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| 2. |
- Andersson, Maria L.E. 1968-, et al.
(author)
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Associations Between Chronic Widespread Pain, Pressure Pain Thresholds and Leptin in Individuals with Knee Pain
- 2022
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Conference paper (other academic/artistic)abstract
- Previous studies have reported associations between obesity, chronic pain and increased pain sensitivity. The adipokine leptin has been suggested to be involved in the osteoarthritis process as well as in pain sensitisation.ObjectivesThe aim was to study associations between chronic widespread pain, pain sensitivity and leptin in individuals with knee pain.MethodsIn all, 306 individuals with knee pain were included in the Halland osteoarthritis cohort, ClinicalTrials.gov NCT04928170. Of those, 265 were included in this cross-sectional baseline study. The mean age (sd) was 51.6 (8.8) years, and 71% was women. The participants marked their painful areas on a pain figure with 18 predefined areas. They were categorised in three different pain groups according to the modified WP2019 definition (1), with knees excluded (due to highest goodness of fit): Chronic widespread pain (CWP), chronic regional pain (ChRP) if CWP was not met, and no chronic pain (NCP). The group with CWP were compared with those reporting no CWP (ChRP and NCP). The pressure pain thresholds (PPT) were measured using a computerised pressure algometry (AlgoMed, Medoc) on eight predefined tender points (trapezius (bilateral), right second rib, right lateral epicondyle, knees, gluteal (bilateral)) (2). Increased pain sensitivity was defined as having PPT in the lowest third in all tender points. Obesity was measured via waistline measurement and a bioimpedance (InBody 770) measuring BMI and visceral fat area (VFA). Serum-Leptin were analysed with an ELISA method (Alpco). Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to describe the groups.ResultsIn this baseline study, 16% reported CWP, and 15% had low pain pressure thresholds at baseline in the study. Those fulfilling CWP were more often women, had higher BMI, VFA, and increased leptin levels and worse KOOS in four of five subscores, see Table 1A. The age and gender-adjusted leptin levels were 21.6 ng/ml (95% CI 18.2-25.0) in the group with no CWP vs. 35.5 ng/ml (95% CI 27.6-43.4) in the CWP group, p=0.002. In a logistic regression adjusting for age and gender, leptin was associated with reporting CWP OR 1.015 (95% CI 1.004-1.027, p= 0.008).Table 1.A Comparisons between those without CWP and those fulfilling CWP and table 1B comparisons between those not having low PPT and those with low PPT.ABNo CWPMean (sd)CWPMean (sd)p-valueNot Low PPTMean (sd)Low PPTMean (sd)p-valuen2104022639Age51.8 (8.7)52.8 (7.6)0.46552.1 (8.5)48.8 (9.9)0.030Gender, female n(%)67900.00472670.524BMI (kg/m2)26.2 (4.6)28.0 (5.0)0.02226.4 (4.9)27.5 (4.3)0.213VFA (cm2)107 (50)137 (56)0.001110 (54)127 (49)0.088Leptin (ng/ml)21.0 (23.9)39.0 (36.6)<0.00123.0 (26.0)31.8 (31.6)0.061CRP (mg/L)1.9 (2.7)2.2 (2.3)0.6022.0 (2.7)1.9 (1.8)0.825KOOSPain (0-100, worst to best)74 (15)61 (17)<0.00173 (15)65 (18)0.002Symptom (0-100, worst to best)72 (17)64 (18)0.01671 (17)67 (19)0.188ADL (0-100, worst to best)84 (13)69 (19)<0.00184 (14)72 (21)<0.001Sport/rec (0-100, worst to best)49 (26)34 (27)0.00149 (26)36 (25)0.009QoL (0-100, worst to best)53 (18)46 (20)0.05053 (18)45 (21)0.017BMI, body mass index; VFA, visceral fat area; CRP, C-reactive protein; KOOS, knee injury and osteoarthritis outcome score; ADL; function in daily living; sport/Rec, Function in sport and recreation; QOL, knee-related Quality of lifeThe participants with low PPT were younger and had a mean (sd) leptin 31.8 ng/ml (31.6) vs 23.0 (26.0), p=0.061 in the group not having low PPT, Table 1B. In a logistic regression adjusting for age and gender, leptin was associated with low PPT OR 1.016 (95% CI 1.004-1.029, p= 0.012).ConclusionThe pathophysiological mechanism causing widespread pain is probably multifactorial, involving both biological and physical factors. The adipokine leptin could be involved in some of these mechanisms, but longitudinal studies are needed to be able to study causal relationships.References[1]Wolfe F, et al. Scand J Pain. 2019;20:77-86.[2]Wolfe F, et al. Arthritis and rheumatism. 1990;33:160-72.Disclosure of InterestsNone declared
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| 3. |
- Sunesson, Evelina, et al.
