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2.
  • Bremander, Ann, 1957-, et al. (author)
  • Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis
  • 2011
  • In: Arthritis care & research. - Hoboken, NJ : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 63:4, s. 550-556
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To study the rate of common comorbidities and cardiovascular disease in patients with ankylosing spondylitis (AS) compared with the general population seeking health care.METHODS: This cohort study included 935 subjects (67% men) ages ≥20 years diagnosed with AS and the adult background population in Southern Sweden. During 2004 to 2007 we recorded the occurrence of physicians' diagnostic codes for a select number of comorbidities commonly associated with AS and cardiovascular disease and risk factors. We obtained standardized morbidity-rate ratios (SMRs) by dividing the observed morbidity rate in AS patients by the expected rate based on the corresponding rate of the disease in the general population of the county seeking health care.RESULTS: The highest SMRs were found for uveitis (34.35, 95% confidence interval [95% CI] 28.55-40.98) and inflammatory bowel disease (9.28, 95% CI 7.07-11.97). Also, we found increased SMRs for ischemic heart diseases (2.20, 95% CI 1.77-2.70), hypertension (1.98, 95% CI 1.72-2.28), and diabetes mellitus (1.41, 95% CI 1.10-1.78). Furthermore, the SMRs for psoriasis, osteoporosis, and atrioventricular blocks were also statistically significantly elevated.CONCLUSION: Inflammatory diseases affecting the eye and the digestive system were the most notable comorbidities in AS patients, but the rate for cardiovascular disease was also high. Using comprehensive longitudinal population-based register data is a promising tool to evaluate the excess consultation rate and total burden of rheumatic disease on patients and society. Copyright © 2011 by the American College of Rheumatology.
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  • Demmelmaier, Ingrid, et al. (author)
  • Current and Maintained Health-Enhancing Physical Activity in Rheumatoid Arthritis : A Cross-Sectional Study
  • 2013
  • In: Arthritis Care and Research. - : Wiley. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 65:7, s. 1166-1176
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To describe and identify the explanatory factors of variation in current and maintained health-enhancing physical activity (HEPA) in persons with rheumatoid arthritis (RA).METHODS: In this cross-sectional study, current HEPA was assessed with the International Physical Activity Questionnaire and maintained HEPA with the Exercise Stage Assessment Instrument, the latter explicitly focusing on both aerobic physical activity and muscle strength training. Sociodemographic, disease-related, and psychosocial data were retrieved from the Swedish Rheumatology Quality (SRQ) registers and a postal questionnaire. The explained variations in the respective HEPA behaviors were analyzed with logistic regression.RESULTS: In all, 3,152 (58.5%) of 5,391 persons identified as eligible from the SRQ registers responded to the questionnaire. Current HEPA was reported by 69%, and maintained HEPA by 11% of the respondents. The most salient and consistent factors explaining variation in both current and maintained HEPA were self-efficacy, social support, and outcome expectations related to physical activity.CONCLUSION: To our knowledge, this is the first study exploring maintained physical activity in a large well-defined sample of persons with RA. Our results indicate that a minority perform maintained HEPA, including both aerobic physical activity and muscle strength training, and that psychosocial factors are the most salient and consistent in the explanation of HEPA variation.
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4.
  • Elmberg, Maria, et al. (author)
  • Increased Risk of Arthropathies and Joint Replacement Surgery in Patients With Genetic Hemochromatosis: A Study of 3,531 Patients and Their 11,794 First-Degree Relatives
  • 2013
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 65:5, s. 678-685
  • Journal article (peer-reviewed)abstract
    • Objective Genetic hemochromatosis (GH) is an autosomal recessive disease in individuals of Northern and Western European descent. Heterozygosity for the C282Y mutation is common (620%). Arthropathy is one of the few complications of GH suggested not to be associated with iron body stores; synovial iron deposition remains in iron-depleted patients. Previous studies suggest an elevated prevalence of clinical and radiographic signs of arthropathy in patients with GH, and 2 smaller studies suggest a possibly elevated risk of joint replacement surgery, but more mixed results are shown regarding risks with HFE genotype. We therefore assessed the risks of arthropathy and joint replacement surgery in patients with GH and in their first-degree relatives (FDRs). Methods We performed a population-based cohort study of 3,531 patients with GH and of their 11,794 FDRs (assumed to be heterozygous for the C282Y mutation) using nationwide Swedish population-based health and census registers. Hazard ratios (HRs) of arthropathies and joint replacement surgeries among patients and their FDRs (versus the general population) were assessed using Cox regression. Results Between 1997 and 2005, 406 of 3,531 patients were reported/hospitalized with any noninfectious arthropathies, including osteoarthritis, corresponding to an HR of 2.38 (95% confidence interval [95% CI] 2.142.64). Patients were also at increased risk of hip replacement (HR 2.77, 95% CI 2.273.38) and knee replacement (HR 2.14, 95% CI 1.582.88) surgery. Among the 11,794 FDRs (patients excluded), we found no increased risk of any of the joint morbidities. Conclusion Patients with GH, but not their FDRs, are at increased risk of arthropathies, including the need for joint replacement surgery.
