre-rehabilitation and after 3 and 12 months. The ANOVA model with Bonferroni correction, adjusted for age, sex and baseline measures, was used for the pairwise comparisons of repeated measures overtime. Association between body composition, physical functioning, and the course of HAQ and cardiorespiratory fitness for 12 months was determined with linear mixed models adjusted for age, gender and comorbidity.Results:The study evaluated 149 patients with rheumatoid arthritis (RA), psoriasis arthritis, spondylarthritis and juvenile idiopathic arthritis, aged mean (SD) 53(13) years, 74% women, disease duration 21(13) years, HAQ 1.1(0.6) at inclusion and DAS28 4.1(1.3) for those with RA.There was a statistically significant reduction of BMI between pre-rehabilitation and after 3 months, reduction of waist circumference, body fat, fat mass and the fat mass index after 3 and 12 months, adjusted p<0.05. The muscle mass of total body, arms and legs did not change significantly post-rehabilitation compared to pre-rehabilitation. Hand grip strength and TST improved together with reduction of HAQ and increased VO2 max after 3 and 12 months, adjusted p<0.05 adjusted for age, sex and baseline measures.The HAQ overtime was independently associated with total body muscle mass, legs muscle mass, hand grip strength, and TST pre-rehabilitation, but not to the change of body composition overtime.The course of VO2 max overtime was independently associated with pre-rehabilitation BMI, waist circumference, muscle mass of total body, arms and legs, fat mass, body fat, the fat mass index and TST, as well as with change of BMI, waist circumference, fat mass and the fat mass index between pre-rehabilitation and after 3 and 12 months.Conclusion:We observed benefits of intervention with a team-rehabilitation program for 4 weeks on body composition profile, functioning, physical limitation and cardiorespiratory fitness, which were presented beyond the time of the rehabilitation period for up to 12 months. Different aspects of body composition and physical capacity were associated with levels of disability measured with HAQ and with cardiorespiratory fitness. This study indicates that in patients with inflammatory arthritis, muscle mass and strength were linked to HAQ over time, whereas the measures of body composition could be more linked to cardiorespiratory fitness than to HAQ.Disclosure of Interests:None declared
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| 4. |
- Andersson, KM, et al.
(författare)
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GGTASE DEFICIENT MACROPHAGES ALTER INTEGRIN EXPRESSION ON LYMPHOCYTES AND FACILITATE DEVELOPMENT OF ARTHRITIS
- 2020
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 79, s. 205-206
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Geranylgeranyltransferase type I (GGTaseI) is the enzyme responsible for the prenylation/ lipidation of the RhoA family proteins, which keeps them attached to the cell membrane. We reported that GGTaseI-deficient (GLC) mice develop a spontaneous and age-dependent arthritis, reproducing the pathology of RA1. Targeting GGTaseI activates RhoA proteins.Objectives:To study which of the activated Rho proteins is responsible for development of arthritis, we deleted individual RhoA, Rac1 or Cdc42 genes in GLC mice. We study consequences of GGTaseI deficiency for lymphocyte function.Methods:Double deficient mice that lack Rac1 (GLC Rac1fl/fl), RhoA (GLC RhoAfl/fl) and Cdc42 (GLC Cdc42fl/fl) were developed by Cre-technology using the LysM-promotor, and were on a mixed genetic background (129Ola/Hsd-C57BL/6)2. Joints of the hind paws were assessed for signs of arthritis histologically and by micro CT at age of 16 weeks. Phenotype of spleen CD4 and CD8 T cells was analysis by flow cytometry. Proliferation and cytokine production was assessed in spleen cultures by ELISA. Gene expression profile was analyzed by RT-PCR.Results:Deletion of Rho proteins had divergent effect on development of arthritis in GLC mice. We observed a reduction of the arthritis index in GLC Rac1fl/fl (n=19, p=0.027) and GLC RhoAfl/fl (n=4, p=0.007) mice compared to GLC (n=16), while GLC Cdc42fl/fl (n=4) had no change in arthritis development. GLC RhoAfl/fl mice increased the bone mass compared to GLC (p=0.029).Flow cytometry analysis showed that RA-prone GLC and GLC Cdc42fl/fl mice had lower number of CD4 cells in spleen. CD4 cells of RA-prone GLC and GLC Cdc42 mice had significantly higher subsets of the regulatory FoxP3+ and FOXp3+CD25+ cells (p=0.016-0.029 and p=0.016-0.029 respectively) compared to control and GLC RhoAfl/fl mice. Additionally, RA-prone mice had higher expression of receptors to extracellular matrix proteins collagen (α2β2) and fibronectin (α5β1) compared to control mice (p=0.016 and p=0.011 resp) and to RA-protected mice (GLC Rac1fl/fl and GLC RhoAfl/fl, p=0.0004 and p=0.011, resp). In total, both the number