(author)
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The Impact of the Covid-19 pandemic on Health and Lifestyle in Individuals with Knee Pain : a HALLOA study
- 2022
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Conference paper (peer-reviewed)abstract
- Background: Covid-19 has affected everyday life, health and lifestyle among the general population and vulnerable groups. Individuals with knee pain are recommended an active lifestyle to reveal pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function and a diminishes quality of life. This adds to the importance of exploring how to preserve health and lifestyle among individuals with knee pain during the pandemic.Objectives: The aim of this study was to explore the impact of the covid-19 pandemic on the health and lifestyle in individuals with knee pain.Methods: Nineteen participants with current knee pain, and with no earlier diagnosed radiographic osteoarthritis, and no rheumatologic disorder or cruciate ligament injury, were recruited from The Halland Osteoarthritis (HALLOA) Cohort Study, twelve female and seven males, between 41-62 (median 51) years of age. Data were collected through individual interviews with open-ended questions: “What impact have you experienced with your health and lifestyle during covid-19?”, and “What activities or strategies have you changed to maintain your health and lifestyle during covid-19? ”. Qualitative content analysis was used, where two categories and five sub-categories emerged ( Table 1 ).Results: The result from this study explored how behaviour and attitude towards valuing life have been adjusted to maintain health and lifestyle among individuals with knee pain during covid-19. The category adjusted behaviours emerged with the sub-categories: spending more time at home, becoming digitally, and spending more time outdoors. These sub-categories determine how a more reclusive behaviour have appeared due to the pandemic, where digital platforms and outdoor activities have facilitated companionship and togetherness when feelings of loneliness and isolation were present. The category valuing life emerged with the sub-categories: having a positive outlook of life and sharing responsibility. These sub-categories establish the importance of trying to be grateful for maintaining health and lifestyle and trying to be solution-oriented to find the best possible outcomes to continue with everyday life, despite the pandemic. While having a responsibility towards others arose as a facility to manage to keep social distance during the pandemic.Conclusion: In conclusion, the behaviour was adjusted to continue with everyday life and maintain health and lifestyle among individuals with knee pain during covid-19. Valuing life was also considered important to maintain health and lifestyle as well as supporting others maintain their health and lifestyle. The result may in the future contribute to alternative ways of maintaining health and lifestyle in different vulnerable groups and may be used in situations other than the pandemic.
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| 5. |
- Sylwander, Charlotte, 1992-, et al.
(author)
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Health Promotion in Individuals with Knee Pain – Different Ways to Enable and Maintain a Balance in Everyday Life Based on the Abilities
- 2022
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Conference paper (other academic/artistic)abstract
- Background: Most individuals with knee pain develop radiographic knee osteoarthritis over time [1], and up to 30% develop chronic widespread pain (CWP) [2]. Many studies only focus on physical activity or weight loss when it comes to managing knee osteoarthritis (KOA) and chronic pain. There is a challenge to get more individuals to follow the existing recommendations for KOA, including physical activity and weight loss [3]. However, the interaction between the various physical, mental, and social factors regarding health promotion is complex. More research is needed to understand health-promoting activities applied amongst individuals with knee pain.Objectives: To explore health-promoting activities in individuals with knee pain.Methods: The study was a part of the Halland Osteoarthritis cohort (ClinicalTrials.gov NCT04928170), including 306 individuals with knee pain without earlier diagnosed KOA, cruciate ligament injury or other rheumatological disorder. A purposeful sample of 22 individuals (13 women, 9 men; median age 52 years) participated in the study. Ten had radiographic KOA, 12 had chronic regional pain, 9 reported CWP, 16 were overweight, and 13 met the WHO recommendations for physical activity with moderate intensity. Semi-structured interviews were conducted and followed a pilot-tested interview guide initiated with open-ended questions such as “What do you do to maintain your health?” and “What enables you to keep health?”. The interviewers followed the participants reasoning, and to obtain depth in the data, the participant received follow-up questions such as “Please, can you tell me more about…?”. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed by latent qualitative content analysis and revealed an overall theme including two categories and six sub-categories.Results: Health-promoting activities in individuals with knee pain were interpreted in the overall theme; enabling and maintaining a balance in everyday life based on abilities. Two categories explored the content in health-promoting activities as 1) Using facilitators to take care of the body with the sub-categories: being physically active, having a healthy diet, and using external resources. For example, the participants took care of the body by being physically active to decrease pain, reducing sugar intake and using external resources such as online workouts or help from health care. 2) Managing stressors of everyday life with the sub-categories: promoting vitality, allowing for recovery, and safeguarding healthy relationships. The participants managed stressors of life by, for example, being in nature, planning their work- and private life and spending time with friends and family. See Table 1 Conclusion: Individuals with knee pain described various health-promoting activities, ranging from physical activity to social interactions, included in the theme of enabling and maintaining a balance in everyday life based on abilities. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and chronic pain while maintaining a healthy lifestyle.REFERENCES:[1] Thorstensson et al. Natural course of knee osteoarthritis in middle-aged subjects with knee pain… . ARD, 2009;68:1890-1893.[2] Bergman et al. Chronic widespread pain and its associations with quality of life and function at a 20-year follow-up… . BMC Musculoskel, 2019;20:592[3] Fernandes et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis . ARD, 2013;72:1128
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| 6. |
- Sylwander, Charlotte, 1992-, et al.
(author)
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Pressure pain thresholds and the associations with chronic widespread pain, knee osteoarthritis and obesity in individuals with knee pain
- 2020
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Conference paper (peer-reviewed)abstract
- Approximate 30% of individuals with symptomatic knee osteoarthritis (OA) had developed chronic widespread pain (CWP) over a period of 20 years [1]. In order to prevent CWP in those with knee pain, it is important to study associated factors.Objectives:The aim was to study pressure pain thresholds among individuals with knee pain with or without radiographic changes, and associations with CWP, radiographic knee OA, and obesity.Methods:Out of 300 individuals with knee pain (with or without radiographic changes) from an ongoing longitudinal study, 279 conducted pressure pain thresholds (PPT) measurement at baseline in this cross-sectional study (71% women; mean age 51 years). The PPT were measured using a computerized pressure algometry on eight predefined tender points (Figure 1) out of the 18 points as part of the definition of fibromyalgia [2]. PPTs were dichotomised based on the lowest tertial vs the two higher tertials for each of the eight points. A group that had ≥4 points with low PPT (low PPT group) was compared to a group that had <4 low PPT (not low PPT group). A pain mannequin categorised the participants in three different pain groups: CWP, chronic regional pain (CRP), and no chronic pain (NCP) according to the definition of the ACR [2]. Radiographic knee OA was defined according to the Ahlbäck five grading scale as having score ≥1 vs score 0 [3]. Obesity was measured by bioimpedance measuring BMI and visceral fat area (VFA, cm2). To study associations, a crude logistic regression model controlled for age and sex was used including main and significant variablesFigure 1Differences in mean PPT in the eight tender pointsResults:The prevalence of CWP was 37% and higher in the low PPT group compared to those in the not low PPT group (Table 1). No differences were found between the groups in BMI, VFA or radiographic knee OA (Table 1). The low PPT group had significantly lower mean PPT on all eight tender points, was younger, had more pain sites, and more cases of fibromyalgia compared to the group with not low PPT (Table 1, Figure 1). Age (OR 0.95; 95% CI 0.92–0.97), having CWP (OR 3.00; CI 1.66–5.06), fibromyalgia (OR 21.91; CI 2.45–194.69) and increased number of pain sites (OR 1.13; CI 1.05–1.22) were associated with low PPT.Table 1.Descriptive statistics for the whole sample and for the groups: low PPT and not low PPTAlln = 279Low PPTn = 99Not low PPTn = 180p-valueAge, mean years (sd)51 (9)49 (9)53 (8)<0.001Women, n (%)197 (71%)69 (70%)128 (71%)0.804Pain group, n (%)<0.001 NCP/CRP160 (63%)41 (47%)119 (71%) CWP95 (37%)46 (53%)49 (29%)Numbers of pain sites, mean (sd)5 (4)6 (5)4 (3)0.003Fibromyalgia, n (%)8 (3%)7 (9%)1 (1%)0.001Knee OA Ahlbäck, n (%)59 (23%)16 (18%)43 (26%)0.132BMI, n (%)127 (48%)42 (47%)85 (48%)0.801 Normal Overweight/Obese139 (52%)48 (53%)91 (52%)VFA, mean cm2(sd)114 (54)115 (51)113 (55)0.788Conclusion:Baseline characteristics of individuals with knee pain showed a higher prevalence of CWP than in the general population [4]. In the group with low PPT, the prevalence was even higher. The study found associations between CWP and low PPT, however, almost half of the individuals with low PPT reported NCP/CRP. Moreover, a third in the group that not had low PPT reported CWP. The development of widespread pain in individuals with knee pain needs to be further studied over time to increase the knowledge of CWP’s origin in order to prevent the condition.References:[1]Bergman et al. BMC Musculoskelet Disord. 2019;20:592[2]Wolfe et al. Arthritis Rheum. 1990;33:160-72[3]Ahlbäck. Acta Radiol Diagn (Stockh). 1968:7-72[4]Andrews et al. Eur J Pain. 2018;22:5-18Disclosure of Interests:None declared
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| 7. |
- Larsson, Ingrid, et al.