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  • Franklin, Jonas, et al. (author)
  • Natural history of radiographic hip osteoarthritis: A retrospective cohort study with 11-28 years of followup.
  • 2011
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 63:5, s. 689-695
  • Journal article (peer-reviewed)abstract
    • Abstract OBJECTIVE: To evaluate the association between radiographic hip osteoarthritis (OA) and future total hip replacement (THR) due to OA or hip fracture. METHODS: We studied a cohort of individuals who had colon radiography from 1980-1997. Minimal joint space (MJS) was measured and each hip was graded for radiographic OA according to the Kellgren/Lawrence scale. Subjects were followed until the end of 2008. A Cox proportional hazards model, adjusted for age and sex, was used to evaluate factors associated with THR and hip fracture. RESULTS: A total of 2,953 hips were studied (57% women). The cumulative incidence of THR was 2.5% and the cumulative incidence of hip fracture was 2.6%. For hips with radiographic hip OA (MJS of 2.5 mm or less), the cumulative incidence of THR was 16.9% and the hazard ratio (HR) for THR was 13.2 (95% confidence interval [95% CI] 8.1-21). Using Kellgren/Lawrence grading, the HR for THR was 12.9 (95% CI 7.9-21) for hips with radiographic OA compared to those without. The HR for all types of hip fracture for hips with radiographic OA (MJS of 2.5 mm or less) was 0.47 (95% CI 0.15-1.5), for intracapsular fractures was 0.29 (95% CI 0.04-2.1), and for extracapsular fractures was 0.67 (95% CI 0.16-2.8). CONCLUSION: The risk of THR due to OA is substantially increased in patients with radiographic hip OA, regardless of symptoms, and increases with decreasing MJS. However, 11-28 years after having had radiographic hip OA, more than 4 of 5 of those having radiographic signs of hip OA had not had a THR for OA.
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  • Golightly, Yvonne M., et al. (author)
  • Psychometric Properties of the Foot and Ankle Outcome Score in a Community-Based Study of Adults With and Without Osteoarthritis
  • 2014
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 66:3, s. 395-403
  • Journal article (peer-reviewed)abstract
    • ObjectiveFoot and ankle problems are common in adults, and large observational studies are needed to advance our understanding of the etiology and impact of these conditions. Valid and reliable measures of foot and ankle symptoms and physical function are necessary for this research. This study examined psychometric properties of the Foot and Ankle Outcome Score (FAOS) subscales (pain, other symptoms, activities of daily living [ADL], sport and recreational function [sport/recreation], and foot- and ankle-related quality of life [QOL]) in a large, community-based sample of African American and white men and women ages 50 years. MethodsJohnston County Osteoarthritis Project participants (n = 1,670) completed the 42-item FAOS (mean age 69 years, 68% women, 31% African American, mean body mass index [BMI] 31.5 kg/m(2)). Internal consistency, test-retest reliability, convergent validity, and structural validity of each subscale were examined for the sample and for subgroups according to race, sex, age, BMI, presence of knee or hip osteoarthritis, and presence of knee, hip, or low back symptoms. ResultsFor the sample and each subgroup, Cronbach's alpha coefficients ranged from 0.95-0.97 (pain), 0.97-0.98 (ADL), 0.94-0.96 (sport/recreation), 0.89-0.92 (QOL), and 0.72-0.82 (symptoms). Correlation coefficients ranged from 0.24-0.52 for pain and symptoms subscales with foot and ankle symptoms and from 0.30-0.55 for ADL and sport/recreation subscales with the Western Ontario and McMaster Universities Osteoarthritis Index function subscale. Intraclass correlation coefficients for test-retest reliability ranged from 0.63-0.81. Items loaded on a single factor for each subscale except symptoms (2 factors). ConclusionThe FAOS exhibited sufficient reliability and validity in this large cohort study.
