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  • 1.
    Arkema, Elizabeth V
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Palmsten, Kristin
    University of California, San Diego, USA.
    Sjöwall, Christopher
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Svenungsson, Elisabet
    Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Salmon, Jane E
    Weill Cornell Medical College, New York, New York.
    Simard, Julia F
    Stanford School of Medicine, Stanford, California, USA ;Karolinska Institute, Stockholm, Sweden.
    What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population-Based Study of Maternal and Fetal Outcomes in SLE and Pre-SLE.2016Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 68, nr 7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To assess maternal and fetal outcomes associated with subclinical (pre-systemic lupus erythematosus [SLE] and SLE presenting up to 5 years postpartum) and prevalent maternal SLE during pregnancy compared with the general population.

    METHODS: This prospective cohort study used population-based Swedish registers to identify 13,598 women with first singleton pregnancies registered in the Medical Birth Register (551 prevalent SLE, 65 pre-SLE within 0-2 years, 133 pre-SLE within 2-5 years, and 12,847 general population). SLE was defined as ≥2 SLE-coded discharge diagnoses in the patient register with ≥1 diagnosis from a specialist. Unadjusted risks of adverse pregnancy or birth outcomes were calculated by SLE status, and Cochran-Armitage tests evaluated trend across exposure groups.

    RESULTS: Maternal outcomes such as preeclampsia, hypothyroidism, stroke, and infection were more common among women with SLE. Sixteen percent of prevalent-SLE pregnancies were diagnosed with preeclampsia compared with 5% of those from the general population. Among the pre-SLE women, preeclampsia was found in 26% of those with SLE within 2 years postpartum and 13% in those with SLE within 2-5 years postpartum. Similarly, infant outcomes, such as preterm birth, infection, and mortality, were worse among those born to mothers with prevalent SLE and pre-SLE during pregnancy. The test for trend was significant for most outcomes.

    CONCLUSION: Our data demonstrate that adverse maternal and fetal outcomes are more common in SLE pregnancies. Furthermore, these unfavorable outcomes are observed in pregnancies occurring prior to the diagnosis of SLE. Thus, the underlying immunologic profile of SLE and alterations preceding clinical SLE may contribute to these pregnancy complications.

  • 2.
    Arnstad, Ellen Dalen
    et al.
    Nord Trondelag Hosp Trust, Levanger Hosp, Levanger, Norway;Norwegian Univ Sci & Technol, Trondheim, Norway.
    Rypdal, Veronika
    Univ Hosp North Norway, Tromso, Norway;Arctic Univ Norway, Tromso, Norway.
    Peltoniemi, Suvi
    Univ Helsinki, Hosp Children & Adolescents, Helsinki, Finland.
    Herlin, Troels
    Aarhus Univ Hosp, Aarhus, Denmark.
    Berntson, Lillemor
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Fasth, Anders
    Univ Gothenburg, Gothenburg, Sweden.
    Nielsen, Susan
    Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark.
    Glerup, Mia
    Ekelund, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning. Ryhov Cty Hosp, Jonkoping, Sweden.
    Zak, Marek
    Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark.
    Aalto, Kristiina
    Univ Helsinki, Hosp Children & Adolescents, Helsinki, Finland.
    Nordal, Ellen
    Univ Hosp North Norway, Tromso, Norway;Arctic Univ Norway, Tromso, Norway.
    Romundstad, Pal Richard
    Norwegian Univ Sci & Technol, Trondheim, Norway.
    Rygg, Marite
    Norwegian Univ Sci & Technol, Trondheim, Norway;St Olavs Hosp, Trondheim, Norway.
    Marhaug, Gudmund
    Anderson-Gare, Boel
    Pedersen, Freddy Karup
    Lahdenne, Pekka
    Pelkonen, Pirkko
    Early Self-Reported Pain in Juvenile Idiopathic Arthritis as Related to Long-Term Outcomes: Results From the Nordic Juvenile Idiopathic Arthritis Cohort Study2019Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 71, nr 7, s. 961-969Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To study self-reported pain early in the disease course of juvenile idiopathic arthritis (JIA) as a predictor of long-term disease outcomes. Methods Consecutive cases of JIA with disease onset from 1997 to 2000 from defined geographical areas of Norway, Sweden, Finland, and Denmark were prospectively enrolled in this population-based cohort study. Self-reported, disease-related pain was measured on a 10-cm visual analog scale (VAS pain). Inclusion criteria were a baseline visit with a pain score 6 months after disease onset, followed by an 8-year study visit. Remission was defined according to Wallace et al (2004) preliminary criteria. Functional disability was measured by the Childhood Health Assessment Questionnaire and the Child Health Questionnaire Parent Form if the child was age <18 years and by the Health Assessment Questionnaire if age >= 18 years. Damage was scored using the Juvenile Arthritis Damage Index. Results The final study cohort consisted of 243 participants, and 120 participants (49%) had oligoarticular onset. At baseline, 76% reported a VAS pain score >0 compared to 57% reporting at 8 years. Half of those who reported baseline pain also reported pain at 8 years but at a lower intensity. Compared to no pain, higher pain intensity at baseline predicted more pain at 8 years, more functional disability, more damage, and less remission without medication. Baseline pain predicted more use of disease-modifying antirheumatic drugs/biologics during the disease course. Participants with oligoarticular JIA reporting pain at baseline were more likely to develop extended oligoarticular JIA or other JIA categories with an unfavorable prognosis. Conclusion Early self-reported, disease-related pain among children and adolescents with JIA is common and seems to predict persistent pain and unfavorable long-term disease outcomes.