(author)
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Patients’ experiences of nurse-led follow-up in biological therapy – a qualitative study
- 2011
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Conference paper (peer-reviewed)abstract
- Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patients may require biological therapy. These patients usually have rheumatologist follow-up twice a year. Nurse-led clinics have been proposed for patients treated with biological therapy that are in low disease activity or remission (Disease Activity Score, DAS <3.2). In an ongoing study at a Swedish rheumatology clinic every other rheumatologist follow-up has been replaced by a rheumatology nurse-led follow-up. At the nurse-led follow-up the patients' disease activity is assessed by examining tender or swollen joints and laboratory tests.Objectives: The purpose of this study was to describe patients' experiences of nurse-led follow-up in biological therapy.Methods: The study had a descriptive design with a qualitative content analysis approach. In qualitative content analysis the interpretations vary in depth and level of abstraction: the manifest content describes the visible, what the text says and creating categories, the latent content involves an interpretation of the underlying meaning of the text, what the text talks about and creating a theme. Seventeen interviews were conducted based on a strategic sampling in order to achieve variation in experiences of nurse-led follow-up in terms of sex, age, civil status, education, duration of disease and therapy and ways of administration.Results: The content analysis of the interviews resulted in the theme "The rheumatology nurse promotes patients with added value" which was based on four categories: familiarity, security, availability and participatory: Familiarity meant that it was easier to ask the rheumatology nurse about disease, treatment and how to live with a chronic disease than the rheumatologist. Patients experienced security in the rheumatology nurse's knowledge and skill. Availability meant that it was easy to contact the rheumatology nurse who spent time to patients' needs. Patients experienced being participatory in their biological therapy and in the rheumatology nurse's examination of the disease activity.Conclusions: The rheumatology nurse follow-up resulted in that patients experienced familiarity, security, availability and being participatory in their biological therapy. The rheumatology nurse promoted patients from another perspective, than the rheumatologist, in the rheumatology care. By replacing every other rheumatologist follow-up with a rheumatology nurse-led follow-up for patients with biological therapy, who are in low disease activity or remission, the rheumatology care will be more complete. A rheumatology nurse and a rheumatologist have different perspectives and complement each other. When patients are given the opportunity to meet both professions regularly they are able to receive optimal rheumatology care.Disclosure of Interest: None DeclaredCitation: Ann Rheum Dis 2011;70(Suppl3):755
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| 8. |
- Larsson, Ingrid, et al.