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  • Gülfe, Anders, et al. (author)
  • Utility-based outcomes made easy: The number needed per QALY gained (NNQ). Observational cohort study from Southern Sweden of TNF blockade in inflammatory arthritis.
  • 2010
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 62:10, s. 1399-1406
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE.: To introduce a novel, simple, utility based outcome measure, the Number Needed per Quality adjusted life year (QALY) gained (NNQ), and to apply it in clinical practice in anti-TNF treated patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondylarthritis (SpA). METHODS.: The NNQ is the number of patients one has to treat in order to gain 1 QALY. It is calculated as the inverted value of the utility gain (area under curve) over 1 year in a cohort subjected to an intervention. EuroQoL-5-dimensions (EQ-5D) utility data from the South Swedish Arthritis Treatment Register was used. RESULTS.: 1001 RA, 241 PsA, and 255 SpA patients were eligible for the study. First, 2(nd) and 3(rd) treatment courses were studied. For RA, NNQ was 4.5, 6.4 and 5.2 for 1(st), 2(nd) and 3(rd) courses, respectively. For PsA and SpA, NNQ was 4.2-4.5 irrespective of treatment order. Treatment groups with N<50 were not analysed. During the study period 2002-2007, there were no secular trends of utility gains. CONCLUSION.: The NNQ is an easily derived and understandable, utility based outcome measure that may be useful for stakeholders, decision makers as well as for clinicians. It was readily applied in this study of TNF blockade across 3 arthritis diagnoses. NNQ varied little over diagnoses and treatment course order, with a possible exception in 2(nd) treatment course in RA.
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  • Haglund, Emma, 1970-, et al. (author)
  • Differences in physical activity patterns in patients with spondylarthritis
  • 2012
  • In: Arthritis Care and Research. - Hoboken : John Wiley & Sons. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 64:12, s. 1886-1894
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To study patient-reported physical activity in patients with spondylarthritis (SpA) and possible differences in physical activity patterns between the SpA subtypes and sexes.METHODS: In 2009, a questionnaire including inquiries concerning physical activity was sent to patients with a SpA diagnosis (n = 3,711). The World Health Organization (WHO) global recommendations of physical activity for health requiring 150 minutes of moderate-intensity physical activity (MI-PA) or 75 minutes of vigorous-intensity physical activity (VI-PA) per week were used as recommended levels. Standardized risk ratios (RRs) were calculated by using physical activity data from the Swedish population. The association within the SpA group between sex, age, disease-related variables, anxiety, and depression and meeting recommended levels of MI-PA and VI-PA (dependent variables) was studied with multivariate analysis.RESULTS: A total of 2,167 patients with SpA (48% men, mean ± SD age 55 ± 14 years) responded to the questionnaire. Sixty-eight percent of the patients met the WHO recommendations, more frequently in women than in men (70% versus 66%). The recommendations were more often met in the SpA group (RR 1.09, 95% confidence interval [95% CI] 1.04-1.15) compared with the Swedish population. There was a tendency for young women to meet the WHO recommendations less often than the Swedish population (RR 0.94, 95% CI 0.63-1.25). Different factors were found to influence whether the patients were exercising with a moderate or vigorous intensity.CONCLUSION: Seven of 10 patients with SpA met the WHO recommendations of physical activity for health, but we found sex and disease subtype differences. This information can be useful in clinical practice when coaching patients to have a healthier lifestyle. © 2012 by the American College of Rheumatology.