  • 3.
    Bjurehed, Linda
    et al.
    Linköpings universitet.
    Brodin, Nina
    Karolinska Institutet, Huddinge, Sweden; Danderyd Hospital, Stockholm, Sweden.
    Nordenskiold, Ulla
    Gothenburg University, Gothenburg, Sweden.
    Björk, Mathilda
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Improved Hand Function, Self-Rated Health, and Decreased Activity Limitations: Results After a Two-Month Hand Osteoarthritis Group Intervention2018Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, nr 7, s. 1039-1045Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To evaluate the effects on hand function, activity limitations, and self‐rated health of a primary care hand osteoarthritis (OA) group intervention. Hand OA causes pain, impaired mobility, and reduced grip force, which cause activity limitations. OA group interventions in primary care settings are sparsely reported.

    Methods

    Sixty‐four individuals with hand OA agreed to participate; 15 were excluded due to not fulfilling the inclusion criteria. The 49 remaining (90% female) participated in an OA group intervention at a primary care unit with education, paraffin wax bath, and hand exercise over a 6‐week period. Data were collected at baseline, end of intervention, and after 1 year. Instruments used were the Grip Ability Test (GAT), the Signals of Functional Impairment (SOFI), dynamometry (grip force), hand pain at rest using a visual analog scale (VAS), the Patient‐Specific Functional Scale (PSFS), the Quick Disabilities of the Arm, Shoulder, and Hand (Quick‐DASH), and the EuroQol VAS (EQ VAS). Data were analyzed using nonparametric statistics.

    Results

    Hand function, activity limitation, and self‐rated health significantly improved from baseline to end of intervention, grip force (right hand: P < 0.001; left hand: P = 0.008), SOFI (P = 0.011), GAT (P < 0.001), hand pain at rest (P < 0.001), PSFS (1: P = 0.008, 2: P < 0.001, and 3: P = 0.004), Quick‐DASH (P = 0.001), and EQ VAS (P = 0.039), and the effects were sustained after 1 year.

    Conclusion

    The hand OA group intervention in primary care improves hand function, activity limitation, and self‐rated health. The benefits are sustained 1 year after completion of the intervention.

