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2. |
- Aronsson, Maria, et al.
(author)
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The effect of a tight control regime with monthly follow-up on remission rates and reported pain in early rheumatoid arthritis
- 2023
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In: Musculoskeletal Care. - : Wiley. - 1557-0681 .- 1478-2189. ; 21:1, s. 159-168
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Journal article (peer-reviewed)abstract
- Objective: To determine whether a tight control (TC) regime with monthly consultations to the physician for the first 6 months, could increase remission rate and improve reported pain of patients with early rheumatoid arthritis (RA). Methods: In this single-centre, TC study, with monthly visits to the physician, a cohort of 100 patients with early RA was consecutively included. They were compared with a reference cohort of 100 patients from the same clinic that had been conventionally managed. The patients were followed for 2 years. Results: The patients in the TC cohort had lower 28- joints disease activity score (DAS28) at three, six, 12 and 24 months, compared with the conventionally managed cohort, p <= 0.001. At 12 months, 71% in the TC cohort versus 46% in the conventional cohort were in remission (DAS28 < 2.6) and at 24 months 68% versus 49% respectively, p < 0.05. The TC cohort reported less pain at three, six, 12 and 24 months, p < 0.001. Multiple logistical regression analyses adjusted for, respectively, age, disease duration, pharmacological treatment, DAS28 and visual analogue scale pain at inclusion, revealed that participation in the TC cohort had an independent positive association with remission at 12 and 24 months and with acceptable pain at 24 months. Conclusion: The intensive follow-up schedule for patients with early RA improved remission and led to improvement in reported pain and physical function. The positive effect of a TC regime in early disease may be due to increased empowerment, developed by meeting health professionals frequently.
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3. |
- Boeters, Debbie M., et al.
(author)
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The prevalence of ACPA is lower in rheumatoid arthritis patients with an older age of onset but the composition of the ACPA response appears identical
- 2017
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In: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 19:1, s. 1-10
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Journal article (peer-reviewed)abstract
- Background: Rheumatoid arthritis (RA) consists of two syndromes, one autoantibody-positive and one autoantibody-negative. Existing data on the relation between age of onset and prevalence of autoantibodies were conflicting. Therefore this multicohort study assessed the age of onset in relation to the presence of autoantibodies. The association with characteristics of the anti-citrullinated protein antibodies (ACPA) response was also explored. Methods: The 1987 criteria-positive RA patients included in the Leiden EAC, BARFOT, ESPOIR, Umeå and Lund cohorts (n = 3321) were studied at presentation for age of onset and the presence of ACPA, rheumatoid factor (RF) and anti-carbamylated protein (anti-CarP) antibodies. Logistic regression analyses were performed; effect sizes were summarized in inverse-weighted meta-analyses. Within ACPA-positive RA, ACPA level was studied in all cohorts; ACPA isotypes, ACPA fine specificity and ACPA avidity index and clinical characteristics were studied in the Leiden EAC. Results: From the age of 50 onward, the proportion of ACPA-negative RA patients increased with age in the five cohorts. Similar observations were made for RF and anti-CarP. The composition of the ACPA response did not change with increasing age of onset with respect to titer, isotype distribution, fine specificity and avidity index. With increasing age of onset, RA patients smoked less often, had higher acute phase reactants and more often had a sub(acute) symptom onset. Conclusions: Data of five cohorts revealed that with older age of onset ACPA-negative RA is more frequent than ACPA-positive RA, while characteristics of ACPA-positive RA as judged by the composition of the ACPA response appeared not age dependent. Further biologic studies are needed to characterize the pathogenesis of ACPA-negative polyarthritis at older age and to promote personalized treatment decisions in ACPA-negative patients in daily practice.
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4. |
- Boman, Jens, et al.
(author)
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Brief manual-based single-session Motivational Interviewing for reducing high-risk sexual behaviour in women : an evaluation
- 2018
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In: International Journal of STD and AIDS (London). - : Sage Publications. - 0956-4624 .- 1758-1052. ; 29:4, s. 396-403
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Journal article (peer-reviewed)abstract
- The objective of this study was to develop and evaluate brief Motivational Interviewing (MI) to facilitate behaviour change in women at high risk of contracting sexually transmitted infections (STIs). One hundred and seventy-three women (mean age 24.7) at high risk of contracting STIs were randomized to a brief risk-reducing MI counselling intervention (n = 74) or assigned to the control group (n = 99). MI skill was assessed using the Motivational Interviewing Treatment Integrity (MITI) Coding System. Seventeen of 74 (23%) women tested for Chlamydia trachomatis (CT) in the MI intervention group and 22 of 99 (22%) in the control group had a genital CT infection 0-24 months before baseline. All additional CT testing was monitored up to 24 months for all 173 women in the study. None of the 49 CT-retested women in the MI group was CT infected, as compared to 3 of 72 (4%) women in the control group. A generalized estimating equations model with sexual high-risk behaviour measured at baseline and at six-month follow-up produced an adjusted estimated odds ratio of 0.38 (95% confidence interval = 0.158, 0.909), indicating efficacy. Brief manual-based single-session MI counselling seems to be effective in reducing high-risk sexual behaviour in women at high risk of acquiring STIs.
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7. |
- Bower, Hannah, et al.
(author)
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Are JAKis more effective among elderly patients with RA, smokers and those with higher cardiovascular risk? A comparative effectiveness study of b/tsDMARDs in Sweden.
- 2023
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In: RMD open. - : BMJ Publishing Group Ltd. - 2056-5933. ; 9:4
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Journal article (peer-reviewed)abstract
- To investigate whether the relative effectiveness of janus kinase inhibitors (JAKis) versus tumour necrosis factor inhibitors (TNFi) or other biological disease-modifying antirheumatic drugs in rheumatoid arthritis differ by the presence or absence of risk factors for cardiovascular (CV) disease, age, sex and smoking.Through Swedish registers, we identified 13493 individuals with 3166 JAKi, 5575 non-TNFi and 11 286 TNFi treatment initiations 2016-2022. All lines of therapy were included, with the majority in second line or higher. Treatment response was defined as the proportion reaching European Alliance of Associations for Rheumatology (EULAR) good response and Clinical Disease Activity Index (CDAI) remission, respectively, within 6 months. Crude percentage point differences in these proportions (JAKis, and non-TNFis, vs TNFis) overall and by risk factors were observed, and adjusted for confounders using linear regression models. Predicted probabilities of response and remission were estimated from adjusted Poisson models, and presented across CV risk and age.Overall, adjusted percentage point differences indicated higher response (+5.0%, 95% CI 2.2% to 7.9%) and remission (+5.8%, 95% CI 3.2% to 8.5%) with JAKis versus TNFis. The adjusted percentage point differences for response in those above 65, at elevated CV risk, and smokers were +5.9% (95% CI 2.7% to 9.0%), +8.3% (95% CI 5.3% to 11.4%) and +6.0% (95% CI 3.3% to 8.7%), respectively. The corresponding estimates for remission were +8.0% (95% CI 5.3% to 10.8%), +5.6% (95% CI 3.0% to 8.2%) and +7.6% (95% CI 5.5% to 9.7%).As used in clinical practice, response and remission at 6 months with JAKis are higher than with TNFi. Among patients with risk factors of concern, effectiveness is similar or numerically further increased. For individualised benefit-to-risk ratios to guide treatment choice, safety and effectiveness in specific patient segments should be considered.
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8. |
- Bower, H., et al.
(author)
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Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: from infection severity to impact on care provision
- 2021
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In: Rmd Open. - : BMJ. - 2056-5933. ; 7:3
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Journal article (peer-reviewed)abstract
- Objectives To compare risks for COVID-19-related outcomes in inflammatory joint diseases (IJDs) and across disease-modifying antirheumatic drugs (DMARDs) during the first two waves of the pandemic and to assess effects of the pandemic on rheumatology care provision. Methods Through nationwide multiregister linkages and cohort study design, we defined IJD and DMARD use annually in 2015-2020. We assessed absolute and relative risks of hospitalisation or death listing COVID-19. We also assessed the incidence of IJD and among individuals with IJD, rheumatologist visits, DMARD use and incidence of selected comorbidities. Results Based on 115 317 patients with IJD in 2020, crude risks of hospitalisation and death listing COVID-19 (0.94% and 0.33% across both waves, respectively) were similar during both waves (adjusted HR versus the general population 1.33, 95% CI 1.23 to 1.43, for hospitalisation listing COVID-19; 1.23, 95% CI 1.08 to 1.40 for death listing COVID-19). Overall, biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) did not increase risks of COVID-19 related hospitalisation (with the exception of a potential signal for JAK inhibitors) or death. During the pandemic, decreases were observed for IJD incidence (-7%), visits to rheumatology units (-16%), DMARD dispensations (+6.5% for bDMARD/tsDMARDs and -8.5% for conventional synthetic DMARDs compared with previous years) and for new comorbid conditions, but several of these changes were part of underlying secular trends. Conclusions Patients with IJD are at increased risk of serious COVID-19 outcomes, which may partially be explained by medical conditions other than IJD per se. The SARS-CoV-2 pandemic has exerted measurable effects on aspects of rheumatology care provision demonstrated, the future impact of which will need to be assessed.
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9. |
- Bower, Hannah, et al.
