| 1. |
- Andersson, Åsa, Professor, 1960-, et al.
(författare)
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Effects on serum protein levels from one bout of high intensity interval training in individuals with axial spondyloarthritis and controls
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton causing pain, inflammation, and stiffness. Individuals with axSpA are at greater risk of developing cardiovascular disease, which can be counteracted by physical activity. High-intensity interval training (HIIT) has been shown to improve cardiovascular health, but the effect on disease activity and the level of inflammation in axSpA has been less studied. With the aim of investigating how levels of inflammatory cytokines, myokines, and protein markers for bone metabolism are acutely affected by one bout of HIIT, we studied serum from individuals with axSpA and healthy controls (HC).Methods: Ten participants with axSpA and 11 age- and sex-matched HC performed a single HIIT bout on a cycle ergometer: 4x4 minutes intervals with three minutes active rest in between. Blood samples were taken before and one hour after the HIIT bout. Serum proteins (IL-6, IL-17, IL-18, TNFa, CXCL-10, VEGF-A, BDNF, DKK-1, osteoprotegerin, osteocalcin, osteopontin, BMP-7, CRP) were analyzed with a Luminex system or ELISA. Descriptive data are presented as mean with standard deviation. A two-way ANOVA was used for comparisons.Results: A main effect from baseline to one hour post HIIT showed that both groups had a significant increase in serum levels (pg/ml) of IL-6: axSpA 2.2 (3.0) to 3.2 (1.8) and HC 0.4 (0.4) to 1.9 (2.0), p=0.03. VEGF-A (pg/ml) was significantly lower in the axSpA group: 159 (138) vs. HC 326 (184), p=0.03, but was not affected by the HIIT bout. BMP-7 (ng/ml) increased in both groups after the HIIT: axSpA 61.6 (13.1) to 75.2 (20.0) and HC 64.6 (20.8 to 75.0 (17.8), p<0.001. For the other proteins analyzed, there were no significant differences in serum concentrations between individuals with axSpA and HC, or within the two groups before and after one bout of HIIT.Conclusions: One acute bout of HIIT significantly increases the serum concentrations of IL-6 and BMP-7 after 1 hour in both individuals with axSpA and HC.© Research Square 2024
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| 2. |
- Andersson, Åsa, Professor, 1960-, et al.
(författare)
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Serum Protein Response To A Single High-Intensity Interval Training Bout – Comparison Between Individuals With Spondyloarthritis And Healthy Controls
- 2022
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 81:Suppl 1, s. 780-781
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Tidskriftsartikel (refereegranskat)abstract
- Axial spondyloarthritis (axSpA) is a chronic inflammatory disease affecting mainly the axial skeleton. To decrease the risk of cardiovascular comorbidity, aerobic training is recommended as a part of disease management in patients with axSpA. High-intensity interval training (HIIT) interventions are, in addition to other recommended treatments, believed to positively affect the disease activity (1). However, the knowledge about the acute effects of HIIT on the inflammatory process at the molecular level is less studied. Understanding the acute HIIT effects on cytokines and additional serum proteins in axSpA is important for further long-term HIIT interventions and recording of the effect of HIIT on the axSpA disease profile.ObjectivesTo study the acute effects on serum proteins, such as cytokines, myokines, and inflammatory- and bone-related proteins, in response to a single bout of HIIT, and to compare the levels between baseline and post-HIIT in patients with axSpA and healthy controls (HC).MethodsThe pilot study included twenty-one participants (10 female, 11 male), mean (SD) age 40 (7) years, ten with axSpA, and eleven age and sex matched HC, who performed a single HIIT on a cycle ergometer consisting of 4x4 minutes interval (90% heart rate, HR-max) with three minutes active rest in between (70% of HR-max). Disease activity (BASDAI, 0-10) in patients with axSpA was 1.6 (0.8). Health status EuroQol (EQ5D, 0-1) were 0.87 (0.11) for axSpA, and 0.93 (0.10) for HC. The groups were well matched with no difference in baseline data for weight, BMI, EQ5D, blood pressure or aerobic capacity.Blood samples were taken before (baseline) and one hour after the single HIIT. The following serum proteins were analyzed on a Luminex MAGPIX System (Luminex corporation, Austin, TX USA): Interleukin (IL)-6, IL-17, IL-18, TNFαAGPIX System (Luminex corporatiosteoprotegerin, osteocalcin, osteopontin, and FGF-23. A three-way analysis of variance (ANOVA) was used to detect differences between groups, between sexes, and before and after a HIIT bout in a 2(group)*2(sex)*2(time) design. For main effects or interactions significant at p≤0.05, simple effect t-tests were used to determine the specific effects.ResultsA group main effect (p=0.048) showed that the serum level of IL-6 was increased one hour after the HIIT session primarily in the HC, 0.4 pg/ml (SD±0.4) at baseline vs. post-HIIT 1.8 (2.0). The concentration of the cytokines/chemokine IL-17, IL-18, TNFα group main effect (p=0.048) showed that the serum level of IL-6 was increased one hour after the HIIT session primarily in30) in VEGF-A showed that the axSpA group had significantly lower VEGF-A at baseline, 159 pg/ml (138) vs 326 (184) in the control group (which might be due to anti-inflammatory medication). A sex main effect (p=0.029) was observed from baseline to post-HIIT for the bone hormone osteocalcin, with a more pronounced decrease of serum osteocalcin in women with axSpA, 14.0 ng/ml (8.3) vs. post HIIT 13.2 (6.9). Moreover, the level of the multifunctional protein osteopontin was significantly lower (sex main effect, p=0.021) in women, 10.7 ng/ml (7.0) vs. men 20.4 (10.1), post-HIIT.ConclusionThis pilot study shows that one bout of HIIT influences the expression of proteins involved in inflammation and metabolism, and that sex is an important factor in the response to HIIT. The results should be followed up in longer intervention studies including higher numbers of participants.References[1]Sveaas, S. H. et al. (2019). High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. British journal of sports medicine, 54(5), 292-297.Disclosure of InterestsÅsa Andersson: None declared, Emma Haglund Consultant of: Novartis, Emma Berthold: None declared, Elisabeth Mogard Consultant of: Novartis, Anna Torell: None declared, M Charlotte Olsson: None declared
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| 3. |
- Drake af Hagelsrum, Klara, et al.
