| 1. |
- Bengtsson, Karin, 1980, et al.
(författare)
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Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study
- 2017
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Ingår i: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: To investigate the risk of first-time acute coronary syndrome (ACS), stroke and venous thromboembolism (VTE) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated spondyloarthritis (uSpA), compared to each other and to the general population (GP). Methods: This is a prospective nationwide cohort study. Cohorts with AS (n = 6448), PsA (n = 16,063) and uSpA (n = 5190) patients and a GP (n = 266,435) cohort, were identified 2001-2009 in the Swedish National Patient and Population registers. The follow-up began 1 January 2006, or 6 months after the first registered spondyloarthritis (SpA) diagnosis thereafter, and ended at ACS/stroke/VTE event, death, emigration or 31 December 2012. Crude and age- and sex-standardized incidence rates (SIRs) and hazard ratios (HRs) were calculated for incident ACS, stroke or VTE, respectively. Results: Standardized to the GP cohort, SIRs for ACS were 4.3, 5.4 and 4.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort, respectively, compared to 3.2 in the GP cohort. SIRs for stroke were 5.4, 5.9 and 5.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort compared to 4.7 in the GP cohort. Corresponding SIRs for VTE were 3.6, 3.2 and 3.5 events per 1000 person-years at risk compared to 2.2 in the GP cohort. Age-and sex-adjusted HRs (95% CI) for ACS events were significantly increased in AS (1.54 (1.31-1.82)), PsA (1.76 (1.59-1.95)) and uSpA (1.36 (1.05-1.76)) compared to GP. Age-adjusted HRs for ACS was significantly decreased in female AS patients (0.59 (0.37-0.97)) compared to female PsA patients. Age-and sex-adjusted HRs for stroke events were significantly increased in AS (1.25 (1.06-1.48)) and PsA (1.34 (1.22-1.48)), and nonsignificantly increased in uSpA (1.16 (0.91-1.47)) compared to GP. For VTE the age-and sex-adjusted HRs for AS, PsA and uSpA were equally and significantly increased with about 50% compared to GP. Conclusions: Patients with AS, PsA and uSpA are at increased risk for ACS and stroke events, which emphasizes the importance of identification of and intervention against cardiovascular risk factors in SpA patients. Increased alertness for VTE is warranted in patients with SpA.
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| 2. |
- Bengtsson, Karin, 1980, et al.
(författare)
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Risk of cardiac rhythm disturbances and aortic regurgitation in different spondyloarthritis subtypes in comparison with general population : A register-based study from Sweden
- 2018
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 77:4, s. 541-548
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To describe the incidence of atrioventricular (AV) block II-III, atrial fibrillation (AF), pacemaker implantation (PM) and aortic regurgitation in patients with ankylosing spondylitis (AS), undifferentiated spondyloarthritis (uSpA) and psoriatic arthritis (PsA) compared with the general population (GP) and with each other. Methods A prospective nationwide study with cohorts of patients with AS (n=6448), PsA (n=16 063) and uSpA (n=5190) and a GP (n=2 66 435) cohort, identified in 2001-2009 in the Swedish National Patient and Population registers. Follow-up began on 1 January 2006 and ended at event, death, emigration or 31 December 2012. Age-standardised and sex-standardised incidence rates and hazard ratios (HRs) were calculated. Results The highest incidence rates were noted for AF (5.5-7.4 events per 1000 person-years), followed by PM (1.0-2.0 events per 1000 person-years). HRs for AV block, AF, PM and aortic regurgitation were significantly increased in AS (HRs 2.3, 1.3, 2.1 and 1.9), uSpA (HRs 2.9, 1.3, 1.9 and 2.0) and PsA (HRs 1.5, 1.5, 1.6 and 1.8) compared with the GP cohort. The highest HRs were seen for AV block in male uSpA (HR 4.2) and AS (HR 2.5) compared with GP. Compared with PsA, significantly increased HRs were noted for PM (HR 1.5) in AS and for AV block (HR 1.8) in uSpA. Conclusions Patients with SpA are at increased risk of aortic regurgitation, cardiac rhythm disturbances and, as a probable consequence, also PM. Particularly for AF, the most common arrhythmia, increased caution is warranted, whereas AV block should be looked for especially in men with AS or uSpA.