(author)
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Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population : a nationwide Swedish cohort study
- 2021
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In: Annals of the Rheumatic Diseases. - : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 80:8, s. 1086-1093
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Journal article (peer-reviewed)abstract
- Objectives: To estimate absolute and relative risks for all-cause mortality and for severe COVID-19 in inflammatory joint diseases (IJDs) and with antirheumatic therapies.Methods: Through Swedish nationwide multiregister linkages, we selected all adult patients with rheumatoid arthritis (RA, n=53 455 in March 2020), other IJDs (here: spondyloarthropathies, psoriatic arthritis and juvenile idiopathic arthritis, n=57 112), their antirheumatic drug use, and individually matched population referents. We compared annual all-cause mortality March-September 2015 through 2020 within and across cohorts, and assessed absolute and relative risks for hospitalisation, admission to intensive care and death due to COVID-19 March-September 2020, using Cox regression.Results: During March-September 2020, the absolute all-cause mortality in RA and in other IJDs was higher than 2015-2019, but relative risks versus the general population (around 2 and 1.5) remained similar during 2020 compared with 2015-2019. Among patients with IJD, the risks of hospitalisation (0.5% vs 0.3% in their population referents), admission to intensive care (0.04% vs 0.03%) and death (0.10% vs 0.07%) due to COVID-19 were low. Antirheumatic drugs were not associated with increased risk of serious COVID-19 outcomes, although for certain drugs, precision was limited.Conclusions: Risks of severe COVID-19-related outcomes were increased among patients with IJDs, but risk increases were also seen for non-COVID-19 morbidity. Overall absolute and excess risks are low and the level of risk increases are largely proportionate to those in the general population, and explained by comorbidities. With possible exceptions, antirheumatic drugs do not have a major impact on these risks.
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10. |
- C Kapetanovic, Meliha, et al.
(author)
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Development of functional impairment and disability in rheumatoid arthritis patients followed for 20 years - relation to disease activity, joint damage and comorbidity.
- 2015
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In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 67:3, s. 340-348
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Journal article (peer-reviewed)abstract
- Objectives. To study the course of impairment measured by signals of functional impairment (SOFI) and disability measured by health assessment questionnaire (HAQ) over 20 years in rheumatoid arthritis (RA) patients followed from diagnosis. To explore the contribution of disease activity, joint damage and comorbidity to variation of SOFI and HAQ over time. Methods. RA patients diagnosed 1985-1989 were prospectively monitored. There were 183 patients, 63 % were women, mean (SD) age was 52 (12) years. Disease activity was measured by 44-joint DAS, joint damage by Larsen score and comorbidity by Charlson Comorbidity Index. Contribution of comorbidity, DAS and joint damage on development of SOFI and HAQ was studied at 0,5,10, 15 and 20 years follow up (hierarchical regression model) and over the total study period using (longitudinal regression model). Results. SOFI progressed over 20 years while progression of HAQ levelled off after 10 years. For SOFI, DAS and joint damage contributed the most (2-28 % and 3-31%, respectively). Over 20 years, SOFI was explained by DAS (20%), joint damage (20%), age (7%) and comorbidity (4%). For HAQ, DAS contributed the most (4-24%). Over 20 years, HAQ was explained by DAS (20%), joint damage (2%), gender (7%), comorbidity (6%) and age (4%). Conclusion. Over 20 years, 51% of the variation of SOFI and 39% of the variation of HAQ could be explained by age, gender and variations in comorbidity, disease activity and joint damage. Over time, disease activity contributed significantly to both SOFI and HAQ. Joint damage contributed predominantly to SOFI. © 2014 American College of Rheumatology.
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11. |
- C Kapetanovic, Meliha, et al.
(author)
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Early changes in bone mineral density measured by digital X-ray radiogrammetry predict up to 20 years radiological outcome in rheumatoid arthritis.
- 2011
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In: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6362. ; 13:1
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Journal article (peer-reviewed)abstract
- ABSTRACT: INTRODUCTION: Change in bone mineral density (BMD) in the hand, as evaluated by digital X-ray radiogrammetry (DXR) of the II-IV metacarpal bones, has been suggested to predict future joint damage in rheumatoid arthritis (RA). This study's objective was to investigate if DXR-BMD loss early in the disease predicts development of joint damage in RA patients followed for up to 20 years. METHODS: 183 patients (115 women and 68 men) with early RA (mean disease duration 11 months) included from 1985 to 1989 were followed prospectively (the Lund early RA cohort). Clinical and functional measures were assessed yearly. Joint damage was evaluated according to the Larsen score on radiographs of hands and feet taken in years 0 to 5, 10, 15 and 20. These radiographs were digitized and BMD of the II-IV metacarpal bones was evaluated by DXR (Sectra, Linkoping. Sweden). Early DXR-BMD change rate (bone loss) per year calculated from the first 2 radiographs taken on average 9 months apart (SD 4.8) were available for 135 patients. Mean values of right and left hand were used. RESULTS: Mean early DXR-BMD loss during the first year calculated was -0.023 g/cm2 (SD 0.025). Patients with marked bone loss, i.e. early DXR-BMD loss above the median for the group, had significantly worse progression of joint damage at all examinations during the 20-year period. CONCLUSIONS: Early DXR-BMD progression rate predicted development of joint damage evaluated according to Larsen at year one and further onwards up to 20 years in this cohort of early RA patients.
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12. |
- C Kapetanovic, Meliha, et al.
(author)
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Long-term mortality rate in rheumatoid arthritis patients with disease onset in the 1980s.
- 2011
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In: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 40, s. 433-438
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Journal article (peer-reviewed)abstract
- Objective: To investigate the mortality rate and possible early predictive factors of mortality after 19-23 years in a cohort of patients with rheumatoid arthritis (RA) followed prospectively from disease onset. Patients and methods: A community-based cohort of 183 patients (63% female) with RA and disease duration < 2 years was recruited 1985-1989. The patients were followed yearly from diagnosis until death or 31 December 2008. Mean age and mean duration of symptoms (range) at diagnosis were 52 (18-78) years and 11 (0-24) months, respectively. Death certificates were obtained from the Swedish Cause of Death Register and causes of death were coded by the International Classification of Diseases (ICD-10). Death rates of RA patients were compared to those of age- and sex-matched controls. Possible predictors of mortality were analysed using a Cox regression model. Results: By 31 December 2008, 69 patients (37 women and 32 men) had died. The standardized mortality ratio (SMR) was 1.23 [95% confidence interval (CI) 0.97-1.55] and p < 0.09. Older age, male sex, smoking, and the presence of cardiovascular disease (CVD) at RA diagnosis were identified as early predictors of mortality. CVD was the most common cause of death (46%), followed by malignancies (29%) and infections (13%). RA was not stated as the direct cause of death in any patient and was mentioned among underlying causes in only 16/69 (23%) patients. Conclusion: Mortality rate after 19-23 years of disease duration in this cohort of patients with disease onset in the 1980s was not significantly increased compared to age- and sex-matched controls. No RA disease-related factor predicted mortality.
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13. |
- C Kapetanovic, Meliha, et al.
(author)
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Orthopaedic surgery in patients with rheumatoid arthritis over 20 years: prevalence and predictive factors of large joint replacement
- 2008
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 67:10, s. 1412-1416
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Journal article (peer-reviewed)abstract
- Objective: To study the prevalence of orthopaedic surgery and to evaluate possible predictive factors for large joint replacements in patients with early rheumatoid arthritis (RA). Patients and methods: A cohort of 183 patients (116 (63.4%) female) with early RA was monitored for 16-20 years after recruitment during 1985-9. Mean (SD) age of patients 51.4 (12.4) years; mean (SD) duration of symptoms before inclusion 12 (7) months and mean (SD) duration of follow-up 16 (4) years. Occurrence of orthopaedic surgery was recorded continuously. A first prosthesis of a large joint (shoulder, elbow, wrist, hip, knee or ankle) was used as outcome variable in the predictive analyses. Results: In total, 386 orthopaedic interventions were performed in 106/183 (58%) patients during follow-up and a large joint replacement was performed in 44/183 (24%) patients. Using a Cox regression model, it was shown that Health Assessment Questionnaire, C-reactive protein and erythrocyte sedimentation rate at inclusion, and radiographic changes in small joints after 1 year, were associated with an increased risk of receiving prosthesis of large joints. Conclusion: In this cohort of patients with RA monitored from early disease stage, orthopaedic surgical procedures were performed in more than half of the patients. This included first large joint replacements in 24% of the cases. Easily available measures were identified as predictors of such joint replacements. This study could serve as a reference for comparison with cohorts of patients with RA recruited today, in which new more efficacious treatments are used.
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14. |
- C Kapetanovic, Meliha, et al.
(author)
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Prevalence and predictive factors of comorbidity in rheumatoid arthritis patients monitored prospectively from disease onset up to 20 years: lack of association between inflammation and cardiovascular disease.
- 2010
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In: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 39, s. 353-359
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Journal article (peer-reviewed)abstract
- Objectives: To study the prevalence of comorbid conditions at diagnosis and during follow-up in a cohort of patients with early rheumatoid arthritis (RA) followed prospectively over 20 years, and to identify possible early predictive factors for future comorbidities. Methods: A community-based cohort of 183 patients (mean age 52 years, 63% female) with early RA was recruited between 1985 and 1989. The presence of comorbidity at RA diagnosis and the occurrence of additional comorbidities were recorded continuously. Possible predictors of future comorbidities were analysed using the Cox proportional hazards model. Results: At RA diagnosis, at least one comorbid condition was present in 43% of the patients. Cardiovascular diseases (CVDs), including hypertension (16% of patients) and malignancy (6% of patients), were most common. In total, 82% of patients developed additional comorbidities during follow-up. CVD and malignancies remained the most frequent comorbidities. Higher age [p < 0.001, odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.15] and the presence of any comorbidity at diagnosis (p = 0.02; OR 1.64, 95% CI 1.08-2.52) predicted future comorbidity. Measures of inflammation at diagnosis or during follow-up were not predictive for development of CVD. Conclusion: Comorbidity was present in a considerable proportion of patients in this cohort. More than 40% of patients had another disease at inclusion and during follow-up and > 80% developed additional conditions. The pattern of comorbidity remained unchanged, with CVD and malignancy being most common. Older age and the presence of comorbidity at RA diagnosis predicted the development of comorbidities. The degree of inflammation at any time point was not predictive of future CVD.
