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Ørnbjerg LM, Brahe CH, Linde L, Jacobsson L, Nissen MJ, Kristianslund EK, Santos MJ, Nordström D, Rotar Z, Gudbjornsson B, Onen F, Codreanu C, Lindström U, Möller B, Kvien TK, Barcelos A, Eklund KK, Tomšič M, Love TJ, Can G, Ionescu R, Loft AG, Mann H, Pavelka K, van de Sande M, van der Horst-Bruinsma IE, Suarez MP, Sánchez-Piedra C, Macfarlane GJ, Iannone F, Michelsen B, Hyldstrup LH, Krogh NS, Østergaard M, Hetland ML. Drug effectiveness of 2nd and 3rd TNF inhibitors in psoriatic arthritis - relationship with the reason for withdrawal from the previous treatment. Joint Bone Spine 2024; 91:105729. [PMID: 38582359 DOI: 10.1016/j.jbspin.2024.105729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To investigate real-world retention and remission rates in PsA patients initiating a 2nd or 3rd TNFi and the association with reason for discontinuation from the previous TNFi-treatment. METHODS Prospectively collected routine care data from 12 European registries were pooled. Retention rates (Kaplan-Meier estimation) and crude/LUNDEX-adjusted rates of Disease Activity Score 28 and Disease Activity index for PSoriatic Arthritis (DAS28 and DAPSA28) remission were calculated and compared with adjusted Cox regression analyses and Chi-squared test, respectively). RESULTS We included 5233 (2nd TNFi) and 1906 (3rd TNFi) patients. Twelve-month retention rates for the 2nd and 3rd TNFi were 68% (95%CI: 67-70%) and 66% (64-68%), respectively. Patients who stopped the previous TNFi due to AE/LOE had 12-month retention rates of 66%/65% (2nd TNFi), and 65%/63% (3rd TNFi), respectively. Patients who stopped the previous TNFi due to LOE after less vs more than 24 weeks had 12-month retention rates of 54%/69% (2nd TNFi), and 58%/65% (3rd TNFi). Six-month crude/LUNDEX-adjusted DAS28 remission rates were 48%/35% and 38%/27%, and DAPSA28 remission rates were 19%/14% and 14%/10%, for the 2nd and 3rd TNFi. CONCLUSION Two-thirds of patients remained on TNFi at 12months for both the 2nd and 3rd TNFi, while one-third and one-quarter of patients were in DAS28 remission after 6months on the 2nd and 3rd TNFi. While drug effectiveness was similar in patients who stopped the previous TNFi due to AE compared to overall LOE, drug effectiveness was better in patients who had stopped the previous TNF due to secondary LOE compared to primary LOE.
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Affiliation(s)
- Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
| | - Cecilie Heegaard Brahe
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Louise Linde
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Eirik Klami Kristianslund
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria José Santos
- Reuma.pt registry; Department of Rheumatology-Hospital Garcia de Orta, Almada and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Dan Nordström
- ROB-FIN Registry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Ziga Rotar
- biorx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Fatos Onen
- TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University, Izmir, Turkey
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Burkhard Möller
- Leitender Arzt der Universitätsklinik für Rheumatologie, Immunologie und Allergologie Inselspital, Bern, Switzerland
| | - Tore K Kvien
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anabela Barcelos
- Reuma.pt registry, Rheumatology Department - Centro Hospitalar do Baixo Vouga, Aveiro and Comprehensive Health Research Center (CHRC), NOVA University of Lisbon, Lisboa, Portugal
| | - Kari K Eklund
- Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Matija Tomšič
- biorx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thorvardur Jon Love
- University of Iceland, Faculty of Medicine, and Landspitali University Hospital, Reykjavik, Iceland
| | - Gercek Can
- TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University, Izmir, Turkey
| | - Ruxandra Ionescu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Anne Gitte Loft
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marleen van de Sande
- Amsterdam UMC, University of Amsterdam, Department of Clinical Immunology and Rheumatology, Amsterdam, The Netherlands; Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam, The Netherlands
| | | | - Manuel Pombo Suarez
- Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Santiago, Spain
| | | | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group) University of Aberdeen, Aberdeen, United Kingdom
| | - Florenzo Iannone
- GISEA registry, Rheumatology Unit-DETO, University of Bari, Bari, Italy
| | - Brigitte Michelsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland; Research Unit, Sørlandet Hospital, Kristianssand, Norway
| | - Lise Hejl Hyldstrup
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | | | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ørnbjerg LM, Rugbjerg K, Georgiadis S, Rasmussen SH, Jacobsson L, Loft AG, Iannone F, Fagerli KM, Vencovsky J, Santos MJ, Möller B, Pombo-Suarez M, Rotar Z, Gudbjornsson B, Cefle A, Eklund K, Codreanu C, Jones G, van der Sande M, Wallman JK, Sebastiani M, Michelsen B, Závada J, Nissen MJ, Sanchez-Piedra C, Tomšič M, Love TJ, Relas H, Mogosan C, Hetland ML, Østergaard M. Patient-Reported Outcomes (PROs) and PRO Remission Rates in 12,262 Biologic-Naïve Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitors in Routine Care. J Rheumatol 2024; 51:378-389. [PMID: 38224992 DOI: 10.3899/jrheum.2023-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To evaluate patient-reported outcomes (PROs) after initiation of tumor necrosis factor inhibitor (TNFi) treatment in European real-world patients with psoriatic arthritis (PsA). Further, to investigate PRO remission rates across treatment courses, registries, disease duration, sex, and age at disease onset. METHODS Visual analog scale or numerical rating scale scores for pain, fatigue, patient global assessment (PtGA), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) from 12,262 patients with PsA initiating a TNFi in 13 registries were pooled. PRO remission rates (pain ≤ 1, fatigue ≤ 2, PtGA ≤ 2, and HAQ-DI ≤ 0.5) were calculated for patients still on the treatment. RESULTS For the first TNFi, median pain score was reduced by approximately 50%, from 6 to 3, 3, and 2; as were