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| 3. |
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| 4. |
- Bengtsson, Karin, 1980, et al.
(författare)
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Comparisons between comorbid conditions and health care consumption in rheumatoid arthritis patients with or without biological disease-modifying antirheumatic drugs : a register-based study
- 2016
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Symptoms and prognosis of patients with rheumatoid arthritis (RA) have improved with more intensive therapy, including the biological disease-modifying anti-rheumatic drugs (bDMARDs). Real life data concerning how comorbidities are distributed among patients treated or not treated with bDMARDs are scarce. Our objective was to investigate differences in comorbidity and health care consumption in RA patients, with and without bDMARDs.METHODS: This cross-sectional study was performed in the Southwestern part of Sweden. Patients, aged ≥ 18 years and diagnosed with RA in secondary health care during 2009-2010, were identified in the regional health care database. Aggregated data of comorbidity and health care consumption were retrieved between 2006 and 2010. RA patients treated with bDMARDs on 31st December 2010 were identified in the Swedish Rheumatology Quality Register (SRQ), which includes the biologics register Anti-Rheumatic Therapy in Sweden (ARTIS). Descriptive, comparative, univariate and multiple logistic regression analyses were used to identify factors associated with bDMARDs.RESULTS: Seven thousand seven hundred and twelve (7712) RA patients were identified (age 64.8 ± 14.9 years, women 74.3%), of whom 1137 (14.7%) were treated with bDMARDs. Overall, the most common comorbidities were infections (69.2%), hypertension (41.1%), chronic respiratory disease (15.3%), ischemic heart disease (14.0%) and malignancy (13.7%). Patients without bDMARDs were older and had more comorbidity. In the multiple logistic regression analysis, older age, cerebrovascular and chronic respiratory disease, heart failure, depression and malignancy were all associated with no present bDMARDs. Infections were associated with bDMARDs. Patients treated with bDMARDs consumed more secondary outpatient care but less visits in primary health care compared to patients without bDMARDs.CONCLUSIONS: Patients treated with bDMARDs versus no bDMARDs were younger and had significantly lower period prevalence for most common comorbidities, with the exception of infections. Differences in comorbidities between RA patients with or without bDMARDs should be taken into consideration when evaluating effectiveness and safety of bDMARDs in ordinary care.
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| 5. |
- Eriksson, J. K., et al.
(författare)
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Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis?
- 2017
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 76:2, s. 364-370
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Tidskriftsartikel (refereegranskat)abstract
- Aims To assess and compare the incidence of cardiovascular (CV) events, by CV phenotype, between patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and the general population. Methods Using linkages of national and populationbased registers, we identified one cohort of prevalent patients with AS (n=5358), one with RA (n=37 245) and one with matched general population subjects (n=25 006). These cohorts were identified in 2006 through 2011 and were followed in 31 December 2012, for first ever occurrence of acute coronary syndromes (ACS), deep venous thromboembolism, pulmonary embolism and stroke, respectively. For each outcome, we calculated incidence rates standardised to the age and sex distribution of the AS cohort, as well as relative risks using Cox proportional hazards models. Results Based on 69 ACS events during 20 251 person-years of follow-up of the patients with AS, and 966 events during 127 014 person-years in the RA cohort, the age/sex-adjusted relative risks for ACS compared with the general population was 1.3 (95% Cl 1.0 to 1.7) for AS and 1.7 (1.4 to 2.0) for RA. For thromboembolic events, the corresponding risks were 1.4 (1.1 to 1.9) in AS and 1.8 (1.5 to 2.1) in RA. Finally, for stroke, the relative risks were 1.5 (1.1 to 2.0) in AS and 1.5 (1.2 to 1.8) in RA, compared with the general population. Conclusions Prevalent patients with AS are at a 30%-50% increased risk of incident CV events. When compared with patients with RA, this level of increase was similar for stroke, but only half as high for ACS and thrombotic events.
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| 6. |
- Forsblad d'Elia, Helena, 1961, et al.