(author)
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Patients’ independence of a nurse for the administration of their subcutaneous anti-TNF therapy : A phenomenographic study
- 2010
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Conference paper (peer-reviewed)abstract
- Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of subcutaneous injections by patients themselves. It is therefore important that the patient perspective is focused upon the life-changing situation due to the administration of regular subcutaneous injections.Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases conceive their independence of a nurse for the administration of their subcutaneous anti-TNF therapy.Methods: The study had a descriptive qualitative design with a phenomenographic approach. Twenty interviews were conducted based on a strategic sampling in order to achieve variation in conceptions of the phenomenon in terms of sex, age, marital status, education, illness duration, duration of medication, distance between home-hospital, and experience of intravenous infusions.Results: Four descriptive categories emerged: 1. Struggling for independence: The patients experienced a struggle and limitations in their lives by the self-administration of the subcutaneous injections. 2. Learning for independence: Patients experienced a learning process by the self-administration of the subcutaneous injections. 3. Participating for independence; Patients experienced control over their lives by themselves administers the subcutaneous injections. 4. Freedom through independence: Patients experienced that they could manage their lives and live as independently as possible by the self-administration of the subcutaneous injections.Conclusion: Independence of a nurse at the subcutaneous anti-TNF injections is a process. There is a striving for independence in which patients are taking themselves further by learning and participating in drug treatment and then experience the injection provides independence. Patients under treatment with subcutaneous anti-TNF injections are at different phases in the process of independence; this is not depending on how long they have self-administered subcutaneous injections.Disclosure of Interest: None declaredCitation: Ann Rheum Dis 2010;69(Suppl3):730Nursing
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| 9. |
- Malm, Karina, et al.
(author)
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Worse physical function at disease onset predicts a worse outcome in physical function, but not in meeting who physical activity recommendations, nine years later
- 2013
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In: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 1468-2060.
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Conference paper (peer-reviewed)abstract
- Background: Long term disease impact on physical functioning in the most affected patients with RA is not well described. Impaired function and inability to be physically active are associated features and it is well known that people with RA are less physically active compared with the general population.Objectives: To study predictive variables for a worse outcome in physical function and physical activity measures in a long time follow-up study.Methods: Between 1992 and 2005 all patients with newly diagnosed RA according to criteria of the American College of Rheumatology were asked to participate in the BARFOT study, a collaboration between six Swedish rheumatology departments. In 2010 all patients (n=2114) included in the study received a follow-up questionnaire 5-18 years after disease onset. Using logistic regression analyses, the dependent variables physical function (dichotomized by their mean value) were measured with the HAQ (scores 0 to 3, best to worst), the RAOS (Rheumatoid Arthritis Outcome Score) subscales ADL and sport/rec (0-100, worst to best) and meeting vs. not meeting WHO recommendations of physical activity (WHOrec) for a healthy life style (moderate intensity ≥150 min/week or higher intensity for at least 30 minutes 2-3 times/week). Possible predictive variables at baseline were function (HAQ and SOFI, Signals of Functional Impairment, 0-44, best to worse), disease activity (CRP, swollen and tender joints), pain (VAS 0-100, best to worst) and age. We also controlled for sex and disease duration in 2010.Results: Questionnaire response was 72% (n=1525), mean (m) age 65 years (SD 14), m follow-up time 9 years (SD 3.7) and 70% (n=1069) were women.At inclusion the patients reported a disease duration of m 8 (SD 9) months, HAQ m 1.0 (SD 0.6), VAS pain m 46 (SD24), SOFI m 8.0 (SD6.0). Disease activity was CRP m 30.2 (SD 35.9), swollen joints m 10.2 (SD 5.7) and tender joints m 8.2 (SD 6.2).In the 2010 survey, time from inclusion was m 9.4 (SD 3.8) years, the HAQ m 0.6 (SD 0.6), and VAS pain m 35.5 (SD 25.6) had decreased (p<0.001). RAOS ADL was m 71,1 (SD 22.0), RAOS sport/rec m 40.0 (SD 30.0) and 61% (N=894) met the WHOrec.Worse scores in the HAQ, VAS pain and SOFI at baseline increased the risk for worse physical function in the 2010 survey measured with the HAQ (VAS pain OR 1.02, SOFI OR 1.09 and HAQ OR 3.98, p<0.000), the RAOS ADL scale (VAS pain OR 1.02, SOFI OR 1,09 and HAQ OR 2.66, p<0.000) and the RAOS sport/rec scale (VAS pain OR 1.02, SOFI OR 1.11 and HAQ OR 2.57, p<0.000). Being a woman, higher age at inclusion and longer disease duration at follow-up also predicted a worse function in the HAQ and both RAOS subscales while none of the studied variables could predict who did/did not meet the WHOrec in 2010.Conclusions: Worse physical function and worse pain at disease onset can predict a worse physical function several years later. However, it does not predict the amount of physical activity actually being performed. It is of importance to already at disease onset recognize patients with impaired function and higher pain levels who are in need of multidisciplinary treatments. It is also important to early in the disease recommend a healthy life style according to the WHOrec since measures of function and being physically active are different entities.Disclosure of Interest: None Declared
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