  • 4.
    Björk, M.
    et al.
    Linköping University, Linköping, Sweden.
    Thyberg, I.
    Linköping University, Linköping, Sweden.
    Valtersson, E.
    Linköping University, Linköping, Sweden.
    Östlund, Gunnel
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Stenström, B.
    Linköping University, Linköping, Sweden.
    Sverker, A.
    Linköping University, Linköping, Sweden.
    Foot Barriers in Patients With Early Rheumatoid Arthritis: An Interview Study Among Swedish Women and Men2018Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, nr 9, s. 1348-1354Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Foot impairments are related to reduced mobility and participation restrictions in daily activities in patients with established rheumatoid arthritis (RA). The new biologic medications are effective and reduce disease activity, but not disability to the same extent. Foot impairments are assumed to be related to participation restrictions also in patients with early RA, diagnosed after the introduction of biologic medications. Knowledge of foot impairments needs to be explored further after the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to explore the patients’ perspective of foot impairments related to early RA. Methods: The sample included 59 patients (ages 20–63 years) who were interviewed about participation dilemmas in daily life using the critical incident technique. The interviews were audio-recorded and transcribed. Data related to foot impairments were extracted and analyzed thematically. A research partner validated the analysis. Results: Patients with early RA described a variety of participation restrictions related to foot impairments: foot hindrances in domestic life, foot impairments influencing work, leisure activities restricted by one's feet, struggling to be mobile, and foot impairments as an early sign of rheumatic disease. Conclusion: There is a need to focus on foot impairments related to early RA, and for health care professionals to understand these signs. A suggestion for future research is to conduct a longitudinal followup of foot impairment related to medication, disease activity, and disability in patients diagnosed after the introduction of bDMARDs. 

  • 5.
    Björk, Mathilda
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Valtersson, Eva
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Östlund, Gunnel
    School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
    Stenström, Birgitta
    Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Sverker, Annette
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Foot barriers in patients with early rheumatoid arthritis: an interview study among Swedish women and men2018Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, nr 9, s. 1348-1354Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Foot impairments are related to reduced mobility and participation restrictions in daily activities in patients with established rheumatoid arthritis (RA). The new biological medications are effective and reduce disease activity, but not disability to the same extent. Foot impairments are assumed to be related to participation restrictions also in patients with early RA, diagnosed after the introduction of biological medications. The knowledge of foot impairments needs to be more explored after the introduction of biological disease-modifying drugs (bDMARDs). The aim of this study was to explore the patients' perspective of foot impairments related to early RA.

    METHODS: The sample included 59 patients (20-63 years) who were interviewed about participation dilemmas in daily life using the Critical Incident Technique. The interviews were audio-recorded and transcribed. Data related to foot impairments were extracted and analyzed thematically. A research partner validated the analysis. The study was approved by the Regional Ethics Committee.

    RESULTS: Patients with early RA described a variety of participation restrictions related to foot impairments: 1) foot hindrances in domestic life, 2) foot impairments influencing work, 3) leisure activities restricted by one's feet 4) struggling to be mobile 5) foot impairments as an early sign of rheumatic disease.

    CONCLUSION: There is a need to focus on foot impairments related to early RA, and for health care professionals to understand these signs. A suggestion for future research is to conduct a longitudinal follow-up of foot impairment related to medication, disease activity and disability in patients diagnosed after the introduction of bDMARDs. This article is protected by copyright. All rights reserved.

  • 6.
    Bremander, Ann
    et al.
    Lund University, Lund, Sweden & Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Englund, Martin
    Lund University, Lund, Sweden & Boston University School of Medicine, Boston, Massachusetts, USA.
    Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis2011Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 63, nr 4, s. 550-556Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    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.