of FoxP3+ CD4 cells and the expression of α5β1 receptors on CD4 cells correlated strongly with the synovitis score (r=0.72, p=0.0017 and r=0.59, p=0.012, respectively).GGTaseI gene lays under the control of HOX proteins essential for cell homing. Importantly, HOX regulate the expression of integrins. Studying the expression of HoxA genes in spleen, we found that RA prone GLC and GLC Cdc42 mice tended to have lower expression of HoxA2 and higher expression of HoxA9 compared to RA-protected GLC Rac1 and GLC RhoA and to control mice. The Hoxa9/Hoxa2 ratio was significantly higher in RA prone mice compared to RA-protected mice (p=0.0085) and control mice (p=0.019). This ratio correlated with α5β1 receptors (r=0.55, p=0.0084), FOXP3+ CD4 cells (r=0.50, p=0.017), and the arthritis index (r=0.50, p=0.033).Conclusion:Taken together this study shows that Rho proteins play divergent role in development of arthritis. Activation of Rac1 and RhoA by GGTaseI deletion changes the pattern of HOXA proteins and increases expression of integrin receptors, which facilitates leukocyte influx in the paw joints. Deletion of Rac1 and RhoA has RA-protective effect in GLC mice.References:[1]Khan, O.M., et al.J Clin Invest121, 628 (2011).[2]Akula, M.K., et al.Nat Commun10, 3975 (2019).Disclosure of Interests:None declared
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| 5. |
- Andersson, KM, et al.
(författare)
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SURVIVIN INHIBITS TRANSCRIPTION OF PBX1 AND SUPPORTS THE EFFECTOR PHENOTYPE OF THE MEMORY CD4 T CELLS IN RHEUMATOID ARTHRITIS
- 2020
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 79, s. 227-228
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The oncogenic protein survivin is a marker of severe rheumatoid arthritis (RA). High serum levels of Survivin predict progressive joint damage1and poor treatment response2.Objectives:To study the role of survivin in the transcriptional regulation of phenotype in CD4+T cells.Methods:CD4+T cells of RA female patients were isolated from the perpheral blood. Activated CD4+cells were treated with survivin inhibitor YM155. Transcriptional analysis was done by RNAseq (Illumina) and conventional qPCR. Chromatin of CD4 cells was immunoprecipitated using polyclonal antibodies to survivin and subjected to deep sequencing (survivin ChIPseq, Hiseq2000, Illumina) and aligned to GRCh38. Statistical analysis of differentially expressed genes (DEG) was done in R-studio using Benjamini-Hochberg adjustment for multiple testing (Bioconductor, DESeq2 package).Results:Survivin ChIPseq of the activated CD4+T cells was enriched with the genes engaged in regulatory transcription factor specific DNA binding (GO:0000987, adj p=0.0005) and RNA polymerase II regulatory transcription (GO:0000978, adj p = 0.0004). Among survivin targets were the genes of HOX-B cluster and TALE family proteins MEIS, PKNOX and PBX1 controlling early leukopoesis and T cell maturation. Inhibition of survivin in PBMC resulted in significant upregulation of PBX1 (p=0.023), MEIS3 (p=0.0036), similar tendency was observed for HOXB6 and HOXC4 genes. RNAseq analysis CD4 cells of RA patients with different transcription of PBX1, identified 1636 genes (adj p<10-5). BIRC5, coding for survivin, was 8.3 folds higher in CD4+cells with low PBX1 (p=0.0005). Among the core transcription factors of T helper cell differentiation, we identifed NF-kB1 and NF-kB2, TBX21, IRF4, IRF8 and STAT3, BATF and BATF3. This followed by significantly higher TNF, IFNg and IL17A and IL17F in PBX1lo CD4 T cells. The pathway enrichment analysis of DEG identified strong over-representation of cytokine-specific genes (GO:005125, GO:0005126, GO:0048018, GO:0030545, FDR q-values 10-12-10-9). The genes of IL4, IL5, IL13, IL9, IL3 and CSF2 located within the chromosome 5 were common for all GO-lists, and were higher in PBX1lo, but none of those genes was identified by survivin-ChIPseq or PBX1-ChIPseq. Analysis of ChIPseq data identified the genes of STAT3, IRF4, IRF8 and BATF as common targets for PBX1 and survivin.Conclusion:This genome-wide analysis indicates that survivin regulates transcription of the TALE family protein PBX1 in CD4+ T cells, which has essential effect for differentiation and phenotype of Th subsets. Low PBX1 in RA patients is associated with terminally differentiated effector CD4+ T cells.References:[1]Svensson, B.et.al.Smoking in combination with antibodies to cyclic citrullinated peptides is associated with persistently high levels of survivin in early rheumatoid arthritis: a prospective cohort study.Arthritis Res Ther16, R12 (2014).[2]Levitsky, A.et.al.Serum survivin predicts responses to treatment in active rheumatoid arthritis: a post hoc analysis from the SWEFOT trial.BMC Med13, 247 (2015).Disclosure of Interests:None declared
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| 6. |
- Andersson, Maria L.E. 1968-, et al.