(författare)
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Drug adherence, response and predictors thereof for tocilizumab in patients with rheumatoid arthritis: results from the Swedish biologics register
- 2015
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Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 54:7, s. 1186-1193
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate drug adherence, clinical response and predictors thereof for tocilizumab in patients with RA in routine care based on prospectively collected data from the Swedish biologics register, Anti-Rheumatic Therapies in Sweden. Methods. RA patients who had started with tocilizumab from September 2008 until March 2012 were identified. Cox regression and logistic regression models were used. Results. A total of 530 RA patients were included, of whom 80.6% were female, 64.7% were on concomitant DMARDs, of which 300 were on MTX and 12% were biologic naive. The overall 6 month, 1 and 2 year estimated drug continuations were 79%, 64% and 50%, respectively. In the multivariate analyses, a low initial level of CRP [hazard ratio (HR) 0.76/1S. D. (95% CI 0.63, 0.91)], high HAQ score [HR 1.23/1S.D. (95% CI 1.06, 1.44)] and prior exposure to different biologics [HR 1.43 (95% CI 1.12, 1.83)] were predictors for drug termination, whereas concomitant DMARD therapy was not. European League Against Rheumatism (EULAR) good, moderate, and no response were achieved by 184 (46.7%), 133 (33.8%) and 77 (19.5%) patients, respectively. Predictors for EULAR good response vs no response (at 2.5-8 months) were low HAQ [odds ratio (OR) 0.56/1S. D. (95% CI 0.40, 0.78)], high 28-joint DAS [OR 2.0/1S. D. (95% CI 1.44, 2.78)] and not being on prednisolone [OR 0.47 (95% CI 0.25, 0.88)] at baseline. Conclusion. In this RA cohort treated with tocilizumab, the estimated 1 year drug continuation was 64% and 80% of the patients achieved a EULAR response. Drug discontinuation was not predicted by no concomitant DMARD, but by low CRP, high HAQ and prior exposure to biologics.
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| 7. |
- Frisell, T., et al.
(författare)
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Patient characteristics influence the choice of biological drug in RA, and will make non-TNFi biologics appear more harmful than TNFi biologics
- 2018
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 77:5, s. 650-657
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Tidskriftsartikel (refereegranskat)abstract
- Objectives With the wide range of biological disease-modifying anti-rheumatic drugs (bDMARDs) available for treating rheumatoid arthritis (RA), and limited evidence to guide the choice for individual patients, we wished to evaluate whether patient characteristics influence the choice of bDMARD in clinical practice, and to quantify the extent to which this would bias direct comparisons of treatment outcome. Methods Register-based study of all Swedish patients with RA initiating necrosis factor inhibitor (TNFi), rituximab, abatacept or tocilizumab in 2011-2015 as their first bDMARD (n=6481), or after switch from TNFi as first bDMARD (n=2829). Group differences in demographics, clinical characteristics and medical history were assessed in multivariable regression models. Predicted differences in safety and treatment outcomes were calculated as a function of patient characteristics, through regression modelling based on observed outcomes among patients with RA starting bDMARDs 2006-2010. Results Patients starting non-TNFi were older than those starting TNFi, had lower socioeconomic status, higher disease activity and higher burden of diseases including malignancy, serious infections and diabetes. Differences were most pronounced at first bDMARD initiation. These factors were linked to treatment outcome independent of therapy, yielding worse apparent safety and effectiveness for non-TNFi biologics, most extreme for rituximab. Standardising to the age/sex distribution of the TNFi group reduced differences considerably. Conclusions There was significant channelling of older and less healthy patients with RA to non-TNFi bDMARDs, in particular as first bDMARD. Whether this channelling represents a maximised benefit/risk ratio is unclear. Unless differences in age, medical history and disease activity are accounted for, they will substantially confound non-randomised comparative studies of available bDMARDs' safety and effectiveness.
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| 8. |
- Holgersen, Ståle, 1980-, et al.
