| 1. |
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| 2. |
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| 3. |
- Barber, Megan R.W., et al.
(författare)
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Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach
- 2020
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 72:12, s. 1800-1808
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Tidskriftsartikel (refereegranskat)abstract
- Objective: There is a paucity of data regarding health care costs associated with damage accrual in systemic lupus erythematosus. The present study was undertaken to describe costs associated with damage states across the disease course using multistate modeling. Methods: Patients from 33 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, disease activity, damage (SLICC/American College of Rheumatology Damage Index [SDI]), hospitalizations, medications, dialysis, and selected procedures were collected. Ten-year cumulative costs (Canadian dollars) were estimated by multiplying annual costs associated with each SDI state by the expected state duration using a multistate model. Results: A total of 1,687 patients participated; 88.7% were female, 49.0% were white, mean ± SD age at diagnosis was 34.6 ± 13.3 years, and mean time to follow-up was 8.9 years (range 0.6–18.5 years). Mean annual costs were higher for those with higher SDI scores as follows: $22,006 (Canadian) (95% confidence interval [95% CI] $16,662, $27,350) for SDI scores ≥5 versus $1,833 (95% CI $1,134, $2,532) for SDI scores of 0. Similarly, 10-year cumulative costs were higher for those with higher SDI scores at the beginning of the 10-year interval as follows: $189,073 (Canadian) (95% CI $142,318, $235,827) for SDI scores ≥5 versus $21,713 (95% CI $13,639, $29,788) for SDI scores of 0. Conclusion: Patients with the highest SDI scores incur 10-year cumulative costs that are ~9-fold higher than those with the lowest SDI scores. By estimating the damage trajectory and incorporating annual costs, data on damage can be used to estimate future costs, which is critical knowledge for evaluating the cost-effectiveness of novel therapies.
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| 4. |
- Battista, Simone, et al.
(författare)
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Factors Associated with Adherence To a Supervised Exercise Intervention for Osteoarthritis : Data From the Swedish Osteoarthritis Registry
- 2023
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Ingår i: Arthritis Care and Research. - : WILEY. - 2151-4658 .- 2151-464X.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore how lifestyle and demographic, socioeconomic and disease-related factors are associated with supervised exercise adherence in an osteoarthritis (OA) management programme and their ability to explain exercise adherence.METHODS: A cohort register-based study on participants from the 'Swedish Osteoarthritis Registry' who attended the exercise part of a nationwide Swedish OA management programme. We ran a multinomial logistic regression to determine the association of exercise adherence with the abovementioned factors. We calculated their ability to explain exercise adherence with the McFadden R2 .RESULTS: Our sample comprises 19,750 (73% female sex; age: 67 (SD: 8.94)) participants. Among them, 5,862 (30%) reached a low level of adherence, 3,947 (20%) a medium level and 9,941 (50%) a high level. After a listwise deletion, the analysis was run on n=16,685 (85%), with low levels of adherence as the reference category. Some factors were positively associated with high levels of adherence, such as older age (relative risk ratio (RRR) =1.01, 95% CI 1.01-1.02 (per year)), and the 'arthritis-specific self-efficacy' (1.04, 95% CI 1.02-1.07 (per 10-point increase)). Others were negatively associated with high levels of adherence, such as 'female' sex (0.82, 95% CI [0.75-0.89]), having a 'medium' (0.89, 95% CI [0.81; 0.98] or a 'high' level of education (0.84, 95% CI [0.76-0.94]). Nevertheless, the investigating factors could explain 1% of the variability in exercise adherence (R2 = 0.012).CONCLUSION: Despite the associations reported above, the low-explained variability suggests that strategies based on lifestyle and demographic, socioeconomic and disease-related factors are unlikely to improve exercise adherence significantly.
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| 5. |
- Bilberg, Annelie, 1965, et al.