(författare)
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Healthcare professionals’ experiences of lifestyle management in patients with early rheumatoid arthritis : A qualitative study
- 2022
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. ; , s. 239-240
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Konferensbidrag (refereegranskat)abstract
- Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemic disease that mainly affects joints and with symptoms such as stiffness, pain, and increased fatigue. RA also appears to be an independent risk factor for accelerated atherosclerosis with an increased risk of cardiovascular diseases, why national and international guidelines recommend proper pharmacological treatment together with a healthy lifestyle (1). Supporting people with early RA to achieve and maintain a healthy lifestyle is therefore of great importance. However, few studies have explored healthcare professionals’ views of working with lifestyle management. A healthy lifestyle does not only have the potential to lower cardiovascular risk but may also improve a person’s quality of life.Objectives: The aim of this study was to explore healthcare professionals´ experiences of lifestyle management in patients with early RA.Methods: In this explorative qualitative study, individual interviews were conducted with 20 healthcare professionals who had a mean of 16 years of professional experience in the field of working with patients with RA. An interview guide with open-ended questions was used e.g.: “How do you work with lifestyle changes in patients with RA?” and “What theories do you use to support lifestyle changes?” Qualitative content analysis was used, where three categories emerged: “The importance of a well-functioning organization”, “The importance of teamwork” and “The importance of person-centered care” and nine subcategories, representing the overall content of the interviews ( Table 1 ).
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| 4. |
- Drake af Hagelsrum, Klara, et al.
(författare)
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Healthcare Professionals’ Experiences Of Lifestyle management In Patients With Early Rheumatoidarthritis – A Qualitative Study
- 2022
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Ingår i: ReumaBulletinen. - Stockholm : Svensk reumatologisk förening. - 2000-2246 .- 2001-8061. ; 154:4, s. 60-61
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemicdisease that mainly affects joints and with symptoms such asstiffness, pain, and increased fatigue. RA also appears to be anindependent risk factor for accelerated atherosclerosis withan increased risk of cardiovascular diseases, why national andinternational guidelines recommend proper pharmacologicaltreatment together with a healthy lifestyle (1). Supportingpeople with early RA to achieve and maintain a healthy lifestyleis therefore of great importance. However, few studies haveexplored healthcare professionals’ views of working with lifestylemanagement. A healthy lifestyle does not only have the potential tolower cardiovascular risk but may also improve a person’s qualityof life.Objectives: The aim of this study was to explore healthcare professionals´experiences of lifestyle management in patients with early RA.Methods: In this explorative qualitative study, individual interviews wereconducted with 20 healthcare professionals who had a mean of 16years of professional experience in the field of working with patientswith RA. An interview guide with open-ended questions was usede.g.: “How do you work with lifestyle changes in patients withRA?“ and “What theories do you use to support lifestyle changes?”Qualitative content analysis was used, where three categoriesemerged: “The importance of a well-functioning organization“,“The importance of teamwork“ and “The importance of personcenteredcare” and nine subcategories, representing the overallcontent of the interviews (table 1).Results: Healthcare professionals’ experiences of lifestyle managementin patients with early RA included the importance of a wellfunctioningorganization with supportive leadership, priority oflifestyle management, and competence development in lifestylemanagement. The importance of teamwork was emphasizedincluding interdisciplinary team, professional expertise in lifestylehabits, and structured approach to lifestyle management. The healthcare professionals also highlighted the importance of personcenteredcare with individually tailored lifestyle management,shared decision-making, and patient engagement.Conclusion: Healthcare professionals’ experiences of lifestyle managementin patients with early RA reveal that commitment from both themanagement, the team, and the patient is important.References: 1. Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendationsfor cardiovascular disease risk management in patients withrheumatoid arthritis and other forms of inflammatory jointdisorders: 2015/2016 update. Ann Rheum Dis 2017;76:17-28.