(författare)
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13 myter om bostadsfrågan
- 2016
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- I tretton kapitel utmanas rådande problemformuleringar om vad som utgör hindren för att skapa en mer tillgänglig bostadsmarknad och rimligare boendesituation åt alla. Är ökad marknadsekonomi lösningen på bostadsbristen? Måste vi sänka kvalitetskraven för att alla ska få tak över huvudet? Hur hänger bostadsfrågan och frågan om integration och segregation ihop? Är gentrifiering en naturlig förändring av staden? Rådande "sanningar" om fler avregleringar, lägre skatter och ökad marknadsfrihet har kommit att stå i vägen för nytänkande. Det behövs fler röster i debatten. 13 myter om bostadsfrågan ger alternativa tolkningar som kan föra in nya perspektiv på bostadskrisen. Boken ges ut av Förlag Dokument Press, med illustrationer av Sara Granér.
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| 9. |
- Magnusson, Hans, et al.
(författare)
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Reaching full density of 100CR6 PM steel by capsule free hot isostatic pressing of high-velocity compacted material
- 2016
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Ingår i: World PM 2016 Congress and Exhibition. - : European Powder Metallurgy Association (EPMA). - 9781899072484
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Konferensbidrag (refereegranskat)abstract
- Spherical gas atomised 100Cr6 steel powder, processed with the MMS-Scanpac® process to 95% density (agglomeration, followed by conventional pressing, low temperature sintering and re-strike using high velocity adiabatic compaction) has been fully compacted using capsule-free hot isostatic pressing. The material is characterised at different steps of the process and the results are discussed in this paper. Sintering steel powder with high content of carbon requires carbon control at sintering. By continuously measuring the atmosphere at sintering the ingoing gases are adjusted so that carbon control is achieved. Computational work has been made in order to determine how the sintering atmosphere should be adjusted based on the oxygen release and moisture content in the furnace at sintering. KEYWORDS: Capsule free HIP, high velocity compaction, 100Cr6, carbon control.
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| 10. |
- Svensson, Elin, 1980, et al.
(författare)
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Design of heat exchanger networks with good controllability
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- One important way to improve the energy efficiency of chemical process plants is to improve the heat integration within and between industrial processes. This is accomplished by recovering excess process heat at high temperatures and using it to replace primary heating at lower temperatures through a heat exchanger network. However, as a process becomes more heat integrated, process control may become more difficult. Poor control performance can, in turn, easily lead to increased costs that outweigh the predicted energy cost savings. It is therefore essential to model and analyze the effect of the process changes and address the identified potential control challenges. However, the majority of existing methods for controllability assessment of heat exchanger networks only consider steady-state properties, and not the dynamic aspects, which in reality can seriously affect process control characteristics. With better methods for controllability analysis alternative design options could be evaluated and compared more reliably at an earlier design stage. This report proposes the basic structure of a step-wise approach for integrating dynamic considerations into the design process for heat recovery improvements in process industry, and suggests suitable methods and tools to be used for the different steps of the proposed framework. As part of this, recent work that has been performed to evaluate and improve the methods used in controllability assessment is outlined. Additionally, a number of areas are identified in which significant further efforts are required before a complete controllability assessment framework can be specified and a toolbox for integrated design and controllability analysis can be developed. One central area requiring continued research and development is to define an adequate controllability index for use in heat exchanger network design. For example, it is relatively easy to argue that some of the commonly applied controllability measures are insufficient since they are based on steady-state system interactions only. However, as illustrated in the report, alternative measures of system interactions that take dynamics into account suffer from other drawbacks, of which one is scaling dependency. Nevertheless, these are interesting for further development of a new controllability assessment method, since the issues with scaling can possibly be dealt with using an approach evaluated in this project. Another area where further work is needed is to develop tools with some level of built-in support for formulation of dynamic models of heat exchanger networks. Model simplifications, or other means of handling the large model sizes typically resulting from dynamic modelling of heat exchanger networks may also be needed in order to overcome difficulties in model simulation and analysis. In addition to the development needs related to individual assessment steps, there is an apparent need for appropriate protocols for information transfer and conversion of models between different tools. This report gives an overview of insights revealed in recent research with respect to the controllability of heat exchanger networks. Through this research, the knowledge for continuing the effort to define a better controllability index for heat exchanger networks has been improved.
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