(författare)
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Supervised Intensive Exercise for Strengthening Exercise Health Beliefs in Patients With Axial Spondyloarthritis: A Multicenter Randomized Controlled Trial
- 2022
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Ingår i: Arthritis Care & Research. - : Wiley. - 2151-464X .- 2151-4658. ; 74:7, s. 1196-1204
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the effect of a 3-month supervised high-intensity exercise program on exercise health beliefs in patients with axial spondyloarthritis. Methods This was secondary analysis of a randomized controlled trial. Participants (ages 23-69 years) were randomized to an exercise group (n = 50) or a control group (n = 50). The intervention was an individually guided cardiorespiratory and strength exercise program performed 2 times per week, plus an additional individual exercise session of personal choice. The control group received standard care and instructions to maintain their physical activity level. Exercise health beliefs using the Exercise Health Beliefs questionnaire (range 20-100, 100 = best), i.e., barriers, benefits, self-efficacy and exercise impact on arthritis, and physical activity, were assessed with self-reported questionnaires at baseline, 3 months, and 12 months after inclusion. Results The majority of the participants in the exercise group (76%) followed >= 80% of the prescribed exercise protocol. There was a significant effect of the intervention on exercise health beliefs at 3 months (estimated mean group differences 4.0 [95% confidence interval (95% CI) 1.4, 6.6]; P = 0.003) and the effect persisted at 12 months follow-up (estimated mean group differences 3.8 [95% CI 1.0, 6.6]; P = 0.008). Participants with higher exercise health beliefs had a higher odds ratio (1.1 [95% CI 1.0, 1.20]; P = 0.003) for being physically active at 12 months follow-up. Conclusion A supervised high-intensity exercise program had beneficial short- and long-term effects on participants' exercise health beliefs. Stronger exercise health beliefs were positively associated with a higher chance to be physically active on a health-enhancing level at 12 months follow-up.
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| 6. |
- Björk, Mathilda, et al.
(författare)
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Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-reported Function : A Systematic Review and Meta-analysis
- 2022
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 74:1, s. 31-43
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: Although physical activity (PA) is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), PA's effect on self-reported function and Quality of Life (QoL) has not been analyzed. This study synthesizes the evidence for the effectiveness of PA on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA).METHODS: The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using RoB 2.0 tool), and data extraction were independently performed by two or more of the authors. The meta-analyses were conducted with a random-effects model.RESULTS: The systematic review included 55 RCTs and the meta-analysis included 37 RCTs. In 55 studies included, 76% investigated RA, 20% investigated SpA, and 4% investigated PsA. In RA effects were found on QoL and function compared to inactive controls, effects not sustained in comparison to active controls. In SpA the effects of PA on QoL were in favor of the control group. Effects on function were found compared to inactive controls and sustained in fatigue and pain when compared to active controls. In PsA no effects on QoL were found but on function compared to inactive controls. The effect size was below 0.30 in the majority of the comparisons.CONCLUSION: PA may improve QoL and self-reported function in RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.
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| 7. |
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| 8. |
- Clarke, Ann E., et al.
(författare)
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Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling
- 2023
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 75:9, s. 1859-1870
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. Methods: NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. Results: A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Conclusion: Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.
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| 9. |
- Coates, Laura C., et al.
(författare)
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The Phenotype of Axial Spondyloarthritis : Is It Dependent on HLA-B27 Status?
- 2021
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 73:6, s. 856-860
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe the radiographic phenotype of axial spondyloarthritis (SpA) according to the presence of HLA-B27. Methods. An international collaboration compared the radiographic phenotype of axial SpA according to HLA-B27 status. Patients with ankylosing spondylitis (AS) and axial psoriatic arthritis (PsA) were collected. Radiographs were read centrally, blinded to clinical details. The symmetry of the sacroiliac joints and lumbar syndesmophytes and the morphology of syndesmophytes (typical marginal versus atypical chunky), together with the modified Stoke Ankylosing Spondylitis Spine Score and the Psoriatic Arthritis Spondylitis Radiographic Index, were recorded. Results. A total of 244 patients with PsA and 198 patients with AS were included. In PsA, 60 patients (25%) were HLA-B27 positive while in AS, 148 patients (75%) were HLA-B27 positive. Patients with HLA-B27 were younger and more often male and had a longer duration of disease. In multivariable logistic regression, HLA-B27 was significantly associated with syndesmophyte symmetry (odds ratio [OR] 3.02 [95% confidence interval (95% CI) 1.38, 6.61]) and marginal syndesmophytes (OR 1.97 [95% CI 1.16, 3.36]) but not with sacroiliac symmetry. Mean radiographic scores were higher for patients with HLA-B27. Conclusion. Patients with axial SpA who are positive for HLA-B27 have more severe radiographic damage, more marginal syndesmophytes, and more frequent syndesmophyte symmetry compared to patients who are negative for HLA-B27.