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| 5. |
- Drake Af Hagelsrum, Klara, et al.
(författare)
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Healthcare professionals' perceptions of working on lifestyle management for patients with early rheumatoid arthritis – a qualitative study
- 2023
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - Abingdon : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA). METHODS: In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified. RESULTS: HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach. CONCLUSIONS: HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 6. |
- Hamberg, Viggo, et al.
(författare)
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Elevated fecal levels of the inflammatory biomarker calprotectin in early systemic sclerosis
- 2023
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Ingår i: Rheumatology International. - : Springer Science and Business Media LLC. - 0172-8172 .- 1437-160X. ; 43:5, s. 961-967
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge on gastrointestinal manifestations in early systemic sclerosis (SSc) is limited. We have investigated gastrointestinal inflammation in SSc at the time of diagnosis using the inflammatory biomarker Fecal calprotectin (F-cal). Consecutive patients with suspected SSc were characterized in relation to the 2013 classification criteria for SSc and classified as SSc or SSc-like disease. F-cal levels were measured with a polyclonal ELISA (Calpro A/S, Lysaker, Norway) and levels above 50 µg/g were considered elevated. F-cal levels were compared to those of control subjects without rheumatic disease. Of 137 patients with suspected SSc, 92 were classified as SSc and 45 as SSc-like disease. Median (interquartile range) disease duration among the SSc participants was 2.5 (1.2, 4.6) years. A substantial proportion of participants classified as SSc (35/92, 38%) and SSc-like disease (14/45, 31%) exhibited elevated F-cal compared to the control group (3/41, 7.3%; p < 0.001 and p = 0.007, respectively). Elevated F-cal was associated with proton pump inhibitor usage (OR 7.14; 95% CI 2.56–29.93; p < 0.001). We conclude that elevated F-cal is present in a subgroup of patients with SSc at the time of diagnosis, suggesting that that GI inflammation may be present in this patient group early in the disease course. F-cal did not exhibit potential to differentiate SSc from SSc-like disease.
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| 7. |
- Landgren, Ellen, et al.
(författare)
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Belonging, happiness, freedom and empowerment - a qualitative study of patients' understanding of health in early rheumatoid arthritis
- 2024
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Ingår i: BMC Rheumatology. - London : Springer Nature. - 2520-1026. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease, that influences patients’ health in different ways, including physical, social, emotional, and psychological aspects. The goal of rheumatology care is to achieve optimal health and personalised care and therefore, it is essential to understand what health means for patients in the early course of RA. The aim of this study was to describe the understanding of health among patients with early RA.Methods: The study had a descriptive qualitative design with a phenomenographic approach. Phenomenography is used to analyse, describe, and understand various ways people understand or experience a phenomenon, in this study, patients’ understandings of health. Individual semi-structured interviews were conducted with 31 patients (22 women and nine men, aged (38–80) with early RA, defined as a disease duration of < 1 year, and disease-modifying anti-rheumatic drugs (DMARDs) for 3–7 months. The phenomenographic analysis was conducted in 7 steps, and the outcome space presents the variation in understanding and the interrelation among categories. In accordance with the European Alliance of Associations for Rheumatology’s (EULAR) recommendations, a patient research partner participated in all phases of the study.Results: The analysis revealed four main descriptive categories: ‘Health as belonging’ was described as experiencing a sense of coherence. ‘Health as happiness’ was understood as feeling joy in everyday life. ‘Health as freedom’ was understood as feeling independent. ‘Health as empowerment’ was understood as feeling capable. Essential health aspects in early RA are comprised of a sense of coherence, joy, independence, and the capability to manage everyday life.Conclusions: This study revealed that patients’ perception of health in early RA encompasses various facets, including a sense of belonging, happiness, freedom, and empowerment. It highlighted that health is multifaceted and personal, emphasizing the importance of acknowledging this diversity in providing person-centred care. The findings can guide healthcare professionals to deepen patients’ participation in treatment goals, which may lead to better treatment adherence and health outcomes. © The Author(s) 2024.
