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- 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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- Bengtsson, K, et al.
(författare)
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RISK FACTORS FOR NON-VERTEBRAL FRACTURES IN ANKYLOSING SPONDYLITIS
- 2022
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 81, s. 785-786
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Osteoporosis is common in patients with ankylosing spondylitis (AS) and a risk factor for fragility fractures. Additional established risk factors for fractures in the general population include higher age, female sex, previous fracture, fall tendency, glucocorticoid treatment, insulin dependent diabetes, smoking and high alcohol consumption.ObjectivesTo estimate the influence of established risk factors for fragility fractures on the development of non-vertebral fractures in AS and population controls.MethodsThrough linkage of national population and health care registers 2001-2016, patients with AS (n=11611, 65.5% men, mean age 48 years) and age-, sex- and geography-matched population controls (n=58050) were identified and from 1 January 2007 (or 3 months after the first registered AS diagnosis if this occurred later) followed prospectively until the time of a non-vertebral fracture, death, emigration or end of study (30 December 2016). Occurrence of established risk factors for a fracture and AS related characteristics at start of follow-up were identified in the National Patient and Prescribed Drug Registers using ICD-10 and ATC codes. Smoking status and anthropometric measurements are not available in these registers. Chi-square, Fischer’s exact test and T tests were used to compare between subjects with and without a non-vertebral fracture during follow-up, separately for AS and controls. Multivariable Poisson regression was used to estimate the influence of each established risk factor in AS and controls. Risk factors for which there were ≤20 observed events in the AS cohort were not included. Results are presented as incidence rate ratios (IRR) with 95% confidence intervals.ResultsIn total 974 (8.4%) patients with AS and 4106 (7.1%) of their controls were registered with a non-vertebral fracture during the study period. The characteristics of the patients and controls at start of follow-up are presented in Table 1 stratified by fracture status during follow-up. Figure 1 displays the results from the Poisson regression.Table 1.ASControlsNo fracture (n=10637)Fracture (n=974)P-valueNo fracture (n=53944)Fracture (n=4106)P-valueMale sex7002 (65.8)603 (61.9)0.01435448 (65.7)2572 (62.6)<0.001Mean age (SD)47.6 (14.7)53.8 (14.8)<0.00147.8 (14.7)53.0 (15.0)<0.001Prior fracture667 (6.3)140 (14.4)<0.0012715 (5.0)486 (11.8)<0.001Osteoporosis*359 (3.4)83 (8.5)<0.001367 (0.7)85 (2.1)<0.001Fall injury without fracture714 (6.7)97 (10.0)<0.0013205 (5.9)350 (8.5)<0.001Harmful use of alcohol158 (1.5)26 (2.7)0.005889 (1.6)171 (4.2)<0.001Hyperthyroidism39 (0.4)7 (0.7)0.105180 (0.3)19 (0.5)0.173Diabetes type 1178 (1.7)30 (3.1)0.002651 (1.2)80 (1.9)<0.001Liver disease66 (0.6)10 (1.0)0.132197 (0.4)32 (0.8)<0.001Malnutrition8 (0.1)3 (0.3)0.05816 (0.0)2 (0.0)0.367Hypogonadism or premature menopause11 (0.1)1 (0.1)1.00033 (0.1)0 (0.0)0.169Use of oral glucocorticoids#1531 (14.4)152 (15.6)0.304839 (1.6)97 (2.4)<0.001Anterior uveitis2168 (20.4)204 (20.9)0.677317 (0.6)32 (0.8)0.126Psoriasis316 (3.0)34 (3.5)0.364605 (1.1)58 (1.4)0.091Inflammatory bowel disease675 (6.3)64 (6.6)0.783441 (0.8)35 (0.9)0.811Use of any DMARD¤3411 (32.1)266 (27.3)0.002465 (0.9)52 (1.3)0.008Use of TNF inhibitor¤1539 (14.5)109 (11.2)0.00543 (0.1)4 (0.1)0.573The data is presented as number (%) if not stated otherwise. *Diagnosed osteoporosis and/or use of osteoporosis medication. #Prednisolone equivalent cumulative dose of ≥450 mg within the last year before start of follow-up. ¤Use within the last year before start of follow-up.Figure 1.Multivariable Poisson regression analyses for a non-vertebral fracture during follow-up, with results presented for each included baseline variable as IRR with 95% CI, separately for AS and controls.ConclusionThe influence of established risk factors for fragility fractures in AS is similar to that in the general population; in both populations with advanced age, prior fracture and harmful use of alcohol being the strongest risk factors.Disclosure of InterestsKarin Bengtsson: None declared, Johan Askling Grant/research support from: AbbVie, AstraZeneca, Bristol Myers Squibb, Eli Lilly, Janssen, Merck, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Mattias Lorentzon: None declared, Björn Rosengren: None declared, Anna Deminger: None declared, Eva Klingberg: None declared, Lennart T.H. Jacobsson Speakers bureau: Lecture and consulting fees from Novartis, Eli Lilly and Janssen, Helena Forsblad-d’Elia: None declared
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- Feldthusen, Caroline, 1977, et al.