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| 10. |
- Dell'Isola, Andrea, et al.
(författare)
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Education, Home Exercise, and Supervised Exercise for People With Hip and Knee Osteoarthritis As Part of a Nationwide Implementation Program : Data From the Better Management of Patients With Osteoarthritis Registry
- 2020
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 72:2, s. 201-207
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the effectiveness of education (ED) plus home exercise (HE) and ED plus supervised exercise (SE) according to information provided by the Better Management of Patients With Osteoarthritis (BOA) Registry, a nationally implemented rehabilitation program for patients with hip and knee osteoarthritis (OA). In addition, we investigated whether or not the effect of the treatments differed based on the joint affected by OA (hip versus knee). Methods: We included 38,030 participants from the BOA Registry with knee or hip OA who were treated with either ED, HE, or SE. The effect of the 3 treatment options on the pain intensity reduction (range 0–10) immediately postintervention and at 12 months was estimated using a mixed-effects model adjusted for age, sex, body mass index, affected joint (hip or knee), pain at baseline, comorbidity, and level of education. Results: The participants undergoing HE or SE experienced a greater pain reduction compared to participants who received ED, both after the treatment (group mean change for ED –0.91 [95% confidence interval (95% CI) –1.15, –0.68], for HE –1.06 [95% CI –1.10, –1.01], and for SE –1.12 [95% CI –1.15, –1.08]) and at 12 months (group mean change for ED –0.58 [95% CI –0.87, –0.30], for HE –0.82 [95% CI –0.87, –0.76], and for SE –0.82 [95% CI –0.86, –0.77]). Patients with knee OA who underwent HE or SE improved more compared to patients with hip OA at both follow-ups. Conclusion: In primary care, HE and SE lead to similar reductions in pain intensity but are more effective than ED alone. In addition, people with knee OA benefit more from HE and SE than people with hip OA.
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| 11. |
- Dell'Isola, Andrea, et al.
(författare)
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Risk of Comorbidities Following Physician-Diagnosed Knee or Hip Osteoarthritis : A Register-Based Cohort Study
- 2022
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 74:10, s. 1689-1695
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To estimate the risk of developing comorbidities in patients after physician-diagnosed knee or hip osteoarthritis (OA). Methods: This was a cohort study using Swedish longitudinal health care register data; we studied residents in the Skåne region age ≥35 years on January 1, 2010 who were free from diagnosed hip or knee OA (n = 548,681). We then identified subjects with at least 1 new diagnosis of knee or hip OA (incident OA) between 2010 and 2017 (n = 50,942 considered exposed). Subjects without diagnosed OA were considered unexposed. From January 2010 both unexposed and exposed subjects were observed for the occurrence of 18 different predefined comorbidities until either relocation outside of the region, death, occurrence of the comorbidity, or December 2017, whichever came first. We calculated unadjusted hazard ratios (HRs) and adjusted HRs of comorbidities using Cox models with knee and hip OA as time-varying exposures. Results: Subjects with incident knee or hip OA had 7% to 60% higher adjusted HRs (range 1.07–1.60) of depression, cardiovascular diseases, back pain, and osteoporosis than individuals without an OA diagnosis. An increased risk of diabetes mellitus was found only for knee OA (adjusted HR 1.19 [95% confidence interval 1.13–1.26]). For the rest of the diagnoses, we found either no increased risk or estimates with wide confidence intervals, excluding clear interpretations of the direction or size of effects. Conclusion: Incident physician-diagnosed knee and hip OA is associated with an increased risk of depression, cardiovascular diseases, back pain, osteoporosis, and diabetes mellitus. However, the latter was only found for knee OA.