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  • Jönsen, Andreas, et al. (author)
  • Association of the Charlson Comorbidity Index With Mortality in Systemic Lupus Erythematosus
  • 2011
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 63:9, s. 1233-1237
  • Journal article (peer-reviewed)abstract
    • Objective. To investigate whether comorbidity as assessed by the Charlson Comorbidity Index (CCI) is associated with mortality in a long-term followup of systemic lupus erythematosus (SLE) patients. Methods. Data were collected from 499 SLE patients attending the Lupus Clinic at the McGill University Health Center, Montreal, Quebec, Canada, and 170 SLE patients from the Department of Rheumatology at Lund University Hospital, Lund, Sweden. This included data on comorbidity, demographics, disease activity, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), and antiphospholipid antibody syndrome (APS). Variables were entered into a Cox proportional hazards survival model. Results. Mortality risk in the Montreal cohort was associated with the CCI (hazard ratio [HR] 1.57 per unit increase in the CCI, 95% confidence interval [95% CI] 1.18-2.09) and age (HR 1.04 per year increase in age, 95% CI 1.00-1.09). The CCI and age at diagnosis were also associated with mortality in the Lund cohort (CCI: HR 1.35, 95% CI 1.13-1.60; age: HR 1.09, 95% CI 1.05-1.12). Furthermore, the SDI was associated with mortality in the Lund cohort (HR 1.40, 95% CI 1.19-1.64), while a wide CI for the estimate in the Montreal cohort prevented a definitive conclusion (HR 1.20, 95% CI 0.97-1.48). We did not find a strong association between mortality and sex, race/ethnicity, disease activity, or APS in either cohort. Conclusion. In this study, comorbidity as measured by the CCI was associated with decreased survival independent of age, lupus disease activity, and damage. This suggests that the CCI may be useful in capturing comorbidity for clinical research in SLE.
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  • Jöud, Anna, et al. (author)
  • Low back pain - epidemiology of consultations.
  • 2012
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 64:7, s. 1084-1088
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: Low back pain (LBP) affects most people at some stage in life. However, the burden on the health care system is unclear. We studied: 1) the one-year consultation prevalence 2) the rate of first-time consultation for LBP and related the frequency to other musculoskeletal conditions and 3) the health care utilization of LBP patients compared to the general population. METHODS: Using the health care register in southern Sweden (population 1.2 million), including diagnoses (ICD-10) by physicians, we identified all who in 2009 were diagnosed with LBP defined as lumbago with sciatica, low back pain, or other/unspecified dorsalgia. We defined first-time consultation as a consultation in 2009 without a record of a LBP diagnosis 2004-2008. Standardized health care utilization ratios were calculated for LBP patients compared to the general population seeking care. RESULTS: The one-year consultation prevalence of LBP in the population was 3.8% (women=4.3%, men=3.3%) and increased with age. LBP had been recorded in 17.1% of all patients (women=16.5%, men=18.0%) who had been diagnosed with any musculoskeletal condition. The rate of first-time consultation was 238 per 10,000 adults (women=265, men=209). The health care utilization ratio in female and male patients with LBP was 1.74 (95% CI 1.73-1.75) and 1.81 (95% CI 1.80-1.82) respectively. CONCLUSION: LBP, diagnosed in every 6(th) patient who consulted due to a musculoskeletal problem, is a public health concern that needs structured management. LBP patients consume close to twice as much health care as the general population and this warrants more awareness. © 2012 by the American College of Rheumatology.
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  • Knoop, Jesper, et al. (author)
  • Association of lower muscle strength with self-reported knee instability in osteoarthritis of the knee: Results from the Amsterdam Osteoarthritis Cohort
  • 2012
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 64:1, s. 38-45
  • Journal article (peer-reviewed)abstract
    • Objective To determine whether muscle strength, proprioceptive accuracy, and laxity are associated with self-reported knee instability in a large cohort of knee osteoarthritis (OA) patients, and to investigate whether muscle strength may compensate for impairment in proprioceptive accuracy or laxity, in order to maintain knee stability. Methods. Data from 283 knee OA patients from the Amsterdam Osteoarthritis cohort were used. Univariable and multivariable logistic regression analyses were performed to assess the association between muscle strength, proprioceptive accuracy (motion sense), frontal plane varus-valgus laxity, and self-reported knee instability. Additionally, effect modification between muscle strength and proprioceptive accuracy and between muscle strength and laxity was determined. Results. Self-reported knee instability was present in 67% of the knee OA patients and mainly occurred during walking. Lower muscle strength was significantly associated with the presence of self-reported knee instability, even after adjusting for relevant confounding. Impaired proprioceptive accuracy and high laxity were not associated with self-reported knee instability. No effect modification between muscle strength and proprioceptive accuracy or laxity was found. Conclusion. Lower muscle strength is strongly associated with self-reported knee instability in knee OA patients, while impairments in proprioceptive accuracy and laxity are not. A compensatory role of muscle strength for impaired proprioceptive accuracy or high laxity, in order to stabilize the knee, could not be demonstrated.