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17. |
- de Rooy, Diederik P. C., et al.
(author)
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Genetic studies on components of the Wnt signalling pathway and the severity of joint destruction in rheumatoid arthritis
- 2013
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 72:5, s. 769-775
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Journal article (peer-reviewed)abstract
- Background Progression of joint destruction in rheumatoid arthritis (RA) is partly heritable; knowledge of genetic factors may increase our understanding of the mechanisms underlying joint destruction. The activity of the Wnt/beta-catenin pathway influences osteoblast differentiation. Dickkopf-1 (Dkk-1) and sclerostin (Sost) are negative regulators and lipoprotein receptor-related protein-5 (LRP-5) and Kremen-1 are transmembrane receptors involved in this pathway. Objective To study variants in the genes encoding these proteins in relation to progression of joint destruction. Methods 1418 patients with RA of four cohorts with 4885 sets of hands and feet x-rays were studied. Explorative analyses were performed on 600 patients with RA from Leiden on single nucleotide polymorphisms (SNPs) tagging Dkk-1, Sost, Kremen-1 and LRP-5. SNPs significantly associating with joint damage progression were subsequently genotyped in cohorts from Groningen (NL), Sheffield (UK) and Lund (Sweden). Data were summarised in meta-analyses. Serum levels of functional Dkk-1 and sclerostin were measured and studied in relation to genotypes. Results In the first cohort, six Dkk-1, three Sost, one Kremen-1 and 10 LRP-5 SNPs were significantly associated with radiological progression of joint destruction. Three Dkk-1 SNPs were associated significantly with progression of joint damage in the meta-analysis, also after correction for multiple testing (rs1896368, rs1896367 and rs1528873). Two Sost SNPs tended to significance (rs4792909 and rs6503475, p=0.07 after false discovery rate correction). Gene-gene interactions between SNPs on Dkk-1 and Sost were seen. Serum levels of Dkk-1 were significantly correlated with the genotypes in rs1896368 (p=0.02). Conclusions Patients with RA carrying risk alleles of genetic variants in Dkk-1 have higher serum levels of functional Dkk-1 and more progressive joint destruction over time.
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18. |
- de Rooy, D. P. C., et al.
(author)
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Smoking as a risk factor for the radiological severity of rheumatoid arthritis: a study on six cohorts
- 2014
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 73:7, s. 1384-1387
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Journal article (peer-reviewed)abstract
- Background Smoking is a risk factor for the development of anti -citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA). Whether smoking predisposes to severe joint damage progression is not known, since deleterious, protective and neutral observations have been made. Objective To determine the effect of smoking on joint damage progression. Methods Smoking status was assessed in 3158 RA patients included in six cohorts (Leiden Early Arthritis Clinic (Leiden-EAC), BARFOT, Lund, Iceland, NDB and Wichita). In total 9412 radiographs were assessed. Multivariate normal regression and linear regression analyses were performed. Data were summarised in a random effects inverse variance meta-analysis. Results When comparing radiological progression for RA patients that were never, past and current smokers, smoking was significantly associated with more severe joint damage in Leiden-EAC (p=0.042) and BARFOT (p=0.015) RA patients. No significant associations were found in the other cohorts, though a meta-analysis on the six cohorts showed significantly more severe joint damage progression in smokers (p=0.01). Since smoking predisposes to ACPA, analyses were repeated with ACPA as additional adjustment factor. Then the association was lost (meta-analysis p=0.29). Conclusions This multi-cohort study indicated that the effect of smoking on joint damage is mediated via ACPA and that smoking is not an independent risk factor for radiological progression in RA.
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19. |
- Di Giuseppe, D., et al.
(author)
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Comparison of treatment retention of originator vs biosimilar products in clinical rheumatology practice in Sweden
- 2021
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In: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 61:9, s. 3596-3605
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Journal article (peer-reviewed)abstract
- Objectives To compare treatment retention between biosimilars and their originator products among first starters (etanercept, infliximab, adalimumab and rituximab), as well as after non-medical switch. Methods Patients with rheumatic diseases starting, for the first time, an originator or biosimilar etanercept, infliximab, adalimumab or rituximab were identified in the national Swedish Rheumatology Quality Register. Moreover, patients switching from an originator to its biosimilar were identified and individually matched to patients continuing on the originator. One-year treatment retention was calculated and hazard ratios (HR) for discontinuation with 95% CIs were estimated, adjusting for comorbidities and socio-economic factors. Results In total, 21 443 first treatment courses were identified. The proportion of patients still on the drug at 1 year and the HR for discontinuation revealed no differences across adalimumab (Humira, Imraldi, Amgevita and Hyrimoz) nor across rituximab products (Mabthera, Ritemvia/Truxima and Rixathon). The proportions on the drug at 1 year were similar for Benepali (77%) and Enbrel (75%) and the adjusted HR for Benepali compared with Enbrel was 0.91 (95% CI 0.83, 0.99). For infliximab, the proportion still on the drug at 1 year was 67% for Remicade and 66% for Remsima/Inflectra and the HR compared with Remicade was 1.16 (95% CI 1.02, 1.33). Among 2925 patients switching from an originator drug to one of its biosimilars, we noted no statistically significant or clinically relevant differences in drug survival compared with those who remained on originator therapy. Conclusion This large observational study supports the equivalence of biologic DMARD biosimilar products and originators when used in routine rheumatology care.
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20. |
- Di Giuseppe, D., et al.
(author)
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Uptake of rheumatology biosimilars in the absence of forced switching
- 2018
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In: Expert Opinion on Biological Therapy. - : Informa UK Limited. - 1471-2598 .- 1744-7682. ; 18:5, s. 499-504
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Journal article (peer-reviewed)abstract
- Background: To describe the uptake and system-level effects of the introduction of biosimilars in a setting without forced switching.Research design and methods: We used data from the Swedish Rheumatology Quality register from start of marketing of infliximab (Remsima (R) and Inflectra (R)) and etanercept (Benepali (R)) biosimilars until 31 December 2016. We compared users of each originator-product and its biosimilar(s) by line of treatment: bDMARD-naive patients, non-medical switchers (vs. matched patients remaining on originator), and patients switching from a previous bDMARD of another type.Results: From the start of marketing 1343 patients started an infliximab biosimilar (22 months) and 2691 started etanercept (9months). Overall, the introduction of these biosimilars resulted in an increase of the total number of ongoing infliximab and etanercept treatments (originator + biosimilar) . At the end of the study period, biosimilars accounted for 31% of all infliximab treatments and 31% of all etanercept-treated patients. For each line of therapy, we noted only small differences in patient characteristics between those starting the originator product vs. its biosimilar(s).Conclusions: Introduction of biosimilars have effects beyond replacement of the originator product, in terms of an increased rate of bDMARD initiation. Selection to non-medical switching displayed no particular disease- or patient-characteristics.
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21. |
- Drake af Hagelsrum, Klara, et al.
(author)
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Healthcare professionals’ experiences of lifestyle management in patients with early rheumatoid arthritis : A qualitative study
- 2022
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In: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. ; , s. 239-240
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Conference paper (peer-reviewed)abstract
- Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemic disease that mainly affects joints and with symptoms such as stiffness, pain, and increased fatigue. RA also appears to be an independent risk factor for accelerated atherosclerosis with an increased risk of cardiovascular diseases, why national and international guidelines recommend proper pharmacological treatment together with a healthy lifestyle (1). Supporting people with early RA to achieve and maintain a healthy lifestyle is therefore of great importance. However, few studies have explored healthcare professionals’ views of working with lifestyle management. A healthy lifestyle does not only have the potential to lower cardiovascular risk but may also improve a person’s quality of life.Objectives: The aim of this study was to explore healthcare professionals´ experiences of lifestyle management in patients with early RA.Methods: In this explorative qualitative study, individual interviews were conducted with 20 healthcare professionals who had a mean of 16 years of professional experience in the field of working with patients with RA. An interview guide with open-ended questions was used e.g.: “How do you work with lifestyle changes in patients with RA?” and “What theories do you use to support lifestyle changes?” Qualitative content analysis was used, where three categories emerged: “The importance of a well-functioning organization”, “The importance of teamwork” and “The importance of person-centered care” and nine subcategories, representing the overall content of the interviews ( Table 1 ).
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22. |
- Drake af Hagelsrum, Klara, et al.