(författare)
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The ASAS Health Index and Environmental Factors Item Set: validity and reliability of the Swedish translations in Swedish patients with ankylosing spondylitis
- 2024
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Ingår i: Scandinavian Journal of Rheumatology. - 0300-9742. ; 53:2, s. 104-111
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo translate the Assessment of SpondyloArthritis international Society (ASAS) Health Index (HI) Environmental Factors Item Set (EFIS) into Swedish and culturally adapt it for a Swedish context, and to assess the construct validity of the Swedish version of the ASAS HI and test-retest reliability in ASAS HI and EFIS in Swedish patients with ankylosing spondylitis (AS).MethodTranslation and cross-cultural adaptation of the EFIS were carried out according to a forward-backward procedure consisting of five steps. The construct validity of the ASAS HI was tested using Spearman correlation with standard health outcomes for axial spondyloarthritis (axSpA). Reliability was analysed by internal consistency with the Cronbach's alpha coefficient for ASAS HI, and test-retest reliability with intraclass correlation coefficients (ICCs) for ASAS HI and kappa agreement for the individual items of EFIS.ResultsThe translation of EFIS showed acceptable face and content validity. ASAS HI showed an acceptable internal consistency (Cronbach's alpha 0.79), and excellent test-retest reliability (ICC 0.87). Test-retest reliability for EFIS showed varied results, with kappa agreement for the individual items ranging from poor (-0.027) to good (0.80).ConclusionsThe Swedish version of ASAS HI proved to be valid and reliable and is recommended for assessing the impact of AS on global functioning and health. A Swedish version of EFIS has been produced and uploaded on the ASAS website. The EFIS proved to have acceptable face and content validity, and may contribute to the contextual interpretation of the ASAS HI.
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- Klingberg, E., et al.
(författare)
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Gut dysbiosis in ankylosing spondylitis is associated with increased fecal calprotectin
- 2018
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Ingår i: Clinical and Experimental Rheumatology. - : Clinical and Experimental Rheumatology. - 0392-856X .- 1593-098X. ; 36:4, s. 696-696
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction/Aims: Intestinal dysbiosis may be involved in the pathogenesis of ankylosing spondylitis (AS). We aimed to define differences in the gut microbiota composition between patients with AS, ulcerative colitis (UC) and healthy controls (HC) and determine the relations between gut microbiota, fecal calprotectin (FCal) and disease related variables in AS.Methods: Fecal microbiota was analyzed in patients with AS(N=150), UC(N=18) and HC(N=17) using 16S rRNA sequence technique in a targeted approach. Fecal bacterial abundance and profile was also compared with a healthy reference group creating a Dysbiosis Index score (DI 1-5). The AS patients were assessed with questionnaires, back-mobility tests, FCal, ESR and CRP.Results: Principal component analysis showed highly separate clustering of the microbiota in stool samples from patients with AS, UC and HC. We found an expansion of Proteobacteria and a contraction of Bacteroidetes and Lachnospiraceae in AS. Dysbiosis (defined as DI≥3) was found in 88% of AS and an elevated DI correlated with increased FCal (rS=0.303; p<0.001). Samples from AS patients with FCal<50 (n=57) and >200 mg/kg (n=36) clustered separately in multivariate analysis. The patients with a FCal>200 mg/kg had lower abundance of bacteria with anti-inflammatory effects such as Faecalibacterium prausnitzii and Clostridium and higher abundance of various types of Streptococci. No clear association was found between the overall fecal microbiota composition and HLAB-27 status, disease activity, function or medication.Conclusions: The fecal microbiota signature differed greatly between patients with AS, UC and HC. An increased FCal, suggestive of intestinal inflammation, was associated with aberrations in the microbiota composition and increased dysbiosis.
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- Law, Lucy, et al.
(författare)
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Factors related to health related quality of life in ankylosing spondylitis, overall and stratified by sex
- 2018
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Ingår i: Clinical and Experimental Rheumatology. - : Clinical and Experimental Rheumatology. - 0392-856X .- 1593-098X. ; 36:4, s. 714-714
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Knowledge about health related quality of life (HRQoL) in Ankylosing spondylitis (AS) is limited. The aims of this study were to assess HRQoL by short form-36 (SF-36) in a cohort of patients with AS compared with controls and to examine associations between SF-36 and spinal radiographic changes, physical function, disease activity and demographic data overall and stratified by sex.Method: A cohort of patients with AS were assessed with spinal radiographs for mSASSS, BASMI, BASFI, ASDAS-CRP, BASDAI, BASG and SF-36. Each patient’s SF-36 results were compared with 5 age- and sex-matched persons (n=1055) from the SF-36 Swedish normative population database. Associations between SF-36 physical component summary (PCS) and mental component summary (MCS) scores and disease related and demographic factors were investigated with univariate and multiple logistic regression analyses with PCS and MCS below/above their respective median values as dependent variables.Results: 210 patients, age (median, IQR) 49.0 (40.0, 61.2) years were included. AS patients scored lower (p<0.001) compared to controls in all SF-36 domains and component summaries. Both sexes scored significantly lower in PCS compared to MCS. Multiple logistic regression analyses revealed that living without a partner (OR 2.38, 95% CI 1.00–5.67), long symptom duration (year in decade OR 1.66, 95% CI 1.16–2.37), higher BASFI (OR 1.98, 95% CI 1.46–2.70) and ASDAS≥2.1 (OR 3.32, 95% CI 1.45-7.62) were associated with worse PCS, while living without a partner (OR 3.04, 95% CI 1.34–6.91), fatigue (VAS global fatigue >median (OR 6.36, 95% CI 3.06–13.19) and ASDAS≥2.1 (OR 2.97, 95% CI 1.41–6.25) were associated with worse MCS.Conclusions: AS patients had significantly lower HRQoL compared with controls. PCS was more affected than MCS in both sexes. Both disease related and demographic factors were associated with HRQoL, partly overlapping for PCS and MCS. Factors associated with HRQoL showed some differences between sexes. Modifying factors, such as ASDAS-CRP and fatigue, may improve HRQoL.
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