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  • Knoop, Jesper, et al. (author)
  • Identification of Phenotypes With Different Clinical Outcomes in Knee Osteoarthritis: Data From the Osteoarthritis Initiative
  • 2011
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 63:11, s. 1535-1542
  • Journal article (peer-reviewed)abstract
    • Objective. To identify subgroups or phenotypes of knee osteoarthritis (OA) patients based on similarities of clinically relevant patient characteristics, and to compare clinical outcomes of these phenotypes. Methods. Data from 842 knee OA patients of the Osteoarthritis Initiative were used. A cluster analysis method was performed, in which clusters were formed based on similarities in 4 clinically relevant, easily available variables: severity of radiographic OA, lower extremity muscle strength, body mass index, and depression. Univariable and multivariable regression analyses were used to compare phenotypes on clinical outcomes (pain and activity limitations), taking into account possible confounders. Results. Five phenotypes of knee OA patients were identified: "minimal joint disease phenotype," "strong muscle phenotype," "nonobese and weak muscle phenotype," "obese and weak muscle phenotype," and "depressive phenotype." The "depressive phenotype" and "obese and weak muscle phenotype" showed higher pain levels and more severe activity limitations than the other 3 phenotypes. Conclusion. Five phenotypes based on clinically relevant patient characteristics can be identified in the heterogeneous population of knee OA patients. These phenotypes showed different clinical outcomes. Interventions may need to be tailored to these clinical phenotypes.
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  • Kristensen, Lars Erik, et al. (author)
  • Is Swollen to Tender Joint Count Ratio a New and Useful Clinical Marker for Biologic Drug Response in Rheumatoid Arthritis? Results From a Swedish Cohort
  • 2014
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 66:2, s. 173-179
  • Journal article (peer-reviewed)abstract
    • ObjectiveTo study the impact of swollen to tender joint count ratio (STR) and other baseline characteristics on treatment response to a first course of anti-tumor necrosis factor (anti-TNF) therapy in rheumatoid arthritis (RA) patients. MethodsPatients with RA initiating their first course of anti-TNF treatment were included in a structured clinical followup protocol. Based on pragmatic thresholds and plausibility, patients were categorized as having low (STR <0.5), moderate (0.5 STR 1.0), or high (STR >1.0) joint count ratios. The data were collected and followed during the period of March 1999 through December 2010. ResultsA total of 2,507 patients were included in the study (median age 56 years, 78% women). Of these patients, 344 (14%) had a low STR, 1,180 (47%) had a moderate STR, and 983 (39%) had a high STR. According to these STR thresholds, 23% of patients (95% confidence interval [95% CI] 18-29%) with low, 39% (95% CI 35-43%) with moderate, and 40% (95% CI 36-44%) with high STR achieved the American College of Rheumatology criteria for 50% improvement (ACR50) response at 6 months after initiation. Correlation tests showed that STR was associated with ACR50 response independent of both swollen and tender joint counts. Logistic regression analysis consistently showed that moderate STR, high STR, not using prednisolone, high baseline Disease Activity Score in 28 joints, and low baseline Health Assessment Questionnaire scores were significantly associated with favorable ACR50 response with odds ratios of 1.93 (P < 0.01), 2.82 (P < 0.01), 0.65 (P < 0.01), 1.49 (P < 0.01), and 0.47 (P < 0.01), respectively. ConclusionSTR is a new and feasible predictor of treatment response in RA. RA patients with a moderate to high STR have a 2- to 3-fold increased likelihood of responding according to ACR50 criteria.