fatigue scores, from 6 to 4, 4, and 3; PtGA scores, from 6 to 3, 3, and 2; and HAQ-DI scores, from 0.9 to 0.5, 0.5, and 0.4 at baseline, 6, 12, and 24 months, respectively. Six-month Lund Efficacy Index (LUNDEX)-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 24%, 31%, 36%, and 43% (first TNFi); 14%, 19%, 23%, and 29% (second TNFi); and 9%, 14%, 17%, and 20% (third TNFi), respectively. For biologic-naïve patients with disease duration < 5 years, 6-month LUNDEX-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 22%, 28%, 33%, and 42%, respectively. Corresponding rates for patients with disease duration > 10 years were 27%, 32%, 41%, and 43%, respectively. Remission rates were 33%, 40%, 45%, and 56% for men and 17%, 23%, 24%, and 32% for women, respectively. For patients aged < 45 years at diagnosis, 6-month LUNDEX-adjusted remission rate for pain was 29% vs 18% for patients ≥ 45 years. CONCLUSION In 12,262 biologic-naïve patients with PsA, 6 months of treatment with a TNFi reduced pain by approximately 50%. Marked differences in PRO remission rates across treatment courses, registries, disease duration, sex, and age at onset of disease were observed, emphasizing the potential influence of factors other than disease activity on PROs.
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Affiliation(s)
- Lykke M Ørnbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark;
| | - Kathrine Rugbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lennart Jacobsson
- L. Jacobsson, MD, PhD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne G Loft
- A.G. Loft, MD, PhD, The DANBIO registry and Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Florenzo Iannone
- F. Iannone, MD, PhD, DETO - Rheumatology Unit, University of Bari, Bari, Italy
| | - Karen M Fagerli
- K.M. Fagerli, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Jiri Vencovsky
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria J Santos
- M.J. Santos, MD, PhD, Rheumatology Department, Hospital Garcia de Orta, Rheumatology Research Unit, Faculdade de Medicina, Lisboa, and Reuma.pt, Portugal
| | - Burkhard Möller
- B. Möller, MD, Department for Rheumatology and Immunology, Inselspital - University Hospital Bern, University of Bern, Bern, Switzerland
| | - Manuel Pombo-Suarez
- M. Pombo-Suarez, MD, PhD, Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ziga Rotar
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- B. Gudbjornsson, MD, PhD, Centre for Rheumatology Research, Landspitali University Hospital (ICEBIO), and the Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Ayse Cefle
- A. Cefle, MD, TURKBIO Registry and Division of Rheumatology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kari Eklund
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Catalin Codreanu
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Gareth Jones
- G. Jones, PhD, BSRBR-AS and Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marleen van der Sande
- M. van der Sande, MD, PhD, Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology, and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - Johan K Wallman
- J.K. Wallman, MD, PhD, Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marco Sebastiani
- M. Sebastiani, MD, PhD, Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Brigitte Michelsen
- B. Michelsen, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, and Research Unit, Sørlandet Hospital, Kristiansand, Norway, and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Jakub Závada
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael J Nissen
- M.J. Nissen, MD, PhD, Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Carlos Sanchez-Piedra
- C. Sanchez-Piedra, MD, PhD, Spanish Agency of Health Technology Assessment, Instituto de Salud Carlos III, Madrid, Spain
| | - Matija Tomšič
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thorvardur J Love
- T.J. Love, MD, PhD, Faculty of Medicine, University of Iceland, and Department of Science, Landspitali University Hospital, Reykjavík, Iceland
| | - Heikki Relas
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Corina Mogosan
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Merete L Hetland
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Landgren AJ, Jonsson CA, Bilberg A, Eliasson B, Torres L, Dehlin M, Jacobsson L, Gjertsson I, Larsson I, Klingberg E. Sex differences in cytokines and adipokines in obese patients with PsA and controls undergoing a weight loss intervention. RMD Open 2024; 10:e003821. [PMID: 38519111 PMCID: PMC10961525 DOI: 10.1136/rmdopen-2023-003821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/20/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE In this post hoc analysis of a previously published study, we compared cytokines and adipokine levels in women and men with psoriatic arthritis (PsA) at baseline (BL) and 6 months (M6) following a weight loss intervention. METHODS Patients with PsA (n=41) between 25 and 75 years of age, with body mass index (BMI)≥33 kg/m2 were included in a weight loss intervention with a very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI<40 or ≥40 kg/m2. As controls (n=39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the patients with PsA. Cytokines and adipokines were measured at BL and M6. RESULTS At BL, serum levels of interleukin (IL)-23, leptin and high molecular weight-adiponectin were higher in women with PsA compared with men, whereas serum levels of interferon (IFN)-γ, IL-12/IL-23 p40 and IL-13 were significantly lower in women. Serum IL-23 was significantly reduced at M6 compared with BL in women but not in men with PsA. In women with PsA, the reduction in IL-23 at M6, ∆IL-23, were positively correlated with ∆Disease Activity Score 28 C reactive protein (CRP) (Spearman's correlation (rS)=0.486, p=0.016), ∆CRP (rS=0.468, p=0.021), ∆leptin (rS=0.683, p<0.001) and negatively correlated with ∆total-adiponectin (rS=-0.433, p=0.035). Also in women, ∆Disease Activity in Psoriatic Arthritis was positively correlated with ∆tumour necrosis factor-α (rS=0.417, p=0.034), ∆IL-1β (rS=0.550, p=0.034), ∆IFN-γ (rS=0.414, p=0.035) and ∆leptin (rS=0.410, p=0.038). None of these correlations were significant in men with PsA. CONCLUSIONS Women and men with PsA differed with regard to serum levels of cytokines and adipokines before and after weight loss.