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| 8. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Patients’ experiences of living with RA after 1-2 years of DMARD treatment
- 2022
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Ingår i: Reumabulletinen. - Stockholm : Svensk reumatologisk förening. - 2000-2246 .- 2001-8061. ; 154:4, s. 66-67
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatoid arthritis (RA) is a disease with a great impact on all aspects of life. Living with RA affects patients’ health including physical, emotional, psychological, and social aspects. Patients with RA are treated with disease-modifying anti-rheumatic drugs (DMARDs) and monitored with tight control to achieve low disease activity or remission. Nevertheless, RA can be life-changing when the patients need long-term treatment to control the disease activity. The goal of treatment for patients with chronic diseases such as RA is to achieve optimal health and a life as normal as possible. It is therefore important to gain knowledge about how patients experience everyday life a short period after the initiation of DMARD treatment. Aim: To describe patients’ experiences of living with RA after 1-2 years of DMARD treatment.Methods: The study has a qualitative design with an inductive approach. Focus groups (n=17) and individual (n=5) interviews were conducted with 22 patients with RA. The participants consisted of 15 women and 7 men with a mean age of 57 years and a disease duration of 12-21 months. The participants were treated with conventional or biological DMARDS for 12-20 months. The main questions were: “Can you tell me how RA impacts your daily life?” “Which outcomes of your RA are important to you at this moment?“ The interviews were analyzed with qualitative content analysis and five categories with an overarching theme emerged (Table 1).Results: Patients’ experiences of living with RA after 1-2 years of DMARD treatment lead to new insights into life and were expressed as 1) Surrendering to disease limitations due to being restricted by pain, fatigue, and in function; 2) Adapting to disease limitations by adjusting one´s work balance and one’s social life; 3) Transitioning in self-identity due to disease limitations by not recognising oneself and experiencing a change of bodily appearance and mood; 4) Fighting disease limitations by experiencing joy through exercise, promoting health by exercise and dietary habits, and; 5) Feeling humility despite disease limitations by being grateful for the treatment and seizing the day.Conclusions: Despite the fact that patients have been living with RA and treated with DMARD for 1-2 years, they are still struggling to make everyday life work. Although patients adapt their lives to the new conditions, their lives are affected by symptoms such as fatigue, pain, stiffness, and side effects such as nausea, hair loss, and weight gain. However, patients highlight the positive effects of how exercise influences their health and how living with RA leads to new insights into life.
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| 9. |
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| 10. |
- Lindqvist, Elisabet, et al.
(författare)
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How good is the agreement between clinical diagnoses and classification criteria fulfilment in axial spondyloarthritis? Results from the SPARTAKUS cohort
- 2023
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 0300-9742 .- 1502-7732. ; 52:4, s. 364-373
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To study the agreement between clinical axial spondyloarthritis (axSpA) diagnoses and fulfilment of the Assessment of SpondyloArthritis international Society (ASAS) axSpA and modified New York (mNY) classification criteria, and to compare disease/health status between axSpA subtypes. Method Patients with prevalent, clinical axSpA attending a rheumatology clinic were enrolled in a cross-sectional study. Assessments included physical evaluation, laboratory testing, questionnaires, and appropriate imaging, allowing classification. Standard axSpA outcome measures were compared between patients fulfilling mNY/radiographic versus non-radiographic axSpA (r-axSpA/nr-axSpA) criteria. Results Of 239 consecutively included patients, 141 fulfilled ASAS r-axSpA and/or mNY criteria, while 57 fulfilled nr-axSpA criteria. The agreement between r-axSpA and mNY criteria fulfilment was 94%. The positive predictive value (PPV) of a clinical ankylosing spondylitis (AS) diagnosis for mNY criteria fulfilment was 71%; the PPV of an undifferentiated axSpA (u-axSpA) diagnosis for fulfilment of nr-axSpA criteria was 30% and 40% for mNY criteria. Patients with r-axSpA/AS were older, more often men, and had longer disease duration, more uveitis, and worse spinal mobility than nr-axSpA patients, who had more enthesitis and dactylitis. Conclusion We found an overall good concordance between clinical axSpA diagnoses and classification criteria fulfilment, with 83% fulfilling ASAS axSpA and/or mNY criteria. Regarding axSpA subtypes, the concordance was weaker, and although the ICD-10 code for AS correctly identified patients meeting mNY criteria in 71% of cases, one-third of mNY-positive patients lacked an AS diagnosis. Moreover, clinical u-axSpA diagnoses could not serve as a proxy to identify nr-axSpA, highlighting the importance of thorough classification in research on axSpA subtypes.
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| 11. |
- Mogard, Elisabeth, et al.
(författare)
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A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis : a cross-sectional study
- 2022
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Ingår i: BMC Rheumatology. - London : BioMed Central (BMC). - 2520-1026. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA).Methods: A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as “healthy” or “unhealthy”, summarized for each patient and stratified into four groups (0–3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis.Results: Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors—more frequently patients with PsA (48%) than AS (39%) or USpA (38%)—and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes.Conclusion: Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health. © 2022, The Author(s).
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| 12. |
- Mogard, Elisabeth, et al.