(author)
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Healthcare Professionals’ Experiences Of Lifestyle management In Patients With Early Rheumatoidarthritis – A Qualitative Study
- 2022
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In: ReumaBulletinen. - Stockholm : Svensk reumatologisk förening. - 2000-2246 .- 2001-8061. ; 154:4, s. 60-61
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Journal article (peer-reviewed)abstract
- Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemicdisease that mainly affects joints and with symptoms such asstiffness, pain, and increased fatigue. RA also appears to be anindependent risk factor for accelerated atherosclerosis withan increased risk of cardiovascular diseases, why national andinternational guidelines recommend proper pharmacologicaltreatment together with a healthy lifestyle (1). Supportingpeople with early RA to achieve and maintain a healthy lifestyleis therefore of great importance. However, few studies haveexplored healthcare professionals’ views of working with lifestylemanagement. A healthy lifestyle does not only have the potential tolower cardiovascular risk but may also improve a person’s qualityof life.Objectives: The aim of this study was to explore healthcare professionals´experiences of lifestyle management in patients with early RA.Methods: In this explorative qualitative study, individual interviews wereconducted with 20 healthcare professionals who had a mean of 16years of professional experience in the field of working with patientswith RA. An interview guide with open-ended questions was usede.g.: “How do you work with lifestyle changes in patients withRA?“ and “What theories do you use to support lifestyle changes?”Qualitative content analysis was used, where three categoriesemerged: “The importance of a well-functioning organization“,“The importance of teamwork“ and “The importance of personcenteredcare” and nine subcategories, representing the overallcontent of the interviews (table 1).Results: Healthcare professionals’ experiences of lifestyle managementin patients with early RA included the importance of a wellfunctioningorganization with supportive leadership, priority oflifestyle management, and competence development in lifestylemanagement. The importance of teamwork was emphasizedincluding interdisciplinary team, professional expertise in lifestylehabits, and structured approach to lifestyle management. The healthcare professionals also highlighted the importance of personcenteredcare with individually tailored lifestyle management,shared decision-making, and patient engagement.Conclusion: Healthcare professionals’ experiences of lifestyle managementin patients with early RA reveal that commitment from both themanagement, the team, and the patient is important.References: 1. Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendationsfor cardiovascular disease risk management in patients withrheumatoid arthritis and other forms of inflammatory jointdisorders: 2015/2016 update. Ann Rheum Dis 2017;76:17-28.
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23. |
- Drake Af Hagelsrum, Klara, et al.
(author)
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Healthcare professionals' perceptions of working on lifestyle management for patients with early rheumatoid arthritis – a qualitative study
- 2023
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In: International Journal of Qualitative Studies on Health and Well-being. - Abingdon : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 18:1
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Journal article (peer-reviewed)abstract
- AIM: To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA). METHODS: In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified. RESULTS: HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach. CONCLUSIONS: HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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24. |
- Eberhardt, Kerstin, et al.
(author)
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Work Disability in Rheumatoid Arthritis -- Development over 15 Years and Evaluation of Predictive Factors Over Time.
- 2007
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In: Journal of Rheumatology. - 0315-162X. ; 34:3, s. 481-487
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Journal article (peer-reviewed)abstract
- Objective. To investigate work disability rates over 15 years in an early rheumatoid arthritis (RA) cohort and to evaluate predictive factors during the course of the study. Methods. All patients with early RA of working age (n = 148) were followed and treated at a team care unit. Mean disease duration at inclusion was 1 year. Work characteristics and disease-related variables were recorded annually. Logistic regression analyses were performed to identify predictors for work disability after 5, 10, and 15 years. Results. Work disability rates were 28%, 35%, 39%, and 44% at study start and after 5, 10, and 15 years, respectively. Forty-seven patients reduced working hours and 34 changed work tasks during the study time. Older age, less education, heavy manual work, and much activity limitation assessed by Health Assessment Questionnaire (HAQ) were predictors of work disability. Demographics and work factors had best predictive value in the early phase, while HAQ was a strong predictor at all points in time. Odds ratios for baseline HAQ, 5 year HAQ, and 10 year HAQ were 6.3, 9.6, and 4.1 for work disability after 5, 10, and 15 years, respectively. Conclusion. The prevalence of work disability was 28% at inclusion. After 15 years' followup the prevalence was 44%, which is lower than previously reported. HAQ was the single prognostic factor with strong predictive value throughout the study.
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25. |
- Frisell, T., et al.
(author)
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Safety of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis as used in clinical practice: results from the ARTIS programme
- 2023
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In: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 82:5
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Journal article (peer-reviewed)abstract
- ObjectiveLongitudinal clinical registry-infrastructures such as Anti-Rheumatic Therapies in Sweden (ARTIS) allow simultaneous comparison of the safety of individual immunomodulatory drugs used in clinical practice, with consistent definitions of treatment cohorts, follow-up and outcomes. Our objective was to assess and compare incidence rates of key safety outcomes for individual targeted synthetic or biological disease-modifying antirheumatic drugs (b/ts DMARDs) in rheumatoid arthritis (RA), updating previous reports and including newer treatments including Janus Kinase inhibitors (JAKi). MethodsNationwide register-based cohort study including all patients with RA in Sweden registered as starting any b/tsDMARD 1 January 2010 through 31 December 2020, followed until 30 June 2021 (N=20 117). The incidence rates of selected outcomes, identified through national healthcare registers, were compared between individual b/tsDMARDs, adjusted for confounding by demographics, RA disease characteristics and comorbidity. ResultsThere were marked differences in treatment discontinuations due to adverse events (rates per 1000 person-years ranged from 18 on rituximab to 57 on tofacitinib), but few significant differences were observed for the serious adverse events under study. Neither cardiovascular events nor general serious infections were more frequent on baricitinib or tofacitinib versus bDMARDs, but JAKi were associated with higher rates of hospital-treated herpes zoster (HR vs etanercept, 3.82 (95% CI 2.05 to 7.09) and 4.00 (1.59 to 10.06)). Low number of events limited some comparisons, in particular for sarilumab and tofacitinib. ConclusionData from ARTIS supports that the b/tsDMARDs currently used to treat RA have acceptable and largely similar safety profiles, but differences exist in particular concerning tolerability and specific infection risks.
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26. |
- Gustafsson, Sandra, et al.
(author)
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Amyloid Fibril Composition as a Predictor of Development of Cardiomyopathy After Liver Transplantation for Hereditary Transthyretin Amyloidosis
- 2012
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In: Transplantation. - 0041-1337 .- 1534-6080. ; 93:10, s. 1017-1023
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Journal article (peer-reviewed)abstract
- Background. Liver transplantation (LTx) is an accepted treatment for hereditary transthyretin (TTR) amyloidosis (ATTR). However, unforeseen heart complications, especially a rapid development of cardiomyopathy after LTx has affected mortality and morbidity. Recently, a relationship between ATTR-fibril composition and cardiomyopathy has been noted. The aim of this study was to investigate whether development of cardiomyopathy and heart failure in LTx ATTR amyloid patients is related to amyloid fibril composition.Methods. Twenty-four patients with hereditary ATTR amyloidosis who had undergone LTx and have had their amyloid fibril type tested were available for the study. They had been examined by echocardiography including tissue Doppler and speckle tracking echocardiography before and after LTx. Patients were divided into two groups according to fibril composition, 10 patients with type A fibrils (a mixture of truncated and full-length TTR) and 14 patients with type B fibrils (full-length TTR fibrils only). There was no difference in time to the follow-up echocardiography between the two groups.Results. After LTx, the group consisting of type A patients developed symptoms of heart failure and with reduced systolic and diastolic ventricular function as shown by echocardiography, whereas no similar deterioration was noted for the group of patients with type B fibrils.Conclusion. Patients with type A fibrils deteriorate an already existing cardiomyopathy and heart failure after LTx, in contrast to patients with type B fibrils. These results might have significant clinical implications in optimizing best patients selection criteria for LTx.
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27. |
- Hagel, Sofia, et al.
(author)
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Team-based rehabilitation improves long-term aerobic capacity and health-related quality of life in patients with chronic inflammatory arthritis.
- 2010
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 32, s. 1686-1696
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Journal article (peer-reviewed)abstract
- Purpose. To examine the effect of an interdisciplinary, out-patient rehabilitation programme for patients with chronic inflammatory arthritis on aerobic capacity and health-related quality of life (HRQOL). Method. One hundred and seventy-four patients, 115 with peripheral arthritis (PA) (91 women, mean age 53 years, disease duration 16 years) and 59 with spondylarthropathies (SpA), (27 women, mean age 46 years, disease duration 14 years) were consecutively enrolled in 18 days of interdisciplinary rehabilitation. We report data from evaluations at inclusion, at discharge, and at 4 and 12 months using a sub-maximal treadmill test of aerobic capacity and the Nottingham Health Profile (NHP) (t-test). Results. At inclusion, less than 20% of all patients tested had aerobic capacity classified as 'average' or better. At discharge, 41% (PA) and 54% (SpA) reached the 'average' level or better with improvements maintained for 12 months. The total NHP scores improved in both groups (mean change -12 (99%CI -15, -9) for PA; mean change -13 (99%CI -19, -8) for SpA) and were maintained. Conclusion. Aerobic capacity and HRQOL improved significantly in this interdisciplinary out-patient rehabilitation study, and improvements were maintained for 12 months. The preserved level of aerobic capacity after 12 months indicated a change to a more physically active lifestyle among the participants.
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28. |
- Hagel, Sofia, et al.