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| 12. |
- Dell'Isola, Andrea, et al.
(författare)
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Road to Total Knee Replacement: Utilization of Knee Surgeries Up to Ten Years Before Total Knee Replacement in England and Sweden
- 2023
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 75:5, s. 1104-1112
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the prevalence and timing of knee surgery (including meniscal, ligamentous, synovial, and osteotomy) in the 10 years prior to primary total knee replacement (TKR) between England and Sweden.METHODS: This was a population-based, case-control study within England and southern Sweden using electronic health care databases. Patients underwent primary TKR between 2015 and 2019. Risk-set sampling showed that general population controls matched 1:1 by age, sex, and practice/municipality. The annual prevalence and prevalence ratio of having at least 1 recorded surgery in each of the 10 years preceding TKR was estimated using Poisson regressions.RESULTS: We included 6,308 and 47,010 TKR cases in Sweden and England, respectively. Meniscal surgeries were the most frequent procedure prior to TKR in both countries; prevalence was higher in England across all time points. The prevalence of meniscal surgery increased in both countries in the years approaching TKR, reaching 33.2 (95% confidence interval [95% CI] 31.6-34.9) per 1,000 persons in England, and 9.83 (95% CI 7.66-12.61) in Sweden. In England, we observed a decrease from 2014 to 2018 in the utilization of this procedure in the 4 years preceding a TKR. The prevalence of all analyzed surgeries was consistently lower in controls.CONCLUSION: There are comparable trends in the use of knee surgery in the years preceding TKR across England and Sweden. Of note, meniscal surgeries remain common, even within the year prior to TKR, highlighting that these patients may experience low-value care. Careful consideration of knee surgery in those with late-stage disease is required.
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| 13. |
- Dell’Isola, Andrea, et al.
(författare)
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Willingness to Undergo Joint Surgery Following a First-Line Intervention for Osteoarthritis : Data From the Better Management of People With Osteoarthritis Register
- 2021
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 73:6, s. 818-827
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: to assess the proportion of participants reconsidering their willingness to undergo surgery after three and 12 months. Secondary aims are to analyse and compare the characteristics of people willing and unwilling to undergo joint surgery for osteoarthritis (OA) before a first-line intervention; to study the association between pain intensity, walking difficulties, self-efficacy and fear of movement with the willingness to undergo surgery.DESIGN: This is an observational study based on Swedish register data. We included 30,578 people with knee or hip OA who participated in a first-line intervention including education and exercise.RESULTS: People willing to undergo surgery at baseline showed a higher proportion of men (40% vs 27%) and more severe symptoms and disability. Respectively, 45% and 30% of the people with knee and hip OA who were willing to undergo surgery at baseline became unwilling after the intervention. At the end of the study period (12 months), 35% and 19% of those with knee and hip OA, respectively, who were willing to undergo surgery at baseline became unwilling. High pain intensity, walking difficulties, and fear of movement were associated with higher odds of being willing to undergo surgery at both follow-ups while increased self-efficacy showed the opposite association.CONCLUSIONS: A first-line intervention for OA is associated with reduced willingness to undergo surgery with a greater proportion among knee OA than hip OA people. Due to its temporal variability, willingness to undergo surgery should be used with care to deem surgery eligibility.
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| 14. |
- Dell'Isola, Andrea, et al.
(författare)
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Willingness to undergo joint surgery following a first-line intervention for osteoarthritis: data from the BOA register.