(författare)
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Chronic Pain and Assessment of Pain Sensitivity in Patients With Axial Spondyloarthritis: Results From the SPARTAKUS Cohort
- 2021
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 48:11, s. 1672-1679
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study differences in pain reports between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA), and to assess how pain sensitivity measures associate with disease and health outcomes. Methods. Consecutive patients with axial SpA (axSpA) were enrolled in the population-based SPARTAKUS cohort (2015-2017) and classified as AS (n = 120) or nr-axSpA (n = 55). Pain was assessed with question-naires (intensity/duration/distribution) and computerized cuff pressure algometry to measure pain sensi-tivity (pain threshold/pain tolerance/temporal summation of pain). Linear regression models were used to compare pain measures between patients with AS and nr-axSpA, and to assess associations between pain sensitivity measures and disease and health outcomes. Results. Of 175 patients with axSpA, 43% reported chronic widespread pain, with no significant differences in any questionnaire-derived or algometry-assessed pain measures between patients with AS and nr-axSpA. Lower pain tolerance was associated with longer symptom duration, worse Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index (BASMI), more pain regions, unacceptable pain, worse Maastricht AS Enthesitis Score (MASES), fatigue, anxiety, and health-related quality of life. Further, lower pain threshold was associated with worse ASDAS-CRP and MASES, whereas higher temporal summation was associated with longer symptom duration, unacceptable pain, and worse BASMI. Conclusion. Chronic pain is common in axSpA, with no observed differences in any pain measures between patients with AS and nr-axSpA. Further, higher pain sensitivity is associated with having worse disease and health outcomes. The results indicate that patients with AS and nr-axSpA, in line with most clinical char-acteristics, have a similar pain burden, and they highlight large unmet needs regarding individualized pain management, regardless of axSpA subgroup.
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| 13. |
- Mogard, Elisabeth, et al.
(författare)
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Chronic pain and assessment of pain sensitivity in patients with established axial Spondyloarthritis – a cross-sectional study
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background/Purpose: Pain remains a common and debilitating symptom in arthritis, despite good options to treat inflammation. In axial spondyloarthritis (axSpA), data on chronic pain remain scarce. Objective: To assess self-reported and observed aspects of pain in subgroups of axial spondyloarthritis (axSpA), and to investigate associations between these pain aspects and different health outcome measures. Methods: A cross-sectional study of patients with axSpA (ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA, based on ICD10 codes)), consecutively enrolled in the SPARTAKUS cohort (n=226). Of 197 patients, for whom all relevant information was available, 173 patients fulfilled the ASAS axSpA criteria, and 115 the modified New York criteria. We investigated self-reported pain (intensity, duration, and distribution) and categorized patients into chronic widespread pain, chronic regional pain and no chronic pain. In addition, pain sensitivity (pain threshold, pain tolerance and temporal summation of pain), was assessed by computerized cuff pressure algometry (CPA). Comparisons between AS and USpA and between women and men were performed using Student`s t-test or Chi-squared test. Associations of pain sensitivity measures and different health outcome measures, adjusted for age and sex, were analyzed by multivariate linear regression. Results: All assessed pain measures, except for number of pain regions, were similar in AS and USpA. Almost 50% of the axSpA patients, reported chronic widespread pain (AS 42%, USpA 53%), which was more pronounced in women (60% vs. 34% for men, p<0.001). For pain sensitivity measures, women had lower pain tolerance as compared to men (AS (p=0.03), USpA (p=0.01)), while pain threshold was lower only for women with USpA (p<0.01) (Table). Furthermore, irrespective of diagnosis subgroup, lower pain tolerance was associated with higher disease activity, more fatigue and less spinal mobility. Conclusion: In this population-based, cross-sectional study of established axial spondyloarthritis, chronic widespread pain was common, affecting 50% of the patients. A clear sex difference was found, with women reporting worse measures for both self-reported pain and pain sensitivity. Overall, lower pain tolerance was associated with worse disease activity, fatigue and spinal mobility. CPA shows promising results regarding assessment of pain sensitivity and provides additional information in pain evaluation in AxSpA. © 2018 American College of Rheumatology
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| 14. |
- Mogard, Elisabeth, et al.
(författare)
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Differences in spinal mobility measures in relation to disease duration and between subgroups with axial spondylarthritis
- 2013
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Ingår i: Arthritis and Rheumatism. - Hoboken, NJ : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 65:Special issue, Supplement 10, s. S896-S896, Meeting Abstract: 2105
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Tidskriftsartikel (refereegranskat)abstract
- Background/Purpose: Spinal mobility is a core domain for research and clinical practice in Ankylosing Spondylitis (AS) but less studied in undifferentiated SpA (USpA). Our objective was to study the change of commonly used spinal mobility measures stratified on disease duration in patients with AS and differences in these measures in AS vs. USpA.Methods: Patients with AS or USpA were identified from a cohort attending a specialist clinic. A cross sectional studie were the first measures of spinal mobility for each patient recorded during 1999 to 2012 were analyzed. Disease duration was split into tertiles, (<17 years (G1), 18-30 years (G2) and >31 years (G3)). Differences between AS G1/G2/G3 were calculated with Kruskal-Wallis. Differences between AS and USpA were controlled for sex and disease duration (ANCOVA).Results: 126 patients with AS vs. 57 with USpA were included in the study, mean (SD) age 48.4 (13.7) vs. 41.6 (11.4) years and 23% vs. 46% were women. In AS, lumbar, and thoracic measures, vital capacity and the BASMI composite score were the first measures to deteriorate in relation to disease duration (G1 vs. G2, p<0.035). Late in the disease all measures had deteriorated (G1 vs. G3, p<0.036). Patients with USpA presented better scores in lumbar, hip and thoracic spinal measures (p<0.05), data controlled for sex and disease duration. In early disease (<17 years) also cervical measures (p<0.05) were less affected compared to patients with AS.Conclusion: The first measures to significantly change during the disease course in AS were the lumbar and thoracic mobility measures and the BASMI score. As expected, patients with USpA were less affected in mobility than patients with AS.