(author)
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Trends in 21st century Health Care Utilization in a Rheumatoid Arthritis Cohort Compared to the General Population
- 2012
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In: Arthritis and Rheumatism. - Hoboken, NJ : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 64:S10, s. S31-S32
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Journal article (peer-reviewed)abstract
- Statement of purpose: To study twenty-first century trends in health care utilization by rheumatoid arthritis (RA) patients compared to the general population. Methods: Observational cohort study; using Swedish health care register data, we identified 3977 Region Skåne residents (mean age year 2001, 62.7 years and 73% women) consulting for RA (ICD-10 codes M05 or M06) in 1998-2001. We randomly sampled two referents from the general population per RA patient matched for age, sex, and area of residence. We calculated the year 2001-2010 trends for the annual ratio (RA cohort/referents) of the mean number of hospitalizations and outpatient clinic visits. Results: By the end of the 10-year period 62% of RA patients and 74% of referents were still alive and resident in the region. From 2001 to 2010 the ratio (RA cohort/referents) of the mean number of hospitalizations for men and women decreased by 27% (p=0.01) and 28% (p=0.004), respectively. The corresponding decrease was 29% (p=0.005), and 16% (p=0.004) for outpatient physician care, 34% (p=0.009) and 18% (p=0.01) for nurse visits, and 34% (p=0.01) and 28% (p=0.004) for physiotherapy (Figure 1 and 2). Figure 1.Health care utilization during the first decade of the twenty-first century by patients in a closed rheumatoid arthritis cohort and their matched referents from the general population. The y-axes show the mean number of visits per subject per calendar year. Figure 2.Health care utilization during the first decade of the twenty-first century by patients in a closed rheumatoid arthritis cohort and their matched referents from the general population. The y-axes show the mean number of visits per subject per calendar year. Conclusions: During the twenty-first century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, the overall inpatient and outpatient health care utilization by a cohort of RA patients decreased relative to the general population.
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29. |
- Hagel, Sofia, et al.
(author)
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Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population.
- 2013
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In: Annals of the Rheumatic Diseases. - London : BMJ. - 1468-2060 .- 0003-4967. ; 72:7, s. 1212-1216
-
Journal article (peer-reviewed)abstract
- PURPOSE: To study 21st century trends in healthcare utilisation by patients with rheumatoid arthritis (RA) compared with the general population. METHODS: Observational cohort study. Using Swedish healthcare register data, we identified 3977 Region Skåne residents (mean age in 2001, 62.7 years; 73% women) presenting with RA (International Classification of Diseases-10 codes M05 or M06) in 1998-2001. We randomly sampled two referents from the general population per RA patient matched for age, sex and area of residence. We calculated the year 2001-2010 trends for the annual ratio (RA cohort/referents) of the mean number of hospitalisations and outpatient clinic visits. RESULTS: By the end of the 10-year period, 62% of patients and 74% of referents were still alive and resident in the region. From 2001 to 2010, the ratio (RA cohort/referents) of the mean number of hospitalisations for men and women decreased by 27% (p=0.01) and 28% (p=0.004), respectively. The corresponding decrease was 29% (p=0.005) and 16% (p=0.004) for outpatient physician care, 34% (p=0.009) and 18% (p=0.01) for nurse visits, and 34% (p=0.01) and 28% (p=0.004) for physiotherapy. The absolute reduction in number of hospitalisations was from an annual mean of 0.79 to 0.69 in male patients and from 0.71 to 0.59 in female patients. The corresponding annual mean number of consultations in outpatient physician care by male and female RA patients changed from 9.2 to 7.7 and from 9.9 to 8.7, respectively. CONCLUSIONS: During the first decade of the 21st century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, overall inpatient and outpatient healthcare utilisation by a cohort of patients with RA decreased relative to the general population.
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30. |
- Hagel, Sofia, et al.
(author)
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Validation of outcome measurement instruments used in a multidisciplinary rehabilitation intervention for patients with chronic inflammatory arthritis: Linking of the International Classification of Functioning, Disability and Health, construct validity and responsiveness to change.
- 2011
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In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 43:5, s. 411-419
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Journal article (peer-reviewed)abstract
- Objective: To determine the validity of 15 standardized instruments frequently used to measure the outcome of chronic arthritis treatment. Methods: Analyses were performed on data collected at a rehabilitation programme (n=216). The outcome measures evaluated were health-related quality of life, global health, pain, physical function and aerobic capacity. The instrument items were linked to the International Classification of Functioning, Disability and Health (ICF) (content validity), construct validity was analysed based on predetermined hypothesis (Spearman's correlations, r(s)), and responsiveness (after 18 days and 12 months) by the standardized response mean. Results: Most instruments covered the ICF component body function and/or activity-participation, only a few covered the environmental component. The short Euroqol-5 Dimensions performed as well as the longer health-related quality of life instruments in covering the ICF and in responsiveness. The health-related quality of life instruments did not measure similar constructs as hypothesized, neither did pain measures. The Bath Ankylosing Spondylitis indices covered several components of the ICF often exhibiting a large responsiveness. Aerobic capacity had the largest responsiveness of all measures. Conclusion: Many instruments are not highly correlated, although at face value they appear to measure the same construct, information also applying to content validity and responsiveness. Results from this study can assist in choosing outcome measures in the clinic and in research.
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31. |
- Hagel, Sofia, et al.
(author)
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Which patients improve the most after arthritis rehabilitation? A study of predictors in patients with inflamatory arthritis in northern Europe, the STAR-ETIC collaboration
- 2014
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In: Journal of Rehabilitation Medicine. - Uppsala : Foundation of Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 46:3, s. 250-257
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investigated.DESIGN: Multicentre prospective observational study in 4 European countries.METHODS: HRQoL was measured with the European Quality 5 Dimensions (EQ-5D) and the Short Form 36 Health Survey (SF-36) in 731 patients who underwent multidisciplinary rehabilitation. Potential predictors were physical functioning (Health Assessment Questionnaire (HAQ)), self-efficacy (Arthritis Self Efficacy Scale (ASES)), psychological health (Hopkins Symptom Check List (HSCL-25)), pain/fatigue (numeric rating scales (NRS)), age, sex, diagnosis, comorbidity, education, clinical setting and change of medication during rehabilitation. Analysis of covariance (ANCOVA) was used to assess for potential predictors and interactions. The minimal important differences for HRQoL were analysed.RESULTS: Reporting worse function (b 0.05, p = 0.01), less psychological well-being (b 0.09, p = 0.000), and experiencing more pain (b 0.03, p = 0.000) or fatigue (b 0.02, p = 0.000) at admission predicted improved HRQoL. Change in medication during rehabilitation (b 0.08, p = 0.013) was associated with greater improvement in HRQoL. These EQ-5D findings were supported by SF-36 findings. Positive minimal important differences were noted in 46% (EQ-5D) and 23-47% (SF-36 subscales) of the patients.CONCLUSION: Patients with more severe symptoms experienced the largest gain in HRQoL post-intervention. The results of this study are of value for selecting the right patients for rheumatological team rehabilitation. © 2014 The Authors
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32. |
- Hagel, Sofia, et al.
(author)
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Which patients improve the most from arthritis rehabilitation? Results from patients with inflammatory arthritis in northern Europe, the STAR-ETIC collaboration.
- 2014
-
In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 46:3, s. 250-257
-
Journal article (peer-reviewed)abstract
- Objective: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investigated. Design: Multicentre prospective observational study in 4 European countries. Methods: HRQoL was measured with the European Quality 5 Dimensions (EQ-5D) and the Short Form 36 Health Survey (SF-36) in 731 patients who underwent multidisciplinary rehabilitation. Potential predictors were physical functioning (Health Assessment Questionnaire (HAQ)), self-efficacy (Arthritis Self Efficacy Scale (ASES)), psychological health (Hopkins Symptom Check List (HSCL-25)), pain/fatigue (numeric rating scales (NRS)), age, sex, diagnosis, comorbidity, education, clinical setting and change of medication during rehabilitation. Analysis of covariance (ANCOVA) was used to assess for potential predictors and interactions. The minimal important differences for HRQoL were analysed. Results: Reporting worse function (b 0.05, p = 0.01), less psychological well-being (b 0.09, p = 0.000), and experiencing more pain (b 0.03, p = 0.000) or fatigue (b 0.02, p = 0.000) at admission predicted improved HRQoL. Change in medication during rehabilitation (b 0.08, p = 0.013) was associated with greater improvement in HRQoL. These EQ-5D findings were supported by SF-36 findings. Positive minimal important differences were noted in 46% (EQ-5D) and 23-47% (SF-36 subscales) of the patients. Conclusion: Patients with more severe symptoms experienced the largest gain in HRQoL post-intervention. The results of this study are of value for selecting the right patients for rheumatological team rehabilitation.
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33. |
- Hagel, Sofia, et al.
(author)
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Who will achieve individually set goals after arthritis team rehabilitation?