(författare)
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Metabolic factors associated to clinical hand osteoarthritis in individuals with knee pain
- 2020
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 79:Suppl. 1, s. 1734-1734
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is some evidence supporting associations between metabolic factors, clinical hand osteoarthritis (OA) and radiographic knee OA. However, more studies are needed regarding early knee OA.Objectives: The aim was to study associations between metabolic factors and clinical hand OA at baseline in a cohort of individuals with knee pain, with and without radiographic knee OA.Methods: In an ongoing five-year longitudinal study of knee pain, hand OA was assessed by clinical examinations in 296 of the included individuals at baseline [1]. BMI, waist circumference (WC) and blood pressure was measured. Body composition was assessed with Inbody 770. Fasting plasma glucose, triglycerides, cholesterol, HDL-and LDL-cholesterol and HbA1c was analysed. Metabolic syndrome (MetS)was present if central obesity (WC ≥94 cm in men and ≥80cm in women) plus any two of the following factors: raised blood pressure (systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mm Hg or treatment of hypertension), raised triglycerides (≥ 1.7 mmol/L or specific treatment), reduced HDL-cholesterol (men < 1.03 mmol/L and women < 1.29 mmol/L or specific treatment), raised glucose (glucose ≥ 5.6 mmol/L, or type 2 diabetes). Hand strength and self-reported disability of the arm, shoulder and hand (quickDASH) was assessed.The individuals were divided according to having clinical hand OA or not, according to Altman [1]. The associations between background factors and clinical hand OA were calculated by crude logistic regression analyses, adjusting for age and sex.Results: Fifty-five percent of the individuals in the study was overweight or obese, 40% had MetS and 23% had radiographic knee OA. In total 34% of the individuals had clinical hand OA. The group with hand OA were older, had higher proportion of body fat, fasting plasma glucose, HbA1C, worse quickDASH score and lower hand strength, table 1. Clinical hand OA was significantly associated to higher age (OR 1.04, 95%CI 1.01-1.07), higher fasting plasma glucose (1.56, 1.05-2.30), worse quickDASH (1.04, 1.02-1.06) and lower hand strength (0.99, 0.99 -0.998), but not to proportion of body fat and HbA1c.Conclusion: In this cross-sectional study, the only metabolic factor associated with clinical hand OA was fasting plasma glucose. Contrary to other studies, there were no gender differences found. The association between development of clinical hand OA and metabolic factors in individuals with knee pain need to be further assessed in longitudinal studies.
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| 7. |
- Andersson, Maria L.E. 1968-, et al.