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| 15. |
- Mogard, Elisabeth
(författare)
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Pain and physical function in patients with spondyloarthritis
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AbstractAnkylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) are two subgroups of the rheumatic disease spondyloarthritis (SpA). The diseases typically debut in early adulthood with periods of fluctuating and persistent pain and stiffness, and can result in consequences such as impaired functioning and reduced quality of life. SpA is a heterogenous group but AS and USpA share many common features. Most evidence is based on studies of men with AS. The aim was to study chronic pain and physical function, including differences betweenAS and USpA, and between men and women, regarding (I) spinal mobility in relation to disease duration, (II) prevalence of chronic widespread pain (CWP), (III) possible risk factors for development of CWP and having persistent CWP, and (IV) different aspects of pain, including pain sensitivity (pain threshold, pain tolerance, and temporal summation of pain).Adult patients with ICD-10 diagnoses corresponding to AS or USpA identified through registers in the Region Skåne, were included in the studies. In Papers I (n=183) and IV (n=226) two clinical cohorts with an axial disease at Skåne University Hospital were studied. In Papers II (n=940) and III (n=712), cross-sectional and longitudinal data from a population-based survey, including patients with AS or USpA were analysed.Patients with SpA showed decreased spinal mobility over time, most evident in AS, and spinal mobility was more severely impaired in the lumbar and thoracic spine in AS compared to USpA. Few differences, between men and women were found, besides anthropometric measures (Paper I). The one-year period prevalence of CWP was 49% in USpA vs. 45% in AS, and more common in females. CWP was associated with female sex, higher BMI and smoking. Men and women with chronic pain reported similar pain intensity, a novel finding (Paper II). Theprevalence of CWP remained high over time, and risk factors for development of, and having persistent CWP included more pain regions, and worse outcomes in health status, disease activity, mental and physical function, and self-efficacy at baseline. Higher age and being female also predicted persistent CWP (Paper III). Patients within the SpA-subgroups reported similar pain sensitivity and pain intensity, but women reported lower pain tolerance, and higher pain intensity compared to men. Lower pain tolerance was associated with worse outcomes in disease activity, fatigue and spinal mobility. In conclusion, concomitant CWP is common in AS and USpA and often persists over time. Together with the finding of impaired spinal mobility in all SpA, these consequences emphasise regular follow-ups, with attention to risk factors for CWP and an early and combinedmanagement with pharmacological and non-pharmacological treatment.
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| 16. |
- Mogard, Elisabeth, et al.
(författare)
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Prevalence of chronic widespread pain in a population-based cohort of patients with spondyloarthritis - a cross-sectional study
- 2018
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Ingår i: BMC Rheumatology. - London : BioMed Central. - 2520-1026. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain, regional or widespread, is a frequent and multidimensional symptom in arthritis. There is still limited information on chronic pain in spondyloarthritis, which is important to recognize for adequate diagnosis and treatment. Our objective was to study differences in prevalence of chronic widespread pain in two spondyloarthritis subgroups: ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA).Methods: A population-based postal survey involving questions on the duration, distribution, and intensity of pain was answered by 940 patients with AS (ICD-10 M45.9) or USpA (ICD-10 M46.1-0, M46.8-9). The patients were categorized as having chronic widespread pain, chronic regional pain, or no chronic pain, and prevalence estimates for the pain groups were calculated, including age- and sex-adjusted prevalence.Results: The prevalence of chronic widespread pain was 45.3% in AS vs. 49.3% in USpA, and that of chronic regional pain was 17.7% vs. 21.9% (p = 0.033). More women than men reported having chronic widespread pain (54.1% vs. 41.2%, p ≤ 0.001), while the sex distribution for chronic regional pain was equal. Reports of pain intensity were equal in AS and USpA, with no significant difference in pain intensity between women and men who had chronic regional pain or chronic widespread pain. In the multiple logistic regression analysis, chronic widespread pain was associated to female sex, being an ever-smoker, and having a higher body mass index, controlled for SpA subgroup and disease duration. Conclusions: The prevalence of chronic widespread pain in patients with AS and USpA is high, and with a female predominance, but with no difference in pain intensity between women and men. Chronic pain can complicate the clinical evaluation in patients with SpA, and highlights the need for a thorough clinical examination, including evaluation of inflammation and an accurate pain analysis, to individualize non-pharmacological and pharmacological treatment decisions © 2018 The Author(s).
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| 17. |
- Mogard, Elisabeth, et al.