  • 7.
    Demmelmaier, Ingrid
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Livsstil och rehabilitering vid långvarig sjukdom. Karolinska Inst, Stockholm, Sweden..
    Iversen, Maura D.
    Karolinska Inst, Stockholm, Sweden.;Northeastern Univ, Boston, MA 02115, Sweden.;Harvard Med Sch, Boston, MA, Sweden..
    How Are Behavioral Theories Used in Interventions to Promote Physical Activity in Rheumatoid Arthritis?: A Systematic Review2018Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, nr 2, s. 185-196Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    ObjectiveTo identify the use of behavioral theories in physical activity interventions in populations with rheumatoid arthritis (RA). MethodsThis review includes articles published in English between January 1, 1980 and November 8, 2015 in MEDLINE, Cochrane, and CINAHL, identified by a strategic literature search. Included studies were published in international peer-reviewed journals, mentioned theory, evaluated a physical activity intervention for adults with RA, and had 1 physical activity variable as the outcome. References and reviews were also checked. Two investigators independently selected articles and extracted data using a validated scale, the theory coding scheme. Additional extracted data included author, sample characteristics, study design, physical activity outcomes, intervention type and duration, and control group. ResultsA total of 245 articles were identified, 211 articles and references were screened, and 29 articles were reviewed. Of these, 18 were excluded, leaving 11 articles with 1,472 participants (75% women). Ten studies (91%) were randomized controlled trials, 8 (73%) assessed physical activity plus self-management, and 3 (27%) physical activity only. Program durations ranged from 5 weeks to 1 year. Eight studies (73%) used a single theory, 7 studies (64%) linked at least 1 intervention technique to theory, 2 studies (18%) analyzed mediating effects of theoretical constructs, and 5 studies (45%) discussed results in relation to theory. ConclusionFindings indicate that physical activity intervention studies claiming the use of behavioral theories use theory to a small extent. We suggest expanding theory use in design, evaluation, and interpretation of physical activity intervention results. Further, we recommend that future studies evaluate the most salient behavioral theories, interventions components, and delivery modes in RA populations.

  • 8.
    Falahee, Marie
    et al.
    Univ Birmingham, Birmingham, W Midlands, England..
    Simons, Gwenda
    Univ Birmingham, Birmingham, W Midlands, England..
    Buckley, Christopher D.
    Univ Birmingham, Birmingham, W Midlands, England.;Sandwell & West Birmingham Hosp NHS Trust, Birmingham, W Midlands, England..
    Hansson, M G
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    Stack, Rebecca J.
    Univ Birmingham, Birmingham, W Midlands, England.;Trent Univ, Nottingham, England..
    Raza, Karim
    Sandwell & West Birmingham Hosp NHS Trust, Birmingham, W Midlands, England..
    Patients' Perceptions of Their Relatives' Risk of Developing Rheumatoid Arthritis and of the Potential for Risk Communication, Prediction, and Modulation2017Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 69, nr 10, s. 1558-1565Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To understand the perspectives of patients with rheumatoid arthritis (RA) about the risk of their relatives developing RA in the future, and about communicating with their relatives concerning risk and its modulation.

    Methods: Twenty-one RA patients took part in semistructured interviews.

    Results: Participants reported willingness to communicate with relatives about their risk of developing RA, but described choosing which relatives to communicate with, on the basis of the relatives' perceived receptivity to such risk information. Participants described the potential for risk information to cause negative emotions. Some participants did not consider RA to be hereditable, and few reported smoking as a risk factor. Patients described a lack of public awareness about the causes of RA and the negative impact that RA has on the quality of life. Awareness of this negative impact was identified as an important driver for predictive and preventive strategies. Participants held positive perceptions of predictive testing for RA, though the results of predictive tests were conceptualized as having a high degree of accuracy. Negative views of predictive testing were associated with an appreciation of the probabilistic nature of risk information. Participants felt that their relatives would prefer lifestyle modification over medication as a risk reduction strategy.

    Conclusion: Information about risk factors for RA, and the potential impact of RA on the quality of life, is needed to support family communication about RA risk. Management of expectations is needed in relation to the probabilistic nature of risk information, and appropriate support should be provided for negative psychological outcomes.

  • 9.
    Kalkan, Almina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Hallert, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Roback, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Skogh, Thomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden2015Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 67, nr 12, s. 1679-1685Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. The prescription of biologic drugs for rheumatoid arthritis (RA) patients has varied considerably across different regions. Previous studies have shown physician preferences to be an important determinant in the decision to select biologic disease-modifying antirheumatic drugs (bDMARDs) rather than nonbiologic, synthetic DMARDs (sDMARDs) alone. The aim of this study was to test the hypothesis that physician preferences are an important determinant for prescribing bDMARDs for RA patients in Sweden. Methods. Using data from the Swedish Rheumatology Quality Register, we identified 4,010 RA patients who were not prescribed bDMARDs during the period 2008-2012, but who, on at least 1 occasion, had an sDMARD prescription and changed treatment for the first time to either a new sDMARD or a bDMARD. Physician preference for the use of bDMARDs was calculated using data on each physicians prescriptions during the study period. The relationship between prescription of a bDMARD and physician preference, controlling for patient characteristics, disease activity, and the physicians local context was evaluated using multivariate logistic regression. Results. When adjusting for patient characteristics, disease activity, and the physicians local context, physician preference was an important predictor for prescription of bDMARDs. Compared with patients of a physician in the lowest preference tertile, patients of physicians in the highest and middle tertiles had an odds ratio for receiving bDMARDs of 2.8 (95% confidence interval [95% CI] 2.13-3.68) and 1.28 (95% CI 1.05-1.57), respectively. Conclusion. Physician preference is an important determinant for prescribing bDMARDs.