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Affiliation(s)
- Anton Jonatan Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Södra Bohuslän, Gothenburg, Sweden
| | - Charlotte A Jonsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Torres
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Rydholm M, Sharma A, Jacobsson L, Turesson C. The relation between synovitis of individual finger joints and grip force over the first 5 years in early rheumatoid arthritis - a cohort study. Arthritis Res Ther 2023; 25:231. [PMID: 38037132 PMCID: PMC10688125 DOI: 10.1186/s13075-023-03212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE The objective of this study was to investigate the relation between swelling and tenderness of individual finger joints and grip force in patients with early rheumatoid arthritis (RA). METHODS In an inception cohort of patients with early RA (symptom duration < 12 months), all patients were examined by the same rheumatologist, and grip force was measured using the Grippit instrument at inclusion, 1 and 5 years. The average grip force values of each hand were evaluated and expressed as % of expected values, based on age- and sex-specific reference values. Linear regression analyses were used to assess the cross-sectional relation between the involvement of individual finger joints and grip force. In generalized estimating equations, the impact of time-varying synovitis/tenderness on grip force over time was estimated. Analyses were adjusted for wrist involvement, erythrocyte sedimentation rate, and patient-reported pain. RESULTS In 215 patients with early RA, grip force was 39% of expected at diagnosis, and increased to 56% after 5 years. Synovitis of the first metacarpophalangeal (MCP) joint (60% and 69% at baseline in the right and left hand) was associated with reduced grip force at inclusion (adjusted ß - 9.2 percentage unit of expected grip force; 95% CI - 13.6 to - 4.8 for both hands combined) and at all follow-up evaluations. Synovitis of MCP I and MCP IV (12% at baseline) was significantly associated with reduced grip force over time in both hands. Proximal interphalangeal (PIP) joint swelling, and tenderness of MCP or PIP joints, had less impact on grip force. CONCLUSION MCP I synovitis is the major contributor to reduced grip force in patients with early RA. This underlines the importance of the involvement of the thumb for impaired hand function in RA. MCP IV synovitis, but not PIP involvement or finger joint tenderness, also has a substantial impact on grip force.
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Affiliation(s)
- Maria Rydholm
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Ankita Sharma
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Lennart Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
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Lindström U, di Giuseppe D, Exarchou S, Alenius GM, Olofsson T, Klingberg E, Jacobsson L, Askling J, Wallman JK. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: an observational nationwide study. RMD Open 2023; 9:rmdopen-2022-002883. [PMID: 37173095 DOI: 10.1136/rmdopen-2022-002883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION We aimed to compare the proportions of patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) remaining on methotrexate (regardless of other disease-modifying antirheumatic drug (DMARD)-changes), and proportions not having started another DMARD (regardless of methotrexate discontinuation), within 2 years of starting methotrexate, as well as methotrexate effectiveness. METHODS Patients with DMARD-naïve, newly diagnosed PsA, starting methotrexate 2011-2019, were identified from high-quality national Swedish registers and matched 1:1 to comparable patients with RA. Proportions remaining on methotrexate and not starting another DMARD were calculated. For patients with disease activity data at baseline and 6 months, response to methotrexate monotherapy was compared through logistic regression, applying non-responder imputation. RESULTS In total, 3642/3642 patients with PsA/RA were included. Baseline patient-reported pain and global health were similar, whereas patients with RA had higher 28-joint scores and evaluator-assessed disease activity. Two years after methotrexate start, 71% of PsA vs 76% of patients with RA remained on methotrexate, 66% vs 60% had not started any other DMARD, and 77% vs 74% had not started specifically a biological or targeted synthetic DMARD. At 6 months, the proportions of patients with PsA versus RA achieving pain-scores ≤15 mm were 26% vs 36%; global health ≤20 mm: 32% vs 42%; evaluator-assessed 'remission': 20% vs 27%, with corresponding adjusted ORs (PsA vs RA) of 0.63 (95% CI 0.47 to 0.85); 0.57 (95% CI 0.42 to 0.76) and 0.54 (95% CI 0.39 to 0.75). DISCUSSION In Swedish clinical practice, methotrexate use is similar in PsA and RA, both regarding initiation of other DMARDs and methotrexate retention. On a group level, disease activity improved during methotrexate monotherapy in both diseases, although more so in RA.