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  • Kristensen, Lars Erik, et al. (author)
  • Presence of peripheral arthritis and male sex predicting continuation of anti–tumor necrosis factor therapy in ankylosing spondylitis: An observational prospective cohort study from the South Swedish arthritis treatment group register
  • 2010
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 62:10, s. 1362-1369
  • Journal article (peer-reviewed)abstract
    • Objective: To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice. Methods: Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic drug (DMARD) treatment course. The mean ± SD age at inclusion was 43 ± 12 years, with a mean ± SD disease duration prior to treatment of 16 ± 12 years. Results: The 2-year drug continuation rate was 74%. Male sex (hazard ratio [HR] of premature discontinuation 0.36 [95% confidence interval (95% CI) 0.19–0.68]) and the presence of peripheral arthritis (HR 0.49 [95% CI 0.27–0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab (HR 0.50 [95% CI 0.25–1.04], P = 0.062), whereas no differences were found comparing the 3 anti–tumor necrosis factor agents in other ways. Higher baseline C-reactive protein level (HR 0.99 [95% CI 0.97–1.00], P = 0.12) and concomitant treatment with nonbiologic DMARDs (HR 0.61 [95% CI 0.34–1.10], P = 0.10) also showed trends to entail better drug adherence. Conclusion: AS patients in this study have an excellent 2-year drug survival rate of 74%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis.
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  • Lertratanakul, Apinya, et al. (author)
  • 25-Hydroxyvitamin D and Cardiovascular Disease in Patients With Systemic Lupus Erythematosus: Data From a Large International Inception Cohort
  • 2014
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 66:8, s. 1167-1176
  • Journal article (peer-reviewed)abstract
    • Objective. An association between 25-hydroxyvitamin D (25[ OH] D; vitamin D) deficiency and increased cardiovascular (CV) risk factors and CV disease (CVD) has been shown in general population studies. Vitamin D deficiency has been noted in systemic lupus erythematosus (SLE), and CVD is a major cause of morbidity and mortality in SLE. The objectives of this study were to estimate the associations of 25(OH) D levels with CV risk factors and to determine whether low baseline 25(OH) D levels predict future CV events in patients participating in an international inception cohort. Methods. Data were collected on 890 participants, including demographics, SLE activity and damage assessments, CV risk factors and events, medications, laboratory assessments of 25(OH) D levels, and inflammatory markers. Multiple logistic and Cox regressions were used to estimate the associations of baseline 25(OH) D levels with baseline CV risk factors and CVD events. The models were adjusted for age, sex, race, season, and country, with and without body mass index. Results. Patients in the higher quartiles of 25(OH) D were less likely to have hypertension and hyperlipidemia and were more likely to have lower C-reactive protein levels and lower Systemic Lupus Erythematosus Disease Activity Index 2000 scores at baseline when compared with the first quartile. Vitamin D levels were not independently associated with CVD event incidence; however, hazard ratios for CVD event incidence decreased with successively higher quartiles. Conclusion. Lower baseline 25(OH) D levels are associated with higher risk for CV risk factors and more active SLE at baseline. There may be a trend toward a lower likelihood of CVD events in those with higher baseline 25(OH) D levels.
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  • Munters, Li Alemo, et al. (author)
  • Improvement in Health and Possible Reduction in Disease Activity Using Endurance Exercise in Patients With Established Polymyositis and Dermatomyositis : A Multicenter Randomized Controlled Trial With a 1-Year Open Extension Followup
  • 2013
  • In: Arthritis Care and Research. - : Wiley. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 65:12, s. 1959-1968
  • Journal article (peer-reviewed)abstract
    • ObjectiveTo determine the effects of a 12-week endurance exercise program on health, disability, VO2 max, and disease activity in a multicenter randomized controlled trial in patients with established polymyositis (PM) and dermatomyositis (DM), and to evaluate health and disability in a 1-year open extension study. MethodsPatients were randomized into a 12-week endurance exercise program group (EG; n = 11) or a control group (CG; n = 10). Assessments of health (Short Form 36 [SF-36]), muscle performance (5 voluntary repetition maximum [5 VRM]), activities of daily living (ADL), patient preference (McMaster Toronto Arthritis Patient Preference Disability Questionnaire), VO2 max, and disease activity (International Myositis Assessment and Clinical Studies criteria of improvement of the 6-item core set) were performed at 0 and 12 weeks. Disability assessments were performed again at 52 weeks in an open extension period. All assessments were performed by blinded observers. ResultsThe EG improved compared to the CG in SF-36 physical function and vitality (P = 0.010 and P = 0.046, respectively), ADL score (P = 0.035), 5 VRM (P = 0.026), and VO2 max (P = 0.010). More patients in the EG (7 of 11) were responders with reduced disease activity compared to none in the CG (P = 0.002). Correlations between VO2 max and SF-36 physical function were 0.90 and 0.91 at 0 and 12 weeks, respectively (P < 0.05). The EG improvement in 5 VRM was sustained up to 52 weeks compared to baseline (5.7 kg; P < 0.001), but not in ADL score or SF-36. ConclusionsEndurance exercise improves health and may reduce disease activity in patients with established PM/DM. This potentially could be mediated through improved aerobic fitness. The results also indicate sustained muscle strength up to 1 year after a supervised program.