(författare)
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Spinal Mobility in Axial Spondyloarthritis : A Cross-Sectional Clinical Study
- 2017
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Ingår i: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 15:1, s. 36-48
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Research concerning spinal mobility in axial spondyloarthritis (axSpA) has focused on ankylosing spondylitis (AS), and data on the clinical diagnosis of undifferentiated spondyloarthritis (USpA) are limited. The objective was to study differences in spinal mobility between axSpA subgroups AS and USpA, including gender differences.METHODS: A total of 183 patients with axSpA from a rheumatology clinic were included in the study. The earliest recorded spinal mobility measures (cervical rotation/flexion/extension/lateral flexion, tragus-to-wall distance, vital capacity, chest expansion, thoracic flexion, thoracolumbar flexion, lateral spinal flexion, lumbar flexion and intermalleolar distance) were obtained by specialized physiotherapists. Differences between subgroups were analysed using analysis of covariance, controlled for gender and disease duration.RESULTS: In the USpA group (n = 57), the mean [standard deviation (SD)] age was 41.6 (11.4) years, and disease duration was 13 (10.6) years, with 54% men. In the AS group (n = 126), the mean (SD) age was 48.4 (13.5) years, and disease duration 24.6 (13.3) years, with 77% men. Spinal mobility was less restricted in USpA versus AS patients (p ≤ 0.05), with a median (interquartile range) tragus-to-wall distance of 11 (10-12) cm versus 13 (11.3-18.5) cm; thoracolumbar flexion 9 (7-10) cm versus 6.5 (4-9) cm; lateral spinal flexion 29 (25-36) cm versus 21.3 (12-31) cm; lumbar flexion 4.5 (3.5-5.0) cm versus 3.5 (2.0-4.5) cm and intermalleolar distance 113 (102-121) cm versus 101 (86-114) cm. There were no differences between the subgroups in cervical mobility, vital capacity, chest expansion or thoracic flexion, and there were few gender differences, besides anthropometric measures.CONCLUSION: Patients with USpA and AS had similar cervical and chest mobility, while thoracic and lumbar mobility were more severely restricted in AS. There were few gender differences in either subgroup. Further studies, to understand the full impact of USpA on spinal mobility, are needed. Copyright © 2016 John Wiley & Sons, Ltd.
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| 18. |
- Mogard, Elisabeth, et al.
(författare)
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The combined effects of lifestyle habits on health-related quality of life, physical and mental functions in patients with spondyloarthritis
- 2019
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Ingår i: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl 2, s. 2144-2144
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Tidskriftsartikel (refereegranskat)abstract
- Background: Earlier studies have found strong correlations between worse health and an unhealthy lifestyle, such as not meeting recommendations of moderate-to-vigorous physical activity, being overweight or obese and the use of tobacco in patients with spondyloarthritis (SpA). The impact of more than one unhealthy lifestyle habit (LsH) is however, scarcely described.Objectives: To study the combined effects of unhealthy LsHs on health-related quality of life (HRQoL) and physical and mental functions in patients with SpA. Differences between SpA subgroups and gender were also studied.Methods: Postal questionnaires were in 2009 and 2011 sent to all patients diagnosed with SpA and registered in the Skane Healthcare Register. This study included patients who at both time points responded to the survey, were ≥20 years, and had ankylosing spondylitits (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthritis (USpA). Cross-sectional data from the 2011 questionnaire were available for 1601 patients (AS n=455, PsA n=883, USpA n=263), with a mean age of 58 (13) years (52% women). Self-reported levels of weekly physical activity at moderate or vigorous intensity, (MVPA), use of tobacco (cigarettes and/or snuff) and BMI (overweight or obese) were dichotomized as “healthy” or “unhealthy”. The number of unhealthy LsH were then summarized and stratified into four groups (scoring 0-3, 0=no unhealthy LsH). HRQoL was assessed with EQ-5D (0-1, worst-best), and physical function with BASFI. Disease activity (BASDAI), pain, fatigue (0-10, best-worst), anxiety, and depression (HADa/d) (0-21, no distress-maximum distress) were also measured. Statistical analyses were performed with Chi Square test and ANOVA.Results: Fourteen percent (n=226) reported none of the studied unhealthy LsH, while 35% (n=555) reported one, 38% (n=611) two, and 13% (n=209) three unhealthy LsH. Reports of one and more unhealthy LsH had increasing negative impact on HRQoL (from mean 0.74 (SD 0.19) to 0.57 (0.30)), disease activity (from 3.2 (2.1) to 4.5 (2.3)), physical function (2.3 (2.1) to 4.4 (2.6)), VAS-pain (3.4 (2.3) to 4.8 (2.5)), VAS-fatigue (4.2 (2.7) to 5.5 (2.7)), anxiety (4.8 (4.2) to 5.6 (4.4)) and depression (3.3 (3.3) to 4.8 (3.8)) in patients with SpA (p=0.019-<0.001).Patients with PsA (p≤0.001) and men (p=0.040) reported more often ≥2 unhealthy LsHs, while patients with USpA were least likely to have ≥2 unhealthy LsHs (Figure 1,2). The negative impact on HRQoL, physical and mental functions still remained significant when stratified into different SpA subgroups and gender, except for anxiety in women, and for patients with PsA or USpA.Conclusion: Our findings support that the combined effect of unhealthy lifestyle habits have negative impact on many aspects of health. There is a need for interventions aiming at screening for not only one but several unhealthy lifestyle habits combined, and to offer coaching to increase behavioral change and promote better health. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
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| 19. |
- Olofsson, Tor, et al.