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Affiliation(s)
- Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniela di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Exarchou
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Gerd-Marie Alenius
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Tor Olofsson
- Department of Clinical Sciences, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
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6
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Bengtsson K, Askling J, Lorentzon M, Rosengren B, Deminger A, Klingberg E, Jacobsson L, Forsblad-d'Elia H. Occurrence and relative risks for non-vertebral fractures in patients with ankylosing spondylitis compared with the general population: a register-based study from Sweden. RMD Open 2023; 9:rmdopen-2022-002753. [PMID: 36787924 PMCID: PMC9930563 DOI: 10.1136/rmdopen-2022-002753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES To estimate the incidence of non-vertebral fractures in ankylosing spondylitis (AS) compared with the general population. METHODS Nationwide register-based cohort study including patients with AS (n=11 611, 65% men, mean age 48 years), and matched general population controls (n=58 050). Five prespecified fracture outcomes: (1) non-vertebral; (2) fracture of the proximal humerus, distal forearm or hip; (3) proximal humerus; (4) distal forearm and (5) hip) were identified through register linkages with follow-up 2007-2016. We used Poisson regression to calculate incidence rates (IRs), number of fractures per 1000 person-years at risk and IR ratios (IRRs), overall and by sex and age. IRRs were adjusted for history of any prior fracture. RESULTS IRs (men/women) for non-vertebral fracture in AS were 11.9 (95% CI 11.0 to 12.9)/14.5 (95% CI 13.1 to 16.1) and in controls 10.0 (95% CI 9.7 to 10.4)/11.8 (95% CI 11.1 to 12.4), IRR (men/women) 1.2 (95% CI 1.1 to 1.3)/1.2 (95% CI 1.1 to 1.4). IRs (men/women) for fractures of the humerus, forearm or hip in AS were 4.0 (95% CI 3.5 to 4.6)/6.3 (95% CI 5.4 to 7.3) and in controls 2.7 (95% CI 2.5 to 2.9)/5.5 (95% CI 5.1 to 6.0), IRR (men/women) 1.5 (95% CI 1.3 to 1.7)/1.1 (95% CI 0.9 to 1.3). IRRs were statistically significantly elevated in men with AS versus controls for forearm fracture (1.4 (95% CI 1.1 to 1.7)) and hip fracture (1.8 (95% CI 1.4 to 2.3)), whereas not in women with AS where the IRRs were 1.1 (95% CI 0.9 to 1.4) and 1.0 (95% CI 0.6 to 1.4). For humerus fracture, IRRs were 1.4 (95% CI 0.99 to 1.9) in men with AS versus controls and 1.1 (95% CI 0.8 to 1.6) in women. CONCLUSIONS Both men and women with AS have a slightly higher risk of non-vertebral fractures than the general population. A statistically significantly higher risk of fractures of the proximal humerus, distal forearm or hip was found in men with AS in comparison to general population, where the relative risk was especially pronounced for hip fracture.
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Affiliation(s)
- Karin Bengtsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden .,Department of Rheumatology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Lorentzon
- Sahlgrenska Osteoporosis Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden,Department of Geriatric Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
| | - Björn Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Malmö, Sweden,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Anna Deminger
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden,Department of Rheumatology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden,Department of Rheumatology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden,Department of Rheumatology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
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7
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Glintborg B, Di Giuseppe D, Wallman JK, Provan SA, Nordström D, Hokkanen AM, Österlund J, Kristianslund E, Kvien TK, Gudbjornsson B, Hetland ML, Michelsen B, Jacobsson L, Askling J, Lindström U. Is the risk of infection higher during treatment with secukinumab than with TNF inhibitors? An observational study from the Nordic countries. Rheumatology (Oxford) 2023; 62:647-658. [PMID: 35723604 PMCID: PMC9891432 DOI: 10.1093/rheumatology/keac358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The positioning of secukinumab in the treatment of axial SpA (axSpA) and PsA is debated, partly due to a limited understanding of the comparative safety of the available treatments. We aimed to assess the risk of the key safety outcome infections during treatment with secukinumab and TNF inhibitors (TNFi). METHODS Patients with SpA and PsA starting secukinumab or TNFi year 2015 through 2018 were identified in four Nordic rheumatology registers. The first hospitalized infection during the first year of treatment was identified through linkage to national registers. Incidence rates (IRs) with 95% CIs per 100 patient-years were calculated. Adjusted hazard ratios were estimated through Cox regression, with secukinumab as the reference. Several sensitivity analyses were performed to investigate confounding by indication. RESULTS Among 7708 patients with SpA and 5760 patients with PsA, we identified 16 229 treatment courses of TNFi (53% bionaïve) and 1948 with secukinumab (11% bionaïve). For secukinumab, the first-year risk of hospitalized infection was 3.5% (IR 5.0; 3.9-6.3), compared with 1.7% (IR 2.3; 1.7-3.0) during 3201 courses with adalimumab, with the IRs for other TNFi lying in between these values. The adjusted HR for adalimumab, compared with secukinumab, was 0.58 (0.39-0.85). In sensitivity analyses, the difference from secukinumab was somewhat attenuated and in some analyses no longer statistically significant. CONCLUSION When used according to clinical practice in the Nordic countries, the observed first-year absolute risk of hospitalized infection was doubled for secukinumab compared with adalimumab. This excess risk seemed largely explained by confounding by indication.