  • 10. Lourdudoss, Cecilia
    et al.
    Di Giuseppe, Daniela
    Wolk, Alicja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Westerlind, Helga
    Klareskog, Lars
    Alfredsson, Lars
    van Vollenhoven, Ronald F
    Lampa, Jon
    Dietary Intake of Polyunsaturated Fatty Acids and Pain in Spite of Inflammatory Control Among Methotrexate-Treated Early Rheumatoid Arthritis Patients.2018Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, nr 2, s. 205-212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate potential associations between dietary intake of polyunsaturated fatty acids (FAs) and pain patterns in early rheumatoid arthritis (RA) patients after 3 months of methotrexate (MTX) treatment.

    METHODS: We included 591 early RA patients with MTX monotherapy from a population-based prospective case-control study, the Epidemiological Investigation of Rheumatoid Arthritis. Dietary data on polyunsaturated FAs (food frequency questionnaires) were linked with data on unacceptable pain (visual analog scale [VAS] >40 mm), noninflammatory/refractory pain (VAS >40 mm and C-reactive protein [CRP] level <10 mg/liter), and inflammatory pain (VAS >40 mm and CRP level >10 mg/liter) after 3 months. Statistical analysis included logistic regression.

    RESULTS: After 3 months of MTX treatment, 125 patients (21.2%) had unacceptable pain, of which 92 patients had refractory pain, and 33 patients had inflammatory pain. Omega-3 FA intake was inversely associated with unacceptable pain and refractory pain (odds ratio [OR] 0.57 [95% confidence interval (95% CI) 0.35-0.95] and OR 0.47 [95% CI 0.26-0.84], respectively). The omega-6:omega-3 FA ratio, but not omega-6 FA alone, was directly associated with unacceptable pain and refractory pain (OR 1.70 [95% CI 1.03-2.82] and OR 2.33 [95% CI 1.28-4.24], respectively). Furthermore, polyunsaturated FAs were not associated with either inflammatory pain or CRP level and erythrocyte sedimentation rate at followup. Omega-3 FA supplementation was not associated with any pain patterns.

    CONCLUSION: Omega-3 FA was inversely associated with, and the omega-6:omega-3 FA ratio was directly associated with, unacceptable and refractory pain, but not with inflammatory pain or systemic inflammation. The inverse association between omega-3 FA and refractory pain may have a role in pain suppression in RA.

  • 11.
    Nordgren, Birgitta
    et al.
    Karolinska Institutet.
    Fridén, Cecilia
    Karolinska Institutet.
    Demmelmaier, Ingrid
    Karolinska Institutet.
    Opava, Christina H
    Karolinska Institutet.
    WHO MAKES IT TO THE BASE?, Selection procedure for a physical activity trial targeting people with RA - the PARA 2010 study.2014Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 66, nr 5, s. 662-670Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    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.