- 2021
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Ingår i: Arthritis care & research. - : Wiley. - 2151-4658 .- 2151-464X. ; 73:6, s. 818-827
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Tidskriftsartikel (refereegranskat)abstract
- to assess the proportion of participants reconsidering their willingness to undergo surgery after three and 12 months. Secondary aims are to analyse and compare the characteristics of people willing and unwilling to undergo joint surgery for osteoarthritis (OA) before a first-line intervention; to study the association between pain intensity, walking difficulties, self-efficacy and fear of movement with the willingness to undergo surgery.This is an observational study based on Swedish register data. We included 30,578 people with knee or hip OA who participated in a first-line intervention including education and exercise.People willing to undergo surgery at baseline showed a higher proportion of men (40% vs 27%) and more severe symptoms and disability. Respectively, 45% and 30% of the people with knee and hip OA who were willing to undergo surgery at baseline became unwilling after the intervention. At the end of the study period (12 months), 35% and 19% of those with knee and hip OA, respectively, who were willing to undergo surgery at baseline became unwilling. High pain intensity, walking difficulties, and fear of movement were associated with higher odds of being willing to undergo surgery at both follow-ups while increased self-efficacy showed the opposite association.A first-line intervention for OA is associated with reduced willingness to undergo surgery with a greater proportion among knee OA than hip OA people. Due to its temporal variability, willingness to undergo surgery should be used with care to deem surgery eligibility.
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| 15. |
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| 16. |
- Drivelegka, Panagiota, et al.
(författare)
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Incident gout and risk of first-time acute coronary syndrome: a prospective, population-based, cohort study in Sweden
- 2023
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 75:6, s. 1292-1299
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the risk of first-time acute coronary syndrome (ACS) in a large cohort of primary and secondary care patients with incident gout, compared to the general population. Methods: Using register data for the period 2007 ̶ 2017, we conducted a prospective, population-based cohort with 20,146 patients with incident gout (mean age, 65.6 years; 67.4% males) and 83,517 matched population controls, without prior history of coronary heart disease. We calculated incidence rates (IR) and hazard ratios (HR) adjusted for baseline comorbidities and dispensed prescriptions. In a sensitivity analysis, we included gout cases and controls with no previously diagnosed comorbidity (6,075 cases and 44,091 controls). Results: The IR of first-time ACS was significantly increased in the gout cohort, compared to controls (9.1 vs 6.3/1,000 person-years). Unadjusted cox regression showed that gout patients had higher risk of first-time ACS compared to controls (HR, 1.44; 95%CI, 1.33-1.56), with higher HR in women (HR, 1.64; 95%CI, 1.41 ̶ 1.90) than in men (HR, 1.36; 95%CI, 1.24 ̶ 1.50). In multivariable analysis the risk diminished but remained significant (HR, 1.15; 95%CI, 1.06-1.25). The risk was similar in the sensitivity analysis (HR, 1.20; 95%CI, 1.01-1.44), and still higher in women (HR, 1.34; 95%CI, 0.86-2.08), than in men (HR, 1.18; 95%CI, 0.97-1.44). Conclusion: Patients with incident gout have a 44% increased risk of first-time ACS, higher in women than in men. This risk is largely explained by the underlying comorbidities, but there is still a modestly increased risk that may be due to gout-related factors.
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| 17. |
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| 18. |
- Foeldvari, Ivan, et al.
(författare)
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Differences Sustained Between Diffuse and Limited Forms of Juvenile Systemic Sclerosis in an Expanded International Cohort
- 2022
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 74:10, s. 1575-1584
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the baseline clinical characteristics of juvenile systemic sclerosis (SSc) patients in the international juvenile SSc inception cohort, and to compare these characteristics between the classically defined juvenile diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) subtypes and among those with overlap features. Methods A cross-sectional study was performed using baseline visit data. Information on demographic characteristics, organ system evaluation, treatment, and patient- and physician-reported outcomes was extracted and summary statistics applied. Comparisons between juvenile dcSSc and lcSSc subtypes and patients with and without overlap features were performed using chi-square and Mann-Whitney U tests. Results At data extraction, 150 juvenile SSc patients were enrolled across 42 centers; 83% were White, 80% were female, juvenile dcSSc predominated (72%), and 17% of the cohort had overlap features. Significant differences were found between juvenile dcSSc and juvenile lcSSc regarding modified Rodnan skin thickness score, the presence of Gottron's papules, digital tip ulceration, results of the 6-minute walk test, and composite pulmonary and cardiac involvement. All of these were more frequent in dcSSc except for cardiac involvement. Juvenile dcSSc patients had significantly worse scores for physician-rated disease activity and damage. A significantly higher occurrence of Gottron's papules and musculoskeletal and composite pulmonary involvement, and a significantly lower frequency of Raynaud's phenomenon, were seen in those with overlap features. Conclusion Results from a large international juvenile SSc cohort demonstrate significant differences between juvenile dcSSc and juvenile lcSSc patients, including more globally severe disease and increased frequency of interstitial lung disease in juvenile dcSSc patients, while those with lcSSc have more frequent cardiac involvement. Those with overlap features had an unexpected higher frequency of interstitial lung disease.