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Affiliation(s)
| | | | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Sella A Provan
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dan Nordström
- Department of Medicine and Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki
| | | | - Jenny Österlund
- Division of Medicine, Helsinki University, Helsinki, Finland
| | | | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Glostrup
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brigitte Michelsen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Ulf Lindström
- Correspondence to: Ulf Lindström, Department of Rheumatology and Inflammation Research, University of Gothenburg, Box 115, Gothenburg, Sweden. E-mail:
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8
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Nissen M, Delcoigne B, Di Giuseppe D, Jacobsson L, Hetland ML, Ciurea A, Nekvindova L, Iannone F, Akkoc N, Sokka-Isler T, Fagerli KM, Santos MJ, Codreanu C, Pombo-Suarez M, Rotar Z, Gudbjornsson B, van der Horst-Bruinsma I, Loft AG, Möller B, Mann H, Conti F, Yildirim Cetin G, Relas H, Michelsen B, Avila Ribeiro P, Ionescu R, Sanchez-Piedra C, Tomsic M, Geirsson ÁJ, Askling J, Glintborg B, Lindström U. The impact of a csDMARD in combination with a TNF inhibitor on drug retention and clinical remission in axial spondyloarthritis. Rheumatology (Oxford) 2022; 61:4741-4751. [PMID: 35323903 DOI: 10.1093/rheumatology/keac174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Many axial spondylarthritis (axSpA) patients receive a conventional synthetic DMARD (csDMARD) in combination with a TNF inhibitor (TNFi). However, the value of this co-therapy remains unclear. The objectives were to describe the characteristics of axSpA patients initiating a first TNFi as monotherapy compared with co-therapy with csDMARD, to compare one-year TNFi retention and remission rates, and to explore the impact of peripheral arthritis. METHODS Data was collected from 13 European registries. One-year outcomes included TNFi retention and hazard ratios (HR) for discontinuation with 95% CIs. Logistic regression was performed with adjusted odds ratios (OR) of achieving remission (Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP < 1.3 and/or BASDAI < 2) and stratified by treatment. Inter-registry heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Peripheral arthritis was defined as ≥1 swollen joint at baseline (=TNFi start). RESULTS Amongst 24 171 axSpA patients, 32% received csDMARD co-therapy (range across countries: 13.5% to 71.2%). The co-therapy group had more baseline peripheral arthritis and higher CRP than the monotherapy group. One-year TNFi-retention rates (95% CI): 79% (78, 79%) for TNFi monotherapy vs 82% (81, 83%) with co-therapy (P < 0.001). Remission was obtained in 20% on monotherapy and 22% on co-therapy (P < 0.001); adjusted OR of 1.16 (1.07, 1.25). Remission rates at 12 months were similar in patients with/without peripheral arthritis. CONCLUSION This large European study of axial SpA patients showed similar one-year treatment outcomes for TNFi monotherapy and csDMARD co-therapy, although considerable heterogeneity across countries limited the identification of certain subgroups (e.g. peripheral arthritis) that may benefit from co-therapy.
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Affiliation(s)
- Michael Nissen
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lucie Nekvindova
- Faculty of Medicine, Charles University, Prague.,Institute of Biostatistics and Analyses, Ltd, Brno, Czech Republic
| | | | - Nurullah Akkoc
- Division of Rheumatology, Department of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tuulikki Sokka-Isler
- University of Eastern Finland, Faculty of Health Sciences and Jyvaskyla Central Hospital, Jyvaskyla, Finland
| | | | - Maria Jose Santos
- Department of Rheumatology, Hospital Garcia de Orta, Almada.,Department of Rheumatology, University of Lisbon, Lisbon, Portugal
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Manuel Pombo-Suarez
- Rheumatology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Burkhard Möller
- Department for Rheumatology and Immunology, Inselspital-University Hospital Bern, Bern, Switzerland
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fabrizio Conti
- Rheumatology Unit, Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gozde Yildirim Cetin
- Division of Rheumatology, Department of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Heikki Relas
- Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Brigitte Michelsen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo.,Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Pedro Avila Ribeiro
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ruxandra Ionescu
- Sfanta Maria Hospital, University of Medicine and Pharmacy, Bucharest, Romania
| | - Carlos Sanchez-Piedra
- Health Technology Assessment Agency of Carlos III Institute of Health (AETS), Madrid, Spain
| | - Matija Tomsic
- Department of Rheumatology, University Medical Centre Ljubljana.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Árni Jón Geirsson
- Department for Rheumatology, University Hospital, Reykjavik, Iceland
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet.,Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Glostrup.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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9