  • 12.
    Parodis, Ioannis
    et al.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Benavides, Angie H. Lopez
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden; Odense Univ Hosp, Denmark.
    Zickert, Agneta
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Pettersson, Susanne
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Moller, Sonia
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Welin, Elisabet
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland. Karolinska Inst, Sweden.
    Voss, Anne
    Odense Univ Hosp, Denmark.
    Gunnarsson, Iva
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    The Impact of Belimumab and Rituximab on Health-Related Quality of Life in Patients With SystemicLupus Erythematosus2019Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 71, nr 6, s. 811-821Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectiveAccumulating evidence supports an impaired health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE). We investigated the effects of 2 biologic treatments on HRQoL of patients with SLE. MethodsPatients with SLE from the Karolinska University Hospital treated with belimumab (n = 34) or rituximab (n = 35) were included; normative values derived from Swedish population-based controls matched for age and sex were used for the purpose of comparisons. Data were collected prospectively at treatment initiation and at months 3, 6, 12, and 24, using the Short Form 36 (SF-36) health questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale, the EuroQol 5-dimension (EQ-5D) instrument, and the Stanford Health Assessment Questionnaire disability index (HAQ DI). ResultsSubstantial decrements from Swedish norms were observed across all SF-36 domains at baseline. Patients treated with belimumab reported gradual improvements in the SF-36 physical component summary (significant from month 12; P = 0.023) and FACIT-Fatigue (significant by month 24; P = 0.001), no changes in EQ-5D scores, and improvements in HAQ DI by month 6 (P = 0.014). Patients treated with rituximab showed rapid improvements in the SF-36 mental component summary and FACIT-Fatigue by month 3 (P = 0.031 and P = 0.007, respectively), as well as improvements in EQ-5D at month 6 (P = 0.016) and HAQ DI at month 3 (P = 0.033). Based on baseline evaluations, patients receiving antimalarial agents (n = 33) performed better in the SF-36 social functioning (P = 0.022) and mental health (P = 0.023) domains compared to patients who did not receive antimalarial agents (n = 36). ConclusionOur results corroborated previous findings of considerable HRQoL impairments in patients with SLE. Patients perceptions of HRQoL showed discrepant patterns over time in the 2 treatment groups and could provide additional information along with the clinical evaluation of biologic therapy in SLE. Further survey on the effects of antimalarial agents on the HRQoL of patients with SLE in larger cohorts is merited.

  • 13.
    Parodis, Ioannis
    et al.
    Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Lopez Benavides, Angie H
    Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Odense University Hospital, Odense, Denmark.
    Zickert, Agneta
    Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Pettersson, Susanne
    Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Möller, Sonia
    Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Welin Henriksson, Elisabet
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Voss, Anne
    Department of Rheumatology, Odense University Hospital, Odense, Denmark.
    Gunnarsson, Iva
    Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    The impact of belimumab and rituximab on health-related quality of life in patients with systemic lupus erythematosus2019Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 71, nr 6, s. 811-821Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Accumulating evidence supports an impaired health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE). We investigated the effects of two biologic treatments on SLE patients' HRQoL.

    METHODS: SLE patients from the Karolinska University Hospital treated with belimumab (n=34) or rituximab (n=35) were included; Swedish population-based age- and sex-matched norms served as controls. Data were collected prospectively at treatment initiation and at months 3, 6, 12 and 24; these included the SF-36, FACIT-Fatigue, EQ-5D, and Stanford HAQ-DI.

    RESULTS: Substantial decrements from Swedish norms were observed across all SF-36 domains at baseline. Belimumab-treated patients reported gradual improvements in the SF-36 physical component summary (significant from month 12; P=0.023) and FACIT-Fatigue (significant by month 24; P=0.001), no changes in EQ-5D scores, and improvements in HAQ-DI by month 6 (P=0.014). Rituximab-treated patients showed rapid improvements in the SF-36 mental component summary and FACIT-Fatigue by month 3 (P=0.031 and P=0.007, respectively), as well as improvements in EQ-5D at month 6 (P=0.016) and HAQ-DI at month 3 (P=0.033). Based on baseline evaluations, patients receiving antimalarial agents (n=33) performed better in the SF-36 social functioning (P=0.022) and mental health (P=0.023) domains compared to patients who were not (n=36).

    CONCLUSION: Our findings corroborated considerable HRQoL impairments in SLE patients. Patients' perceptions of HRQoL showed discrepant patterns over time in the two treatment groups, and could provide additional information along with the clinical evaluation of biologic therapy in SLE. Survey on the effects of antimalarial agents on SLE patients' HRQoL in larger cohorts is merited.

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