- 2013
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In: Arthritis and Rheumatism. - Hoboken, NJ : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 65:Special issue, Supplement 10, s. S898-S898, Meeting Abstract: 2110
-
Journal article (peer-reviewed)abstract
- Background/Purpose: To study goal achievement among patients with chronic inflammatory arthritis after arthritis rehabilitation performed in multidisciplinary team rehabilitation programs.Methods: 146 consecutive patients with rheumatoid arthritis (RA) and spondylarthritis (SpA), age 18 years or older, completing arthritis rehabilitation for 5 days or more at 2 rheumatology specialist units were included in this study. At admission and discharge the patients were evaluated with measures on functioning (HAQ), self efficacy (ASES), psychological health (Hopkins Symptom Checklist – HSCL-25), pain and fatigue (NRS) and on health related quality of life (HRQoL) as captured by the EQ-5D and the SF-36. Comorbidity and social demographics was also reported. The patients, in cooperation with the health professionals, set individual goals for their rehabilitation period. At discharge the patients reported if the goal was achieved completely, partially or not at all.Non parametric statistical analyses were performed and Chi2 and Kruskal-Wallis analyses were used to study the relationship between goal achievement and baseline and change variables. Results: 108/146 patients reported whether goals were achieved or not, and were included in further analyses. 76% were females and 55% had RA. At baseline median age was 54 years (IQR 17), median HAQ 0.88 (IQR 0.88), median HRQoL as captured by the EQ-5D 0.62 (IQR 0.57) and median psychological wellbeing according to HSCL-25 1.62 (IQR 0.68). The patients reported median fatigue 6.0 (IQR 4.0) and median pain 5.0 (IQR 3.0) when entering the rehabilitation program that lasted for median 18 days (IQR 2).58/108 patients (54%) rated their goal to be completely achieved, 40 patients (37%) reported partial goal achievement while 10 (9%) patients had not achieved their goal. Positive reporting of having followed the recommendations (compliance) during the rehabilitation period was obtained from 100 (93%) of the patients.Change after intervention and compliance did not affect reports of goal achievement after rehabilitation. Females reported goal achievement more often than men did (p=0.019). Those not achieving their goals reported less psychological wellbeing (HSCL-25, p=0.011) at admission together with reports of worse pain (SF-36bp, p=0.011). Conclusion: 54% of the included patients reported complete goal achievement after arthritis team rehabilitation. Neither change after intervention nor compliance affected patients’ reports of goal achievement. Female patients were more prone to achieve their goals while patients experiencing less psychological wellbeing or more pain at baseline were less prone to report goal achievement.
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34. |
- Hamberg, Viggo, et al.
(author)
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Elevated fecal levels of the inflammatory biomarker calprotectin in early systemic sclerosis
- 2023
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In: Rheumatology International. - : Springer Science and Business Media LLC. - 0172-8172 .- 1437-160X. ; 43:5, s. 961-967
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Journal article (peer-reviewed)abstract
- Knowledge on gastrointestinal manifestations in early systemic sclerosis (SSc) is limited. We have investigated gastrointestinal inflammation in SSc at the time of diagnosis using the inflammatory biomarker Fecal calprotectin (F-cal). Consecutive patients with suspected SSc were characterized in relation to the 2013 classification criteria for SSc and classified as SSc or SSc-like disease. F-cal levels were measured with a polyclonal ELISA (Calpro A/S, Lysaker, Norway) and levels above 50 µg/g were considered elevated. F-cal levels were compared to those of control subjects without rheumatic disease. Of 137 patients with suspected SSc, 92 were classified as SSc and 45 as SSc-like disease. Median (interquartile range) disease duration among the SSc participants was 2.5 (1.2, 4.6) years. A substantial proportion of participants classified as SSc (35/92, 38%) and SSc-like disease (14/45, 31%) exhibited elevated F-cal compared to the control group (3/41, 7.3%; p < 0.001 and p = 0.007, respectively). Elevated F-cal was associated with proton pump inhibitor usage (OR 7.14; 95% CI 2.56–29.93; p < 0.001). We conclude that elevated F-cal is present in a subgroup of patients with SSc at the time of diagnosis, suggesting that that GI inflammation may be present in this patient group early in the disease course. F-cal did not exhibit potential to differentiate SSc from SSc-like disease.
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35. |
- Jacobsson, Lennart, et al.
(author)
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Treatment with TNF-blockers and mortality risk in patients with rheumatoid arthritis.
- 2007
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 66:5, s. 670-675
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Journal article (peer-reviewed)abstract
- Objective: To assess mortality in patients with rheumatoid arthritis ( RA) treated with tumour necrosis factor (TNF) inhibitors, compared with a standard RA population. Methods: Patients were recruited from a regional register, which includes over 90% of patients with RA treated with TNF blockers in the area in 1999 or later, and a local community-based cohort of patients with RA, established in 1997. Of a total of 1430 patients in the combined cohort,80 years old, 921 received treatment with TNF inhibitors during the study period. The total cohort was linked with the national register for cause of death. Overall mortality in those treated versus those not treated with TNF blockers was estimated using standardised mortality ratios and time-dependent Cox proportional hazards. Results: There were 188 deaths per 7077 person-years at risk in the total cohort. Controlling for age, sex, disability and baseline comorbidity, the adjusted HR for death was 0.65 (95% CI 0.46 to 0.93) in those treated with anti-TNF versus those not treated. The effect was significant in women (HR=0.52, 95% CI 0.33 to 0.82) but not in men (HR=0.95, 95% CI 0.52 to 1.71). Conclusion: After adjusting for disease severity, treatment with TNF inhibitors was found to be associated with a reduced mortality in women but not men with RA. These findings are compatible with a critical role for inflammation in RA-associated premature mortality.
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36. |
- Janelidze, Shorena, et al.
(author)
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Increased CSF biomarkers of angiogenesis in Parkinson disease
- 2015
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In: Neurology. - 0028-3878 .- 1526-632X. ; 85:21, s. 1834-1842
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Journal article (peer-reviewed)abstract
- To study biomarkers of angiogenesis in Parkinson disease (PD), and how these are associated with clinical characteristics, blood-brain barrier (BBB) permeability, and cerebrovascular disease.
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37. |
- Johansson, Birgitta, et al.
(author)
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Effects of vitamin status and health in dairy cows fed without synthetic vitamins
- 2012
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In: Landbauforschung Völkenrode. Sonderheft. - 0376-0723. ; , s. 394-397
-
Conference paper (peer-reviewed)abstract
- Synthetic vitamin supplementation is not consistent with organic production and it is important to investigate how dairy cows manage without synthetic vitamin supplementation. The study aimed to compare the performance of cows given no synthetic vitamins (NSV) with cows (control; C) fed synthetic vitamins according to Swedish recommendations. Swedish Holstein cows (n=28) fed a 100 % organic diet were studied during two lactations. Vitamin status in cow plasma and milk, milk yield and composition, health and fertility were measured. From each cow, five blood and five milk samples were collected during lactation. In first lactation, C cows tended to have a higher concentration of α-tocopherol and their β-carotene concentration was higher compared to NSV cows. The C cows tended to have fewer cases of mastitis than NSV cows in the second lactation. No differences were found in production and fertility. In conclusion, dairy cows need vitamin A and E supplement, at least around calving when the requirements are high.
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38. |
- Johansson, Birgitta, et al.
(author)
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Status of vitamins E and A and β-carotene and health in organic dairy cows fed a diet without synthetic vitamins
- 2014
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In: Journal of Dairy Science. - : American Dairy Science Association. - 0022-0302 .- 1525-3198. ; 97, s. 1682-1692
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Journal article (peer-reviewed)abstract
- Synthetic vitamin supplementation is not consistent with organic production, so it is important to investigate whether dairy cows can maintain their health and production without synthetic vitamins being added to their diet. In basic dairy cow diets, provitamin A (beta-carotene) and vitamin E are mainly found in pasture and in grass and legume silages, but the concentrations are highly variable. This study compared the vitamin status and health of cows without synthetic vitamin supplementation (NSV group) with control cows (CON group) fed synthetic vitamins according to Swedish recommendations (600 IU of vitamin E and 80,000 IU of vitamin A per cow per day) to investigate whether dairy cows can fulfill their requirements of vitamins A and E without supplementation with synthetic vitamins. Vitamin concentrations in blood plasma and milk, health, fertility, milk yield, and milk composition were measured in Swedish Holstein cows (n = 28) during 2 complete lactations. All cows were fed a 100% organic diet containing grass-legume silage, cold-pressed rapeseed cake, peas, cereal grains, and minerals. Blood samples were collected from each cow 3 wk before expected calving, at calving, and 3 wk, 3 to 5 mo, and 7 to 9 mo after calving. Samples of colostrum were taken and milk samples were collected 4 d after calving and at the same time as the 3 blood samplings after calving. The only difference in vitamin status between groups was found in colostrum in yr 1, when CON cows tended to have a higher concentration of alpha-tocopherol, and their beta-Carotene concentration was higher compared with NSV cows. The NSV cows tended to have more cases of mastitis than CON cows in yr 2. Within the NSV group, fewer cows were healthy and more cases of mastitis were observed in yr 2 than in yr 1. The groups did not differ in production parameters. In conclusion, the vitamin status in blood and milk of the studied cows indicated that cows in organic dairy production can fulfill their requirements of vitamins A and E without any supplementation of synthetic vitamins, except at the time around calving, when the requirements are high. However, the impaired health of NSV cows in yr 2 may indicate a long-term negative health effect in cows fed no synthetic vitamins.
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39. |
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40. |
- Knevel, R., et al.
(author)
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A genetic variant in granzyme B is associated with progression of joint destruction in rheumatoid arthritis
- 2013
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In: Arthritis and Rheumatism. - : Wiley. - 1529-0131 .- 0004-3591. ; 65:3, s. 582-589
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Journal article (peer-reviewed)abstract
- Objective Genetic factors account for an estimated 4558% of the variance in joint destruction in rheumatoid arthritis (RA). The serine proteinase granzyme B induces target cell apoptosis, and several in vitro studies suggest that granzyme B is involved in apoptosis of chondrocytes. Serum levels of granzyme B are increased in RA and are also associated with radiographic erosions. The aim of this study was to investigate GZMB as a candidate gene accounting for the severity of joint destruction in RA. Methods A total of 1,418 patients with 4,885 radiograph sets of the hands and feet from 4 independent cohorts were studied. First, explorative analyses were performed in 600 RA patients in the Leiden Early Arthritis Clinic cohort. Fifteen single-nucleotide polymorphisms (SNPs) tagging GZMB were tested. Significantly associated SNPs were genotyped in data sets representing patients from the Groningen, Sheffield, and Lund cohorts. In each data set, the relative increase in the annual rate of progression in the presence of a genotype was assessed. Data were summarized in a meta-analysis. The association of GZMB with the RNA expression level of the GZMB genomic region was tested by mapping expression quantitative trait loci (QTLs) on 1,469 whole blood samples. Results SNP rs8192916 was significantly associated with the rate of joint destruction in the first cohort and in the meta-analysis of all data sets. Patients homozygous for the minor allele of rs8192916 had a higher rate of joint destruction per year compared with other patients (P = 7.8 x 104). Expression QTL of GZMB identified higher expression in the presence of the minor allele of rs8192916 (P = 2.27 x 105). Conclusion SNP rs8192916 located in GZMB is associated with the progression of joint destruction in RA as well as with RNA expression in whole blood.