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  • Nilsdotter, Anna, et al. (author)
  • Measures of Hip Function and Symptoms
  • 2011
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 63, s. 200-207
  • Journal article (peer-reviewed)
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  • Nordgren, Birgitta, et al. (author)
  • WHO MAKES IT TO THE BASE?, Selection procedure for a physical activity trial targeting people with RA - the PARA 2010 study.
  • 2014
  • In: Arthritis care & research. - : Wiley. - 2151-464X .- 2151-4658. ; 66:5, s. 662-670
  • Journal article (peer-reviewed)abstract
    • Objectives: To compare, in a large well defined sample of individuals with RA at target for a physical activity (PA) trial, those who were finally included with those who were not. Methods: 3152 individuals answered questionnaires on socio-demographic, disease-related, and psycho-social factors and PA levels. Differences between individuals making it to the baseline assessments and those who did not were analyzed in three steps. Results: In a first step, 1932 individuals were eligible for the trial as they were interested, not physically active enough, and fluent in Swedish and not participating in any other study. They were mainly female, younger, better educated, had higher income, were more likely to live with children, and had better support for exercise and higher outcome expectations on PA than the 1208 non-eligible individuals. In a second step, the 286 individuals accepting participation were better educated, had higher income, more support for exercise, less fear-avoidance beliefs and higher outcome expectations on PA than the 1646 declining participation. In a third step, the 244 individuals assessed at baseline reported less fatigue than the 42 withdrawing before assessments. Conclusions: To our knowledge, this is the first study describing the entire selection procedure from a target sample for a PA trial to the sample assessed at baseline, in individuals with RA. Factors other than those related to the disease seem to mainly determine participation and largely resemble determinants in the general population. Socio-demographic and psycho-social factors should be recognized as important for PA in people with RA.
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  • Seror, Raphaele, et al. (author)
  • Accurate Detection of Changes in Disease Activity in Primary Sjogren's Syndrome by the European League Against Rheumatism Sjogren's Syndrome Disease Activity Index
  • 2010
  • In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 62:4, s. 551-558
  • Journal article (peer-reviewed)abstract
    • Objective. To assess and compare the sensitivity to change of the European League Against Rheumatism Sjogren's Syndrome Disease Activity Index (ESSDAI) with that of other primary Sjogren's syndrome (SS) disease activity indexes. Methods. We abstracted 96 patient profiles, including data on 3 successive visits (visits 1-3), from the medical charts of patients with primary SS. Patient profiles were scored with the ESSDAI, SS Disease Activity Index (SSDAI), and Sjogren's Systemic Clinical Activity Index (SCAI). Thirty-nine experts assessed 5 profiles for whether disease activity had improved, worsened, or remained stable at visits 2 and 3. Results. For improved patients, the standardized response means (SRMs) for all scores did not differ, and ranged from -1.08 to -1.38 between visits 1 and 2 and from -0.50 to -0.76 between visits 2 and 3. For patients with worsened activity, the SRMs between visits 1 and 2 and between visits 2 and 3 were +0.46 and +1.10 for the ESSDAI, -0.03 and +0.79 for the SSDAI, and +0.17 and +1.02 for the SCAI, respectively. For patients with stable activity, the SRMs between visits 1 and 2 and between visits 2 and 3 were 0.00 and -0.13 for the ESSDAI, -0.44 and -0.11 for the SSDAI, and -0.36 and +0.34 for the SCAI, respectively. Conclusion. For patients with improved activity, the 3 disease activity indexes showed similar, large sensitivity to change. However, the ESSDAI seemed to detect changes in activity more accurately than other disease activity indexes. Notably, for patients with stable activity, the ESSDAI did not show erroneous improvement.
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