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Sumpter NA, Takei R, Cadzow M, Topless RKG, Phipps-Green AJ, Murphy R, de Zoysa J, Watson H, Qasim M, Lupi AS, Abhishek A, Andrés M, Crișan TO, Doherty M, Jacobsson L, Janssen M, Jansen TL, Joosten LAB, Kapetanovic M, Lioté F, Matsuo H, McCarthy GM, Perez-Ruiz F, Riches P, Richette P, Roddy E, Stiburkova B, So A, Tausche AK, Torres RJ, Uhlig T, Major TJ, Stamp LK, Dalbeth N, Choi HK, Vazquez AI, Leask MP, Reynolds RJ, Merriman TR. Association of Gout Polygenic Risk Score With Age at Disease Onset and Tophaceous Disease in European and Polynesian Men With Gout. Arthritis Rheumatol 2022; 75:816-825. [PMID: 36281732 DOI: 10.1002/art.42393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/19/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether a gout polygenic risk score (PRS) is associated with age at gout onset and tophaceous disease in European, East Polynesian, and West Polynesian men and women with gout. METHODS A 19-variant gout PRS was produced in 7 European gout cohorts (N = 4,016), 2 East Polynesian gout cohorts (N = 682), and 1 West Polynesian gout cohort (N = 490). Sex-stratified regression models were used to estimate the relationship between the PRS and age at gout onset and tophaceous disease. RESULTS The PRS was associated with earlier age at gout onset in men (β = -3.61 in years per unit PRS [95% confidence interval (95% CI) -4.32, -2.90] in European men; β = -6.35 [95% CI -8.91, -3.80] in East Polynesian men; β = -3.51 [95% CI -5.46, -1.57] in West Polynesian men) but not in women (β = 0.07 [95% CI -2.32, 2.45] in European women; β = 0.20 [95% CI -7.21, 7.62] in East Polynesian women; β -3.33 [95% CI -9.28, 2.62] in West Polynesian women). The PRS showed a positive association with tophaceous disease in men (odds ratio [OR] for the association 1.15 [95% CI 1.00, 1.31] in European men; OR 2.60 [95% CI 1.66, 4.06] in East Polynesian men; OR 1.53 [95% CI 1.07, 2.19] in West Polynesian men) but not in women (OR for the association 0.68 [95% CI 0.42, 1.10] in European women; OR 1.45 [95% CI 0.39, 5.36] in East Polynesian women). The PRS association with age at gout onset was robust to the removal of ABCG2 variants from the PRS in European and East Polynesian men (β = -2.42 [95% CI -3.37, -1.46] and β = -6.80 [95% CI -10.06, -3.55], respectively) but not in West Polynesian men (β = -1.79 [95% CI -4.74, 1.16]). CONCLUSION Genetic risk variants for gout also harbor risk for earlier age at gout onset and tophaceous disease in European and Polynesian men. Our findings suggest that earlier gout onset involves the accumulation of gout risk alleles in men but perhaps not in women, and that this genetic risk is shared across multiple ancestral groups.
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Affiliation(s)
- Nicholas A Sumpter
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, and Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Riku Takei
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham
| | - Murray Cadzow
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Ruth K G Topless
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | | | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Janak de Zoysa
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Huti Watson
- Ngāti Porou Hauora Trust, Te Puia Springs, New Zealand
| | | | - Alexa S Lupi
- Department of Epidemiology and Biostatistics, Michigan State University, and The Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, Michigan
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK, and GlobalGoutGenetics Consortium
| | - Mariano Andrés
- GlobalGoutGenetics Consortium, and Department of Rheumatology, Alicante General University Hospital-ISABIAL, Miguel Hernandez University, Alicante, Spain
| | - Tania O Crișan
- GlobalGoutGenetics Consortium, and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK, and GlobalGoutGenetics Consortium
| | - Lennart Jacobsson
- GlobalGoutGenetics Consortium, and Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Matthijs Janssen
- GlobalGoutGenetics Consortium, and Complex Gout Expert Centre, Department of Rheumatology, Viecuri Medical Centre, Venlo, The Netherlands
| | - Tim L Jansen
- GlobalGoutGenetics Consortium, and Complex Gout Expert Centre, Department of Rheumatology, Viecuri Medical Centre, Venlo, The Netherlands
| | - Leo A B Joosten
- GlobalGoutGenetics Consortium, and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, and Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Meliha Kapetanovic
- GlobalGoutGenetics Consortium, and Lund University and Skåne University Hospital, Lund, Sweden
| | - Frédéric Lioté
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hirotaka Matsuo
- GlobalGoutGenetics Consortium, and Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Geraldine M McCarthy
- GlobalGoutGenetics Consortium, and Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | - Fernando Perez-Ruiz
- GlobalGoutGenetics Consortium, and Rheumatology Division, Osakidetza, OSI EE-Cruces, Cruces University Hospital, Barakaldo, Biocruces-Bizkaia Health Research Institute, Barakaldo, and the Medicine Department of the Medicine School of the University of the Basque Country, Leioa, Spain
| | - Philip Riches
- GlobalGoutGenetics Consortium, and IGC, University of Edinburgh, Scotland
| | - Pascal Richette
- GlobalGoutGenetics Consortium, and Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Cité, Paris, France
| | - Edward Roddy
- GlobalGoutGenetics Consortium, and School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Blanka Stiburkova
- GlobalGoutGenetics Consortium, and Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic, and Institute of Rheumatology, Prague, Czech Republic
| | - Alexander So
- GlobalGoutGenetics Consortium, and Service of Rheumatology, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Anne-Kathrin Tausche
- GlobalGoutGenetics Consortium, and Division of Rheumatology, University Clinic Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Rosa J Torres
- GlobalGoutGenetics Consortium, and Department of Biochemistry, La Paz University Hospital Health Research Institute (FIBHULP), IdiPaz, and Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Till Uhlig
- GlobalGoutGenetics Consortium, and Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Tanya J Major
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Lisa K Stamp
- GlobalGoutGenetics Consortium, and Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand, and GlobalGoutGenetics Consortium
| | - Hyon K Choi
- Clinical Epidemiology Unit, Massachusetts General Hospital, Boston
| | - Ana I Vazquez
- Department of Epidemiology and Biostatistics, Michigan State University, and The Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, Michigan