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| 19. |
- Foeldvari, Ivan, et al.
(författare)
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Underdetection of Interstitial Lung Disease in Juvenile Systemic Sclerosis
- 2022
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 74:3, s. 364-370
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Utilizing data obtained from a prospective, international, juvenile systemic sclerosis (SSc) cohort, the present study was undertaken to determine if pulmonary screening with forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) is sufficient to assess the presence of interstitial lung disease (ILD) in comparison to high-resolution computed tomography (HRCT) in juvenile SSc. Methods. The juvenile SSc cohort database was queried for patients enrolled from January 2008 to January 2020 with recorded pulmonary function tests (PFTs) parameters and HRCT to determine the discriminatory properties of P FT parameters, FVC, and DLco in detecting ILD. Results. Eighty-six juvenile SSc patients had both computed tomography imaging and FVC values for direct comparison. Using findings on HRCT as the standard measure of ILD presence, the sensitivity of FVC in detecting ILD in juvenile SSc was only 40%, the specificity was 77%, and area under the curve (AUC) was 0.58. Fifty-eight juvenile SSc patients had both CT imaging and DLco values for comparison. The sensitivity of DLco in detecting ILD was 76%, the specificity was 70%, and AUC was 0.73. Conclusion. The performance of PFTs in juvenile SSc to detect underlying ILD was quite limited. Specifically, the FVC, which is one of the main clinical parameters in adult SSc to detect and monitor ILD, would miss -60% of children who had ILD changes on their accompanying HRCT. The DLco was more sensitive in detecting potential abnormalities on HRCT, but with less specificity than the FVC. These results support the use of HRCT in tandem with PFTs for the screening of ILD in juvenile SSc.
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| 20. |
- Glerup, Mia, et al.
(författare)
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Changing patterns in treatment, remission status and categories in a long-term Nordic cohort study of juvenile idiopathic arthritis.
- 2022
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Ingår i: Arthritis care & research. - : Wiley. - 2151-4658 .- 2151-464X.
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Tidskriftsartikel (refereegranskat)abstract
- To explore sustainability of achieved remission off medication and defined ILAR categories in juvenile idiopathic arthritis (JIA). To describe the trajectory of disease course over time by comparing treatment, disease activity and ILAR categories from baseline, 8 and 18years of disease.Included were 373 of the 510 initially recruited consecutive cases of JIA from the prospective longitudinal, population-based Nordic JIA cohort with disease onset during 1997-2000 from Denmark, Norway, Sweden, and Finland in an 18-year follow-up study. Clinical data was collected consecutively at baseline, 8 and 18years of disease, and evaluated regarding treatment, disease activity and ILAR category.Significantly more patients (70%) were off medication after 18years of follow-up compared to after 8years (59.7%); nevertheless, the number of patients in remission had not increased (52% versus 51%). Twelve percent of patients changed ILAR category between 8 and 18years after disease onset. Almost half of the changes were due to updated information about heredity in a first degree relative. In the same period, the psoriatic group increased significantly in number (p<0.001) contrasting the oligoarticular category, which decreased (p=0.02). The undifferentiated group increased 24% from 8 to 18years, however, this was not significant (p=0.06).In this Nordic JIA cohort study the remission rate did not increase even though significantly more patients were off medication at the 18-year follow-up compared to 8years after disease onset. The distribution of patients in the ILAR categories continued to change significantly throughout the 18-year study period.