(författare)
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Metabolic Factors Associated to Radiographic Knee Osteoarthritis in Individuals with Knee Pain
- 2020
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 79:Suppl. 1, s. 793-793
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Tidskriftsartikel (refereegranskat)abstract
- Metabolic factors have been shown to be associated to radiographic knee osteoarthritis (OA) [1]. More knowledge about associations between metabolic factors and early clinical knee OA is needed.Objectives:The aim was to study associations between metabolic factors and radiographic knee OA in individuals with knee painMethods:In total 272 individuals with radiographs at baseline, from an ongoing longitudinal study of knee pain (without cruciate ligament injury), were included in the present cross-sectional study. At baseline BMI, waist circumference (WC) and visceral fat area (VFA) were assessed. Fasting plasma glucose, triglycerides, cholesterol, HDL-and LDL-cholesterol were analysed. Metabolic syndrome (MetS) was present if central obesity (WC ≥94 cm in men and ≥80cm in women) plus any two of the following factors: raised blood pressure (systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mm Hg or treatment of hypertension), raised triglycerides (≥ 1.7 mmol/L or specific treatment), reduced HDL-cholesterol (men < 1.03 mmol/L and women < 1.29 mmol/L or specific treatment), raised glucose (glucose ≥ 5.6 mmol/L, or type 2 diabetes).The individuals were divided in two groups according to Ahlbäck [2], one group, who had grade I or more in at least one knee (radiographic knee OA, ROA) n=62 and the other group, not fulfilling Ahlbäck criteria (no radiograhic knee OA, No OA) n=211. The associations between metabolic factors and knee OA were calculated by crude logistic regression analyses, adjusting for age and sex.Results:The group with radiographic knee OA were older, had higher BMI, higher amount of visceral fat and more had central obesity, table 1. Ninety- four percent of the group with ROA had central obesity compared to 76%, p=0.002 in the no OA group. There was no difference between the groups regarding MetS, 44% in the ROA group vs. 39%, p=0.5. The group with ROA had increased cholesterol, triglycerides and LDL-cholesterol. There were no differences in fasting glucose between the groups, though both groups had a mean glucose value in the upper range of normal value, table 1. Factors associated to having radiographic knee OA were age (OR 1.11, 95% CI 1.06-1.17), BMI (1.07, 1.003-1.13), central obesity (3.91, 1.32-11.61) and raised triglycerides (2.35, 1.03-5.38).Table 1.Baseline descriptivesNo OAMean (sd)ROAMean(sd)p-valueN21162Age50 (9)56 (4)<0.001Sex, women, %66710.454BMI25.9 (4.7)27.7 (4.7)0.007VFA (cm2)109 (53)126 (52)0.026WC, cm94 (13)99 (13)0.006Raised Blood pressure, %66530.063Cholesterol (mmol/L)5.2 (1.0)5.5 (1.1)0.033Triglycerides (mmol/L)1.0 (0.6)1.2 (0.7)0.035Raised triglycerides, %9210.008LDL-cholesterol (mmol/L)3.4 (1.0)3.7 (1.1)0.027HDL-cholesterol (mmol/L)1.7 (0.4)1.7 (0.5)0.547Reduced HDL11150.460Glucose (mmol/L)5.5 (0.9)5.5 (0.5)0.858Conclusion:There were associations between some metabolic factors and radiographic knee OA in individuals with knee pain. Fasting glucose was increased in both groups. The associations between metabolic risk factors and the development of knee OA needs to be assessed in longitudinal studies.References:[1]Sellam J, Bone Spine 2013;80:568-73.[2]Ahlback S,. Acta Radiol Diagn (Stockh) 1968Suppl 277:7-72.Disclosure of Interests:None declared
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| 8. |
- Andreasson, K, et al.
(författare)
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PATIENTS WITH INFLAMMATORY MYOPATHIES WHO DO NOT REACH HEALTH ENHANCING LEVELS OF PHYSICAL ACTIVITY REPORT HIGHER LEVELS OF ANXIETY AND DEPRESSION - A CROSS-SECTIONAL STUDY OF SELF-REPORTED DATA
- 2020
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 79, s. 1265-1265
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The adult idiopathic inflammatory myopathies (IIM) comprise dermatomyositis (DM), polymyositis (PM), immune-mediated necrotizing myopathy (IMNM), antisynthetase syndrome (ASS), overlap myositis and inclusion body myositis (IBM). Impaired physical capacity, self-reported fatigue and pain are common features in IIM. Quality of life is reduced compared to population-based reference values. To our knowledge self-reported levels of physical activity has not been studied in patients with IIM. Further, anxiety and depression are common in other rheumatic diseases, such as SLE, but is less studied in IIM, and not previously in relation to levels of physical activity. There is evidence for symptom reducing effects of exercise for patients suffering from depression (1).Objectives:The objective of this study is to assess the levels of self-reported physical activity, depression and anxiety amongst adult patients with IIM. A further aim is to evaluate differences in anxiety/depression based on levels of physical activity as well as to analyze relationships between physical activity and anxiety/depression.Methods:All patients with IIM visiting the Rheumatology clinic at Karolinska University Hospital in Solna between February 2019 and January 2020 where asked to fill in questionnaires about their levels of physical activity for the last seven days using the International Physical Activities Questionnaire – short form (IPAQ), and anxiety and depression using Hospital Anxiety and Depression Scale (HADS). The myositis team nurse distributed the questionnaires. Spearman’s rho was used for correlation analysis. Kruskal-Wallis test and post-hoc adjustment with Bonferroni correction was used to analyze group differences. HADS is scored in two separate scales, one for depression (HADS-D) and one for anxiety (HADS-A). The cut-off value for probable depression or anxiety is ≥8 of a maximum of 21 per scale (2). IPAQ-results was scored as 1 (low, < 150 min/w), 2 (moderate, ≥ 150 min/w – health-enhancing levels of physical activity, HEPA, according to WHO) and 3 (high, ≥ 300 min/w).Results:A total of 61 patients answered the questionnaires. 