| | - Megan P Leask
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham
| | - Richard J Reynolds
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham
| | - Tony R Merriman
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Department of Biochemistry, University of Otago, Dunedin, New Zealand, and GlobalGoutGenetics Consortium
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10
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Di Giuseppe D, Lindström U, Aaltonen K, Relas H, Provan S, Gudbjornsson B, Hetland ML, Askling J, Kauppi M, Geirsson AJ, Chatzidionysiou K, Jørgensen TS, Dreyer L, Michelsen B, Jacobsson L, Glintborg B. The occurrence of multiple treatment switches in axial spondyloarthritis. Results from five Nordic rheumatology registries. Rheumatology (Oxford) 2021; 61:3647-3656. [PMID: 34940795 DOI: 10.1093/rheumatology/keab946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/16/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In axial spondyloarthritis (axSpA), switching between multiple biologic or targeted synthetic (b/ts-) DMARDs might indicate difficult-to-treat disease. We aimed to explore the occurrence of multiple switching in routine care axSpA patients using various definitions, and to identify associated clinical characteristics upon start of first b/tsDMARD (baseline). METHODS Observational cohort study including patients with axSpA starting a first-ever b/tsDMARD 2009-2018 based on data from five biologic registries (Denmark/Sweden/Finland/Norway/Iceland). Comorbidities and extra-articular manifestations were identified through linkage to national registries. Multi-switching was defined in overlapping categories according to b/tsDMARD treatment history: treatment with ≥3 b/tsDMARDs, ≥4 or ≥ 5 b/tsDMARDs during follow-up. We explored the cumulative incidence of patients becoming multi-switchers with ≥3 b/tsDMARDs stratified by calendar-period (2009-11/2012-13/2014-15/2016-2018). In the subgroup of patients starting a first b/tsDMARD 2009-2015, baseline characteristics associated with multi-switching (within 3 years' follow-up) were explored using multiple logistic regression analyses. RESULTS Among 8,398 patients included, 6,056 patients (63% male, median age 42 years) started a first b/tsDMARD 2009-2015, whereof proportions treated with ≥3, ≥4 or ≥ 5 b/tsDMARDs within 3 years' follow-up were 8%, 3%, 1%, respectively.Calendar-period did not affect the cumulative incidence of multi-switching.Baseline characteristics associated with multi-switching (≥3 b/tsDMARDs) were female gender, shorter disease duration, higher patient global score, comorbidities, and having psoriasis but not uveitis. CONCLUSION In this large Nordic observational cohort of axSpA patients, multiple switching was frequent with no apparent time-trend. Clinical associated factors included gender, but also previous comorbidities and extraarticular manifestations illustrating the ongoing challenge of treating this patient group.
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Affiliation(s)
- Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kalle Aaltonen
- Ministry of Social Affairs and Health, Pharmaceuticals Pricing Board, Helsinki, Finland
| | - Heikki Relas
- Departments of Medicine and Rheumatology, Helsinki University Hospital (ROB-FIN), Helsinki, Finland
| | | | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), Landspitali University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Johan Askling
- Clinical Epidemiology Division, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Markku Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Katerina Chatzidionysiou
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tanja Schjødt Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Denmark
| | - Brigitte Michelsen
- Department of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Division of Rheumatology, Department of Medicine, Sørlandet Sykehus, Kristiansand, Norway
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Landgren AJ, Dehlin M, Jacobsson L, Bergsten U, Klingberg E. Cardiovascular risk factors in gout, psoriatic arthritis, rheumatoid arthritis and ankylosing spondylitis: a cross-sectional survey of patients in Western Sweden. RMD Open 2021; 7:rmdopen-2021-001568. [PMID: 34031261 PMCID: PMC8154995 DOI: 10.1136/rmdopen-2021-001568] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/26/2021] [Accepted: 04/22/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives We aimed to compare traditional (trad) cardiovascular risk factors (CVRFs) among patients with gout, psoriatic arthritis (PsA), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) stratified by sex. Methods A survey was sent to patients with gout (n=1589), PsA (n=1200), RA (n=1246) and AS (n=1095). Patients were retrieved from Sahlgrenska University Hospital, the hospitals of Uddevalla and Skövde, and 12 primary care centres in Western Sweden. The prevalence of self-reported trad-CVRFs was compared between diagnoses by age standardisation with the 2018 population of Sweden as the standard population. Results In total, 2896 (56.5%) of 5130 patients responded. Hypertension was the most frequently found comorbidity, reported by 65% of patients with gout, 41% with PsA, 43% with RA and 29% with AS. After age standardisation, women and men with gout had significantly more obesity (body mass index ≥30 kg/m2), hypertension, diabetes, hyperlipidaemia and multiple trad-CVRFs, compared with those with PsA, RA and AS. Obesity was significantly more common in PsA than in RA. In women, obesity, hypertension and multiple trad-CVRFs were more frequently reported in PsA than in RA and AS, whereas similar prevalence of CVRFs and coexistence of multiple trad-CVRFs were found in men with PsA, RA and AS. Conclusions Women and men with gout had the highest prevalence of trad-CVRFs. Differences in occurrence of CVRFs by sex were found in patients with PsA, RA and AS. In women, patients with PsA had higher occurrence of trad-CVRFs than those with RA and AS, whereas in men the distribution of CVRFs was similar in PsA, RA and AS.