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41. |
- Knevel, Rachel, et al.
(author)
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A genetic variant in osteoprotegerin is associated with progression of joint destruction in rheumatoid arthritis
- 2014
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In: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 16:3
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Journal article (peer-reviewed)abstract
- Introduction: Progression of joint destruction in rheumatoid arthritis (RA) is partly heritably; 45 to 58% of the variance in joint destruction is estimated to be explained by genetic factors. The binding of RANKL (Receptor Activator for Nuclear Factor kappa B Ligand) to RANK results in the activation of TRAF6 (tumor necrosis factor (TNF) receptor associated factor-6), and osteoclast formation ultimately leading to enhanced bone resorption. This bone resorption is inhibited by osteoprotegerin (OPG) which prevents RANKL-RANK interactions. The OPG/RANK/RANKL/TRAF6 pathway plays an important role in bone remodeling. Therefore, we investigated whether genetic variants in OPG, RANK, RANKL and TRAF6 are associated with the rate of joint destruction in RA. Methods: 1,418 patients with 4,885 X-rays of hands and feet derived from four independent data-sets were studied. In each data-set the relative increase of the progression rate per year in the presence of a genotype was assessed. First, explorative analyses were performed on 600 RA-patients from Leiden. 109 SNPs, tagging OPG, RANK, RANKL and TRAF6, were tested. Single nucleotide polymorphisms (SNPs) significantly associated in phase-1 were genotyped in data-sets from Groningen (Netherlands), Sheffield (United Kingdom) and Lund (Switzerland). Data were summarized in an inverse weighted variance meta-analysis. Bonferonni correction for multiple testing was applied. Results: We found that 33 SNPs were significantly associated with the rate of joint destruction in phase-1. In phase-2, six SNPs in OPG and four SNPs in RANK were associated with progression of joint destruction with P-value <0.05. In the meta-analyses of all four data-sets, RA-patients with the minor allele of OPG-rs1485305 expressed higher rates of joint destruction compared to patients without these risk variants (P = 2.35x10(-4)). This variant was also significant after Bonferroni correction. Conclusions: These results indicate that a genetic variant in OPG is associated with a more severe rate of joint destruction in RA.
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42. |
- Knevel, R., et al.
(author)
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Genetic variants in IL15 associate with progression of joint destruction in rheumatoid arthritis: a multicohort study
- 2012
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 71:10, s. 1651-1657
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Journal article (peer-reviewed)abstract
- Background Interleukin (IL)-15 levels are increased in serum, synovium and bone marrow of patients with rheumatoid arthritis (RA). IL-15 influences both the innate and the adaptive immune response; its major role is activation and proliferation of T cells. There are also emerging data that IL-15 affects osteoclastogenesis. The authors investigated the association of genetic variants in IL15 with the rate of joint destruction in RA. Method 1418 patients with 4885 x-ray sets of both hands and feet of four independent data sets were studied. First, explorative analyses were performed on 600 patients with early RA enrolled in the Leiden Early Arthritis Clinic. Twenty-five single-nucleotide polymorphisms (SNPs) tagging IL-15 were tested. Second, SNPs with significant associations in the explorative phase were genotyped in data sets from Groningen, Sheffield and Lund. In each data set, the relative increase of the progression rate per year in the presence of a genotype was assessed. Subsequently, data were summarised in an inverse weighting meta-analysis. Results Five SNPs were significantly associated with rate of joint destruction in phase 1 and typed in the other data sets. Patients homozygous for rs7667746, rs7665842, rs2322182, rs6821171 and rs4371699 had respectively 0.94-, 1.04-, 1.09-, 1.09- and 1.09- fold rate of joint destruction compared to other patients (p = 4.0x10(-6), p = 3.8x10(-4), p = 5.0x10(-3), p = 5.0x10(-3) and p = 9.4x10(-3)). Discussion Independent replication was not obtained, possibly due to insufficient power. Meta-analyses of all data sets combined resulted in significant results for four SNPs (rs7667746, p < 0.001; rs7665842, p < 0.001; rs4371699, p = 0.01; rs6821171, p = 0.01). These SNPs were also significant after correction for multiple testing. Conclusion Genetic variants in IL-15 are associated with progression of joint destruction in RA.
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43. |
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44. |
- Krabben, A., et al.
(author)
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Association of Genetic Variants in the IL4 and IL4R Genes With the Severity of Joint Damage in Rheumatoid Arthritis: A Study in Seven Cohorts
- 2013
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In: Arthritis and Rheumatism. - : Wiley. - 1529-0131 .- 0004-3591. ; 65:12, s. 3051-3057
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Journal article (peer-reviewed)abstract
- ObjectiveThe progression of joint destruction in rheumatoid arthritis (RA) is determined by genetic factors. Changes in IL4 and IL4R genes have been associated with RA severity, but this finding has not been replicated. This study was undertaken to investigate the association between IL4- and IL4R-tagging single-nucleotide polymorphisms (SNPs) and the progression rate of joint damage in RA in a multicohort candidate gene study. MethodsIL4- and IL4R-tagging SNPs (n = 8 and 39, respectively) were genotyped in 600 RA patients for whom 2,846 sets of radiographs of the hands and feet were obtained during 7 years of followup. Subsequently, SNPs significantly associated with the progression of joint damage were genotyped and studied in relation to 3,415 radiographs of 1,953 RA patients; these included data sets from Groningen (The Netherlands), Lund (Sweden), Sheffield (UK), the North American Rheumatoid Arthritis Consortium (US), Wichita (US), and the National Data Bank (US). The relative increase in progression rate per year in the presence of a genotype was determined in each cohort. An inverse variance weighting meta-analysis was performed on the 6 data sets that together formed the replication phase. ResultsIn the discovery phase, none of the IL4 SNPs and 7 of the IL4R SNPs were significantly associated with the joint damage progression rate. In the replication phase, 2 SNPs in the IL4R gene were significantly associated with the joint damage progression rate (rs1805011 [P = 0.02] and rs1119132 [P = 0.001]). ConclusionGenetic variants in IL4R were identified, and their association with the progression rate of joint damage in RA was independently replicated.
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45. |
- Landgren, Ellen, et al.
(author)
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Belonging, happiness, freedom and empowerment - a qualitative study of patients' understanding of health in early rheumatoid arthritis
- 2024
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In: BMC Rheumatology. - London : Springer Nature. - 2520-1026. ; 8:1
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Journal article (peer-reviewed)abstract
- Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease, that influences patients’ health in different ways, including physical, social, emotional, and psychological aspects. The goal of rheumatology care is to achieve optimal health and personalised care and therefore, it is essential to understand what health means for patients in the early course of RA. The aim of this study was to describe the understanding of health among patients with early RA.Methods: The study had a descriptive qualitative design with a phenomenographic approach. Phenomenography is used to analyse, describe, and understand various ways people understand or experience a phenomenon, in this study, patients’ understandings of health. Individual semi-structured interviews were conducted with 31 patients (22 women and nine men, aged (38–80) with early RA, defined as a disease duration of < 1 year, and disease-modifying anti-rheumatic drugs (DMARDs) for 3–7 months. The phenomenographic analysis was conducted in 7 steps, and the outcome space presents the variation in understanding and the interrelation among categories. In accordance with the European Alliance of Associations for Rheumatology’s (EULAR) recommendations, a patient research partner participated in all phases of the study.Results: The analysis revealed four main descriptive categories: ‘Health as belonging’ was described as experiencing a sense of coherence. ‘Health as happiness’ was understood as feeling joy in everyday life. ‘Health as freedom’ was understood as feeling independent. ‘Health as empowerment’ was understood as feeling capable. Essential health aspects in early RA are comprised of a sense of coherence, joy, independence, and the capability to manage everyday life.Conclusions: This study revealed that patients’ perception of health in early RA encompasses various facets, including a sense of belonging, happiness, freedom, and empowerment. It highlighted that health is multifaceted and personal, emphasizing the importance of acknowledging this diversity in providing person-centred care. The findings can guide healthcare professionals to deepen patients’ participation in treatment goals, which may lead to better treatment adherence and health outcomes. © The Author(s) 2024.
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46. |
- Landgren, Ellen, et al.