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| 21. |
- Glerup, Mia, et al.
(författare)
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Long-Term Outcomes in Juvenile Idiopathic Arthritis : Eighteen Years of Follow-Up in the Population-Based Nordic Juvenile Idiopathic Arthritis Cohort
- 2020
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Ingår i: Arthritis care & research. - : WILEY. - 2151-464X .- 2151-4658. ; 72:4, s. 507-516
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The present study was undertaken to assess the long-term course, remission rate, and disease burden in juvenile idiopathic arthritis (JIA) 18 years after disease onset in a population-based setting from the early biologic era.Methods: A total of 510 consecutive cases of JIA with disease onset between 1997 and 2000 from defined geographic regions in Denmark, Norway, Sweden, and Finland were prospectively included in this 18-year cohort study. At the follow-up visit, patient-reported demographic and clinical data were collected.Results: The study included 434 (85%) of the 510 eligible JIA participants. The mean +/- SD age was 24.0 +/- 4.4 years. The median juvenile arthritis disease activity score in 71 joints (JADAS-71) was 1.5 (interquartile range [IQR] 0-5), with the enthesitis-related arthritis (ERA) category of JIA having the highest median score (4.5 [IQR 1.5-8.5], P = 0.003). In this cohort, 46% of patients still had active disease, and 66 (15%) were treated with synthetic disease-modifying antirheumatic drugs and 84 (19%) with biologics. Inactive disease indicated by a JADAS-71 score of <1 was seen in 48% of participants. Clinical remission off medication (CR) was documented in 33% of the participants with high variability among the JIA categories. CR was most often seen in persistent oligoarticular and systemic arthritis and least often in ERA (P < 0.001).Conclusion: A substantial proportion of the JIA cohort did not achieve CR despite new treatment options during the study period. The ERA category showed the worst outcomes, and in general there is still a high burden of disease in adulthood for JIA.
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| 22. |
- Glerup, Mia, et al.
(författare)
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Long-term outcomes in juvenile idiopathic arthritis: 18 years of follow-up in the population-based Nordic Juvenile Idiopathic Arthritis (JIA) cohort.
- 2020
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Ingår i: Arthritis care & research. - : Wiley. - 2151-4658 .- 2151-464X. ; 72:4, s. 507-516
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Tidskriftsartikel (refereegranskat)abstract
- This study assessed the long-term course, remission rate and disease burden in juvenile idiopathic arthritis (JIA) 18 years after disease onset in a population-based setting from the early biologic era.A total of 510 consecutive cases of JIA with disease onset between 1997 and 2000 from defined geographic regions in Denmark, Norway, Sweden and Finland were prospectively included in this 18-year cohort study. At the follow-up visit, patient-reported, demographic and clinical data were collected.The study included 434 (85%) of the 510 eligible JIA participants. The mean age ± SD was 24.0 ± 4.4 years. The median juvenile arthritis disease activity (JADAS71) score was 1.5 (IQR 0-5), with the ERA category of JIA having the highest median score, 4.5 (IQR 1.5-8.5) (P=0.003). In this cohort, 46% still had active disease, and 66 (15%) were treated with synthetic disease-modifying anti-rheumatic drugs and 84 (19%) with biologics. Inactive disease indicated by JADAS71 <1 was seen in 48% of participants. Clinical remission off medication (CR) was documented in 33% of the participants with high variability among the JIA categories. CR was most often seen in persistent oligoarticular and systemic arthritis and least often in ERA (P<0.001).A high prevalence of the JIA cohort did not achieve CR despite new treatment options during the study period. The ERA category showed the worst outcomes and, in general, there is still a high burden of disease in adulthood for JIA. This article is protected by copyright. All rights reserved.
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| 23. |
- Glintborg, B., et al.