52 (85 %) of the patients reported to reach HEPA and 24 of these patients reported to be active on a high level. 22 patients (36 %) scored probable anxiety or depression, with six scoring ≥8 for both depression and anxiety. Patients with low levels of physical activity (IPAQ-1) scored significantly higher anxiety and depression compared to those reaching HEPA (IPAQ-2 and IPAQ-3) p<0.0001 – 0.020. The correlation between physical activity and depression (Fig. 1) was rs=-0.48 (-0.66; -0.26) and between physical activity and anxiety (Fig. 2), rs=-0.27 (-0.49; -0.02).Conclusion:Self-reported data indicates that most patients with IIM in this sample reached HEPA level or higher. Patients who do not reach HEPA score significantly higher anxiety and depression compared to those reaching HEPA. However, levels of physical activity correlates moderately to depression and weakly to anxiety. The number of patients who reached HEPA is high compared to studies in rheumatoid arthritis or the general population. This could be explained by frequent visits to physical therapists early in the disease and yearly check-ups with a focus on exercise and physical activity. Further the inter-professional myositis team also has a focus on exercise and the importance of everyday physical activity. This is cross-sectional, self-reported data and longitudinal studies are needed also including objective measures. This is preliminary data with data collection ongoing throughout 2020.References:[1]Craft, LL et al. The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry. 2004;6(3):104-111[2]Zigmond, AS et al. The hospital anxiety and depression scale. Acta Psychiat. Scand. 1983;67(6):361-70Disclosure of Interests:None declared
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| 9. |
- Bech, B, et al.
(författare)
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2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis
- 2020
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Ingår i: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 79:1, s. 61-68
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Tidskriftsartikel (refereegranskat)abstract
- To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.
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| 10. |
- Bengtsson, K., et al.
(författare)
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Higher risk of incident fracture in patients with ankylosing spondylitis compared to the general population
- 2020
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 79, s. 745-746
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Ankylosing spondylitis (AS) is characterized by pathologic new bone formation and bone loss. Vertebral fracture (VF) is a known complication of AS, whereas the risk of other major osteoporotic fractures (MOFs) is less studied.Objectives: To estimate incidence rates (IRs) of incident fractures (any, VF and other MOF (humerus, forearm and hip)) in patients with AS compared to controls from general population.Methods: This is a nationwide, register-based and observational cohort study including patients diagnosed with AS (n=11611, 65% men, mean age 48 years) identified in the National patient register (NPR) 2001 through 2015, and age- and sex-matched controls (n=58050) from the Swedish Population Register. The study period started 1 January 2007 or 3 months after the first AS diagnosis, whichever came later, and ended at the first occurrence of each fracture outcome (identified in the NPR), death, emigration or 31 December 2016. Patients and controls with any prior fracture in NPR within a 6-year period before start of the study period were not included. Any fracture (except skull and phalangeal fractures), VF and other MOF were identified in NPR according to pre-specified ICD codes. Each fracture outcome was analysed separately. Poisson regression was used to calculate IRs and incidence rate ratios (IRRs), overall and stratified by sex. Kaplan-Meier curves were plotted.Results: In total 807 (7.0%) of patients with AS and 3201 (5.5%) of matched controls had a history of prior fracture within a 6-year period, and were excluded from further analyses. We noted higher IRs for any fracture, VF and other MOF in AS vs controls, see Figure for Kaplan-Meier curves and Table for IRs and IRRs. In sex-stratified analyses, men with AS (vs. male controls) had a higher relative risk for all fracture outcomes, whereas among women with AS (vs. female controls), a higher relative risk was demonstrated for any fracture and VF. 5-year cumulative incidence for any fracture, VF and other MOF was 6.2%, 1.6% and 1.7%, respectively in AS and 4.3%, 0.3% and 1.2%, respectively in controls.
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