(author)
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“Mastering a New Life Situation” – Patients’ Preferences of Treatment Outcomes in Early Rheumatoid Arthritis – A Longitudinal Qualitative Study
- 2020
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In: Patient Preference and Adherence. - : Dove Medical Press Ltd.. - 1177-889X. ; 14, s. 1421-1433
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Journal article (peer-reviewed)abstract
- Purpose: To explore patients’ preferred treatment outcomes during their first two years with rheumatoid arthritis (RA). Patients and Methods: A qualitative, longitudinal, multicenter study with interviews at two time points was performed in Sweden. Individual interviews were conducted at time point 1 with 31 patients with RA, defined as disease duration of ≤1 year and treatment for 3–7 months. Seven focus group interviews and five individual interviews were conducted at time point 2 with 22 patients 12–20 months after treatment initiation. The interviews were analyzed using the Qualitative Analysis Guide of Leuven. A core category with four related concepts emerged. Results: The core finding of patient-preferred treatment outcomes was “mastering a new life situation”. Patients preferred to experience control of the disease by controlling the symptoms and by experiencing absence of disease. To experience autonomy by regaining former activity level, experiencing independence, and being empowered was another preferred outcome. Patients preferred to regain identity through being able to participate, experience well-being, and regain former self-image. To experience joy in everyday life through vitality and believing in the future was another preferred outcome. Patients’ preferences developed over time from the acute phase of controlling the symptoms and wanting to return to the life they lived prior to diagnosis, to a more preventive way of self-management and empower-ment to master the new life situation. Conclusion: The patients’ preferred treatment outcomes during the first two years with RA were to master their new life situation and changed from a preference to return to a life lived prior disease onset, to a preference of living with quality of life, despite RA. This study increases the understanding of patients’ preferred treatment outcomes in the early disease course and can be a foundation for tailoring interventions to be more person-centered and to improve long-term treatment outcomes. © 2020 Landgren et al.
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47. |
- Landgren, Ellen, et al.
(author)
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Patients’ experiences of health in early rheumatoid arthritis – a qualitative study
- 2018
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In: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 77, s. 1802-1803
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Journal article (other academic/artistic)abstract
- Background: The World Health Organization defines health as ”a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Health changes dramatically when a person becomes ill in a chronic disease as rheumatoid arthritis (RA). RA is a disease with great impact on all aspects of life. Living with RA affects patients’ health including physical, emotional, psychological and social aspects. The purpose of a person-centered care is to see patients as experts; sharing decisions with them and helping them manage their health. Therefore it is important to understand how patients in early disease stage of RA experience the concept of health.Objectives: The purpose of this study was to describe patients’ experiences of health in early RA.Methods: The study had a descriptive design with a qualitative content analysis approach. Individual interviews were conducted with 24 patients with early RA. In this study the patients had disease duration less than 12 months. A manifest qualitative content analysis was used to analyze the question: “What does health mean to you?”Results: In the early stage of RA, patients experienced health as the most important goal in their life. They described health as well-being, independence, life satisfaction and vitality. Health as well-being meant to feel good, be painless and have a good sleep to feel rested. Health as independence meant to have both physical and financial prerequisites to perform everyday activities, to exercise and being able to travel. Health as life satisfaction meant to feel joy in life, enjoy the family and to believe in the future. Health as vitality meant to have the energy, power and strength to cope with everyday life. The patients expressed that their health had been adversely affected by the RA disease and they had a strong desire for full health including well-being, independence, life satisfaction and vitality.Conclusions: Patients in an early stage of RA describe a strong desire to regain health in terms of well-being, independence, life satisfaction and vitality. The concept of health at early RA is similar to health at established RA in terms of well-being, independence and life satisfaction. Unique findings for patients with early RA are the description of health as vitality, and the emphasis of having energy, power and strength to cope with everyday life. Health professionals should have these different ways of experiencing health in mind when providing person-centred care to patients with early RA. Depending on the patients’ perception of health, different support strategies are needed.
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48. |
- Landgren, Ellen, et al.
(author)
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Patients’ Perceptions of Person‐Centered Care in Early Rheumatoid Arthritis : A Qualitative Study
- 2021
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In: ACR Open Rheumatology. - Hoboken, NJ : John Wiley & Sons. - 2578-5745. ; 3:11, s. 788-795
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Journal article (peer-reviewed)abstract
- Objective: Most research on patient experiences of rheumatoid arthritis (RA) care is performed with patients who have established RA and less often with patients with early RA. Experiences of and expectations about health care may change over time, which is why the aim was to explore patients’ perceptions of person-centered care (PCC) early in the RA disease course.Methods: Thirty-one patients with early RA were interviewed in this qualitative study. An abductive qualitative content analysis was conducted based on the framework of McCormack and McCance (1,2). The four constructs, prerequisites, care environment, person-centered processes, and person-centered outcomes, constituted the four categories in the deductive part of the study. An inductive analysis generated 11 subcategories exploring the content of PCC.Results: For patients with early RA, PCC was described in terms of 1) prerequisites including being treated with respect, meeting dedicated health care professionals, and meeting professional competence; 2) care environment including having access to a multidisciplinary team, having access to health care, and encountering a supportive organization; 3) person-centered processes including being listened to, being supported, and being involved in decision-making; and 4) person-centered outcomes including being satisfied with received health care and achieving optimal health.Conclusion: Genuine PCC is important for patients early in the RA disease course, supporting the implementation of a person-centered approach during all stages in the health care system. This study contributes to information about how to further develop person-centeredness in rheumatology care. © 2021 The Authors.
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49. |
- Landgren, Ellen, et al.
(author)
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“To regain one’s health” – patients’ preferencesof treatment outcomes in early rheumatoid arthritis – a qualitative study
- 2019
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In: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl 2, s. 648-648
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Journal article (peer-reviewed)abstract
- Background: Rheumatology care strives to identify and meet the needs of the patients, and to understand disease and treatment impact from the patients’ perspective. A better understanding of patients’ expectations from the treatment is needed to enable a patient centered approach in clinical practice and a shared-decision making as recommended in the EULAR treatment recommendations for rheumatoid arthritis (RA). Understanding of patients’ expectations in the early stage of the RA disease may facilitate adherence to treatment, patient independence and prevent unmet needs in the future.Objectives: To explore patients’ preferred treatment outcomes in early rheumatoid arthritis (eRA).Methods: A qualitative, explorative study. Individual interviews were conducted with 31 patients with eRA, defined as disease duration of ≤ 1 year and disease-modifying antirheumatic drugs (DMARDs) treatment for 3-6 months 1 . Interviews were analyzed using a constant comparison method according to the Qualitative Analysis Guide of Leuven (QUAGOL) and lasted in a core category and four related concepts.Results: The patient-preferred treatment outcomes in eRA were described in the core category “to regain one’s health” and the four related concepts: to experience external control of the disease, to experience independence, to regain identity and to experience joy in everyday life. The patients expected to experience external control of the disease by the given treatment to regain one’s health. It was perceived as controlling the symptoms and as absence of disease. Independence was perceived as regaining former activity levels, experiencing autonomy and using active coping strategies. Patients wanted to regain identity through participation, empowerment and their self-image. Joy in everyday life was perceived as vitality and believing in the future.Conclusion: Patients’ preferred treatment outcomes in eRA were to regain one’s health including both external and internal control. External control as disease control and independence as well as internal control as identity and joy in everyday life. The results from this study can assist healthcare professionals to better understand patients’ preferred treatment outcomes early in the disease process and to tailor the interventions accordingly to improve long term treatment outcome. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
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50. |
- Larsson, Ingrid, 1968-, et al.
(author)
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Patients’ experiences of living with RA after 1-2 years of DMARD treatment
- 2022
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In: Reumabulletinen. - Stockholm : Svensk reumatologisk förening. - 2000-2246 .- 2001-8061. ; 154:4, s. 66-67
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Journal article (peer-reviewed)abstract
- Background: Rheumatoid arthritis (RA) is a disease with a great impact on all aspects of life. Living with RA affects patients’ health including physical, emotional, psychological, and social aspects. Patients with RA are treated with disease-modifying anti-rheumatic drugs (DMARDs) and monitored with tight control to achieve low disease activity or remission. Nevertheless, RA can be life-changing when the patients need long-term treatment to control the disease activity. The goal of treatment for patients with chronic diseases such as RA is to achieve optimal health and a life as normal as possible. It is therefore important to gain knowledge about how patients experience everyday life a short period after the initiation of DMARD treatment. Aim: To describe patients’ experiences of living with RA after 1-2 years of DMARD treatment.Methods: The study has a qualitative design with an inductive approach. Focus groups (n=17) and individual (n=5) interviews were conducted with 22 patients with RA. The participants consisted of 15 women and 7 men with a mean age of 57 years and a disease duration of 12-21 months. The participants were treated with conventional or biological DMARDS for 12-20 months. The main questions were: “Can you tell me how RA impacts your daily life?” “Which outcomes of your RA are important to you at this moment?“ The interviews were analyzed with qualitative content analysis and five categories with an overarching theme emerged (Table 1).Results: Patients’ experiences of living with RA after 1-2 years of DMARD treatment lead to new insights into life and were expressed as 1) Surrendering to disease limitations due to being restricted by pain, fatigue, and in function; 2) Adapting to disease limitations by adjusting one´s work balance and one’s social life; 3) Transitioning in self-identity due to disease limitations by not recognising oneself and experiencing a change of bodily appearance and mood; 4) Fighting disease limitations by experiencing joy through exercise, promoting health by exercise and dietary habits, and; 5) Feeling humility despite disease limitations by being grateful for the treatment and seizing the day.Conclusions: Despite the fact that patients have been living with RA and treated with DMARD for 1-2 years, they are still struggling to make everyday life work. Although patients adapt their lives to the new conditions, their lives are affected by symptoms such as fatigue, pain, stiffness, and side effects such as nausea, hair loss, and weight gain. However, patients highlight the positive effects of how exercise influences their health and how living with RA leads to new insights into life.
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