(författare)
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One-Year Treatment Outcomes of Secukinumab Versus Tumor Necrosis Factor Inhibitors in Spondyloarthritis: Results From Five Nordic Biologic Registries Including More Than 10,000 Treatment Courses
- 2022
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Ingår i: Arthritis Care & Research. - : Wiley. - 2151-464X .- 2151-4658. ; 74:5, s. 748-758
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe baseline characteristics and to compare treatment effectiveness of secukinumab versus tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA) using adalimumab as the main comparator. Methods This was an observational, prospective cohort study. Patients with SpA (clinical ankylosing spondylitis, nonradiographic axial SpA, or undifferentiated SpA) starting secukinumab or a TNFi during 2015-2018 were identified from 5 Nordic clinical rheumatology registries. Data on comorbidities and extraarticular manifestations (psoriasis, uveitis, and inflammatory bowel disease) were captured from national registries (data available in 94% of patients) and included in multivariable analyses. We assessed 1-year treatment retention (crude survival curves, adjusted hazard ratios [HRadj] for treatment discontinuation) and 6-month response rates (Ankylosing Spondylitis Disease Activity Score [ASDAS] score <2.1, Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] <40 mm, crude/LUNDEX-adjusted, adjusted logistic regression analyses with odds ratios [ORs]) stratified by line of biologic treatment (first, second, and third plus). Results In total, 10,853 treatment courses (842 secukinumab and 10,011 TNFi, of which 1,977 were adalimumab) were included. The proportions of patients treated with secukinumab during the first, second, and third-plus lines of treatment were 1%, 6%, and 22%, respectively). Extraarticular manifestations varied across treatments, while other baseline characteristics were largely similar. Secukinumab had a 1-year retention comparable to adalimumab as a first or second line of treatment but poorer as a third-plus line of therapy (secukinumab 56% [95% confidence interval (95% CI) 51-61%] versus adalimumab 70% [95% CI 64-75%]; HRadj 1.43 [95% CI 1.12-1.81]). Across treatment lines, secukinumab had poorer estimates for 6-month response rates than adalimumab, statistically significantly only for the third-plus line (adjusted analyses: ASDAS score <2.1 OR 0.56 [95% CI 0.35-0.90]; BASDAI <40 mm OR 0.62 [95% CI 0.41-0.95]). Treatment outcomes varied across the 5 TNFi. Conclusion Secukinumab was mainly used in biologics-experienced patients with SpA. Secukinumab and adalimumab performed similarly in patients who had failed a first biologic, although with increasing prior biologic exposure, adalimumab was superior.
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| 24. |
- Golightly, Yvonne M., et al.
(författare)
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Association of Traumatic Knee Injury With Radiographic Evidence of Knee Osteoarthritis in Military Officers
- 2023
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 75:8, s. 1744-1751
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The association between knee injury and knee osteoarthritis (OA) is understudied relative to its importance, particularly in younger populations. This study was undertaken to examine the association of knee injury with radiographic features of knee OA in military officers, who have a physically demanding profession and high rates of knee injury. Methods: Participants were recruited in 2015–2017 from an existing program that enrolled 6,452 military officers during 2004–2009. Officers with a history of knee ligament or meniscal injuries (n = 117 via medical record review) were compared to officers with no history of knee injury (n = 143). Bilateral posteroanterior knee radiographs were obtained using a standardized fixed-flexion positioning frame. All images were read for Kellgren/Lawrence (K/L) grade, osteophyte (OST), and joint space narrowing (JSN) scores. Data were analyzed using linear-risk regression models with generalized estimating equations. Results: Injured and noninjured participants were similar (mean age 28 years, mean body mass index 25 kg/m2, ~40% female). The mean time from first knee injury to imaging among injured participants was 9.2 years. Compared with noninjured knees, greater prevalence of radiographic OA (K/L grade ≥ 2), OST (grade ≥ 1), and JSN (grade ≥ 1) was observed among injured knees, with prevalence differences of +16% (95% confidence interval [95% CI] 10%, 22%), +29% (95% CI 20%, 38%), and + 17% (95% CI 10%, 24%), respectively. Approximately 1 in 6 officers with prior knee injury progressed to radiographic OA by age 30 years. Conclusion: At the midpoint of a projected 20-year military career, officers with a history of traumatic knee injury have a markedly increased prevalence of knee radiographic OA compared to officers without injury.
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| 25. |
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