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- Hallert, Eva, et al.
(författare)
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Disease activity and disability in women and men with early rheumatoid arthritis : An 8-year follow-up of the Swedish TIRA project
- 2012
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Ingår i: Arthritis Care and Research. - : John Wiley & Sons. - 0893-7524 .- 1529-0123 .- 2151-464X. ; 64:8, s. 1101-1107
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare women and men regarding course of disease activity and disability over 8 years from diagnosis of recent onset rheumatoid arthritis (RA). PATIENTS AND METHODS: 149 patients were followed for 8 years from RA diagnosis (1996-98) regarding 28-joint count disease activity score (DAS28), pain (visual analogue scale, VAS), grip force, Grip Ability Test (GAT), Signals of Functional Impairment (SOFI hand, upper/lower extremity), walking speed, activity limitation (Health Assessment Questionnaire, HAQ) and prescribed disease-modifying anti-rheumatic drugs (DMARDs). RESULTS: Disease activity pattern over time was similar in women and men, showing improvement during the first year and thereafter a stable situation during 6 years. However, at the 7- and 8-year follow-ups deterioration was seen with a less favourable course in women. HAQ did not differ between sexes at diagnosis, but at all follow-ups women had significantly higher scores than men. Women also had lower grip force and lower walking speed, but higher upper extremity mobility. DMARD prescription was similar for both sexes. Over eight years, disease duration, sex, biologics, grip force, SOFI-hand and pain intensity together explained 43% of the variation in DAS, while grip force, SOFI-lower, GAT and pain intensity could together explain 55% of variations in HAQ. CONCLUSIONS: Disease activity was fairly well managed, but disability gradually deteriorated. Despite similar medication, women had more disability than men. The discrepancy between disease activity and disability indicates unmet needs for multi-professional interventions to prevent progressing disability and patients at risk for disability need to be identified early in the process. © 2012 by the American College of Rheumatology.
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| 2. |
- Thyberg, Ingrid, et al.
(författare)
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Potential of the HAQ score as clinical indicator suggesting comprehensive multidisciplinary assessments : the Swedish TIRA cohort 8 years after diagnosis of RA
- 2012
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Ingår i: Clinical Rheumatology. - : Springer Science and Business Media LLC. - 0770-3198 .- 1434-9949. ; 31:5, s. 775-783
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Tidskriftsartikel (refereegranskat)abstract
- This study explores the potential of the health assessment questionnaire (HAQ) score as a clinical indicator that can be used to suggest comprehensive multidisciplinary assessments, by relating it to more general aspects of disability. In a cohort of 132 patients with early RA (mean age 55, 68% women), 28 joint count Disease Activity Scores (DAS-28), HAQ, and Short Form 36 (SF-36) scores were registered at annual follow-up visits 8 years after diagnosis. The patients were tentatively sub-grouped into a high-HAQ group (HAQ ≥1 at the 8-year follow-up) and a low-HAQ group. The high-HAQ group, comprising 36% of the cohort, had a higher mean HAQ score at inclusion and beyond at all visits compared to the low-HAQ group, and 24% of all individual patients in the high-HAQ group had a HAQ score ≥1 at inclusion. Although the DAS-28 improved in both groups, patients in the high-HAQ group also had significantly more persistent disability according to the SF-36: five scales at each follow-up visit and all eight scales at the majority of the visits. Individual RA patients with HAQ ≥1 probably have considerable persistent disabilities according to the SF-36. The HAQ score could be used as a clinical indicator suggesting comprehensive multidisciplinary assessments of the components of disability and corresponding interventions, in addition to the established use of HAQ at group levels and in parallel with the medication strategy based on DAS-28.
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| 3. |
- Bertilsson, L, et al.
(författare)
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A 5-year prospective population-based study of juvenile chronic arthritis: onset, disease process, and outcome.
- 2012
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Ingår i: Scandinavian journal of rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 41:5, s. 379-82
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate, in a population-based cohort of patients with juvenile chronic arthritis (JCA), onset characteristics, progression, outcome, and prognostic factors longitudinally for 5 years. Methods: This cohort consisted of 132 incidence cases identified between 1984 and 1986 in southwestern Sweden followed for 5 years with annual reports of subgroup, joint assessment, disease activity, eye examinations, laboratory measurements, and medication. At the 5-year follow-up, the Childhood Health Assessment Questionnaire (Child-HAQ) was evaluated. European League Against Rheumatism (EULAR) criteria for diagnosis and disease activity were used. Results: During the 5 years only four patients were lost to follow-up, 34% changed subgroup and 8% developed uveitis. At the 5-year follow-up the disease was active in 12% of the patients, stable in 28%, inactive in 25%, and in remission in 34%. Among those examined, 24% had radiological changes, of whom half had advanced changes. The Child-HAQ median score at the 5-year follow-up was 0.13 (range 0.0-1.9). The number of involved joints at inclusion correlated positively with active disease at the 5-year follow-up. Age at disease onset, the number of involved joints, and the number of joints with arthritis correlated positively with continuous disease and Child-HAQ score. Conclusion. Our study shows a diverse disease course during the first 5 years of JCA where one-third changed subgroup and two-thirds did not reach remission. Age of disease onset, the number of involved joints, and the number of joints with arthritis at inclusion were associated with poor outcome at the 5-year follow-up.
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| 4. |
- Sandqvist, Gunnel, et al.
(författare)
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Managing work life with systemic sclerosis
- 2012
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Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 51:2, s. 319-323
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To explore how individuals with systemic sclerosis (SSc) manage their work life. Methods. We conducted four focus group interviews which included 17 patients. The interviews were tape recorded and transcribed verbatim. The transcribed texts were analysed according to thematic content analysis. Relevant statements, that generated preliminary categories, were identified after which, themes and underlying sub-themes were generated. Results. Four themes emerged: adaptation, strategy, communication and attitude. Flexible working hours, workplace and work assignments corresponding to the individuals’ recourses, were the most important adaptation requirements for SSc patients. Reluctance to disclose their illness was the most prominent reason for not requesting adaptations. Strategies to facilitate working at home, such as receiving assistance with household chores as well as buying in cleaning services were easy to realize and saved energy for meaningful activities. The participants tried to prioritize meaningful activities rather than spending energy on unnecessary activities both at work and outside of work. Fatigue influenced activities at work but mostly outside of work and to manage their working life the participants were dependent of having time for recovery, above all rest.Conclusion. The ability to develop adaptations and strategies, to a great extent, depends on the individual’s understanding and acceptance of their disease, awareness and respect for their own needs for meaningful activities and an ability to communicate this at work and outside of work. As health professionals we should enhance the confidence of persons with SSc to strengthen their ability to bring about the necessary dialogue.
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