(författare)
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Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis : Results from the SPARTAKUS cohort
- 2019
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Ingår i: Rheumatology (United Kingdom). - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 58:7, s. 1176-1187
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To examine faecal calprotectin (F-calprotectin) levels and presence of anti-Saccharomyces cerevisiae antibodies (ASCA) and their associations with disease subtype and current status in axial SpA (axSpA). Methods. F-calprotectin and ASCA in serum were compared between consecutive patients with a clinical axSpA diagnosis, classified as non-radiographic axSpA (nr-axSpA; n = 40) or AS (n = 90), and with healthy controls (n = 35). Furthermore, standard axSpA outcome measures were compared between axSpA patients (nr-axSpA and AS combined) with elevated vs normal F-calprotectin, ASCA IgA and IgG, respectively. Results. Elevated F-calprotectin (≥50 mg/kg) was observed in 27% of nr-axSpA patients, 38% of AS patients and 6% of controls. F-calprotectin was significantly higher in AS vs nr-axSpA [AS: geometric mean 41 (95% CI 32, 54) mg/kg; nr-axSpA: 24 (95% CI 16, 38) mg/kg; P = 0.037], and in each axSpA subtype vs controls. Overall, worse disease activity and physical function scores were observed among axSpA patients with elevated vs normal F-calprotectin levels, with significant differences regarding patient's visual analogue scale for global health, ASDAS using CRP, and BASFI (adjusted for age, sex, NSAID use, anti-rheumatic treatments, and CRP). ASCA titres and seropositivity (≥10 U/ml) were similar in nr-axSpA (IgA/IgG-seropositivity: 8%/26%) and AS (7%/28%), and clinical outcome measures did not differ between patients with elevated vs normal ASCA IgA or IgG, respectively. Compared with controls (IgA/IgG-seropositivity: 0%/17%), ASCA IgA was significantly higher in both axSpA subtypes, and IgG was significantly higher in the AS group. Conclusion. In patients with axSpA, gut inflammation measured by elevated F-calprotectin is associated with worse disease activity and physical function, and may be a marker of more severe disease.
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| 20. |
- Sagard, Jonas, et al.
(författare)
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Gut dysbiosis associated with worse disease activity and physical function in axial spondyloarthritis
- 2022
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Based on clinical and genetic associations, axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) are suspected to have a linked pathogenesis. Gut dysbiosis, intrinsic to IBD, has also been observed in axSpA. It is, however, not established to what degree gut dysbiosis is associated with axSpA disease severity. The objective of this study was to compare gut dysbiosis frequency between controls, non-radiographic axial spondyloarthritis (nr-axSpA), and ankylosing spondylitis (AS) patients and investigate whether gut dysbiosis is cross-sectionally associated with axSpA disease activity, physical function, mobility, or pain. Methods Gut dysbiosis was assessed by 16SrRNA analysis of feces from 44/88 nr-axSpA/AS patients (ASAS/mNY criteria) without inflammatory bowel disease (IBD) and 46 controls without IBD or rheumatic disease. The GA-map (TM) Dysbiosis Test was used, grading gut microbiota aberrations on a 1-5 scale, where >= 3 denotes dysbiosis. Proportions with dysbiosis were compared between the groups. Furthermore, standard axSpA measures of disease activity, function, mobility, and pain were compared between patients (nr-axSpA and AS combined) with and without dysbiosis, univariately, and adjusted for relevant confounders (ANCOVA). Results Gut dysbiosis was more frequent in AS than controls (36% versus 17%, p=0.023), while nr-axSpA (25% dysbiosis) did not differ significantly from either AS or controls. Univariately, most axSpA measures were significantly worse in patients with dysbiosis versus those without: ASDAS-CRP between-group difference 0.6 (95% CI 0.2-0.9); BASDAI 1.6 (0.8-2.4); evaluator's global disease activity assessment (Likert scale 0-4) 0.3 (0.1-0.5), BASFI 1.5 (0.6-2.4), and VAS pain (cm) 1.3 (0.4-2.2). Differences remained significant after adjustment for demographics, lifestyle factors, treatments, gut inflammation (fecal calprotectin >= 50 mg/kg), and gut symptoms, except for VAS pain. BASMI and CRP were not associated with dysbiosis. Conclusion Gut dysbiosis, more frequent in AS patients than controls, is associated with worse axSpA disease activity and physical function, seemingly irrespective of both gut inflammation and treatments. This provides further evidence for an important link between disturbances in gastrointestinal homeostasis and axSpA.
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