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Affiliation(s)
- Anton Jonatan Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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12
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Wadström K, Jacobsson L, Mohammad AJ, Warrington KJ, Matteson EL, Turesson C. Comment on: Negative associations for fasting blood glucose, cholesterol and triglyceride levels with the development of giant cell arteritis: reply. Rheumatology (Oxford) 2021; 60:e262-e263. [PMID: 33576780 PMCID: PMC8249078 DOI: 10.1093/rheumatology/keab143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karin Wadström
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö
| | - Lennart Jacobsson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö.,Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenberg, Gothenburg
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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13
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Eberhard A, Bergman S, Mandl T, Olofsson T, Rydholm M, Jacobsson L, Turesson C. Predictors of unacceptable pain with and without low inflammation over 5 years in early rheumatoid arthritis-an inception cohort study. Arthritis Res Ther 2021; 23:169. [PMID: 34127054 PMCID: PMC8201925 DOI: 10.1186/s13075-021-02550-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/25/2021] [Indexed: 01/12/2023] Open
Abstract
Objectives Pain is a major symptom in patients with rheumatoid arthritis (RA). In early RA, pain is usually due to synovitis, but can also persist despite effective anti-inflammatory treatment. The objective of this study was to investigate the pain course over time and predictors of unacceptable pain and unacceptable pain with low inflammation, in patients with early RA. Methods An inception cohort of 232 patients with early RA, recruited in 1995–2005, was followed in a structured programme for 5 years. Pain was assessed using a visual analogue scale (VAS; 0–100). Unacceptable pain was defined as VAS pain > 40 based on the patient acceptable symptom state (PASS) and low inflammation as CRP < 10 mg/l. Baseline predictors of unacceptable pain were evaluated using logistic regression analysis. Results Pain improved significantly during the first 6 months, but then remained basically unchanged. Thirty-four per cent of the patients had unacceptable pain 5 years after inclusion. Baseline predictors of unacceptable pain after 5 years were lower swollen joint counts [odds ratio (OR) 0.71 per standard deviation (95% confidence interval (CI) 0.51–0.99)] and higher VAS for pain and global assessment of disease activity. Unacceptable pain with low inflammation after 5 years was negatively associated with anti-CCP antibodies [OR 0.50 (95% CI 0.22–0.98)]. Conclusion Over one third of the patients had unacceptable pain 5 years after inclusion. Lower swollen joint count was associated with unacceptable pain at 5 years. The results may be explained by the positive effects of treatment on pain related to inflammation. Non-inflammatory long-lasting pain appears to be a greater problem in anti-CCP-negative patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02550-7.
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Affiliation(s)
- Anna Eberhard
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1b, 214 28, Malmö, Sweden.
| | - Stefan Bergman
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Mandl
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1b, 214 28, Malmö, Sweden
| | - Tor Olofsson
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Maria Rydholm
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1b, 214 28, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1b, 214 28, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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14
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Wadström K, Jacobsson L, Mohammad AJ, Warrington KJ, Matteson EL, Turesson C. Negative associations for fasting blood glucose, cholesterol and triglyceride levels with the development of giant cell arteritis. Rheumatology (Oxford) 2021; 59:3229-3236. [PMID: 32240313 PMCID: PMC7590417 DOI: 10.1093/rheumatology/keaa080] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives To investigate metabolic features that may predispose to GCA in a nested case–control study. Methods Individuals who developed GCA after inclusion in a population-based health survey (the Malmö Preventive Medicine Project; N = 33 346) were identified and validated through a structured review of medical records. Four controls for every validated case were selected from the database. Results A total of 76 cases with a confirmed incident diagnosis of GCA (61% female, 65% biopsy positive, mean age at diagnosis 70 years) were identified. The median time from screening to diagnosis was 20.7 years (range 3.0–32.1). Cases had significantly lower fasting blood glucose (FBG) at baseline screening compared with controls [mean 4.7 vs 5.1 mmol/l (S.d. overall 1.5), odds ratio (OR) 0.35 per mmol/l (95% CI 0.17, 0.71)] and the association remained significant when adjusted for smoking [OR 0.33 per mmol/l (95% CI 0.16, 0.68)]. Current smokers had a reduced risk of GCA [OR 0.35 (95% CI 0.18, 0.70)]. Both cholesterol [mean 5.6 vs 6.0 mmol/l (S.d. overall 1.0)] and triglyceride levels [median 1.0 vs 1.2 mmol/l (S.d. overall 0.8)] were lower among the cases at baseline screening, with significant negative associations with subsequent GCA in crude and smoking-adjusted models [OR 0.62 per mmol/l (95% CI 0.43, 0.90) for cholesterol; 0.46 per mmol/l (95% CI 0.27, 0.81) for triglycerides]. Conclusion Development of GCA was associated with lower FBG and lower cholesterol and triglyceride levels at baseline, all adjusted for current smoking, suggesting that metabolic features predispose to GCA.
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Affiliation(s)
- Karin Wadström
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Sweden
| | - Lennart Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology & Inflammation Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Sweden
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15
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Michelsen B, Ørnbjerg LM, Kvien TK, Pavelka K, Nissen MJ, Nordström D, Santos MJ, Koca SS, Askling J, Rotar Z, Gudbjornsson B, Codreanu C, Loft AG, Kristianslund EK, Mann HF, Ciurea A, Eklund KK, Vieira-Sousa E, Yazici A, Jacobsson L, Tomšič M, Löve TJ, Ionescu R, van der Horst-Bruinsma IE, Iannone F, Pombo-Suarez M, Jones GT, Hyldstrup LH, Krogh NS, Hetland ML, Østergaard M. Impact of discordance between patient's and evaluator's global assessment on treatment outcomes in 14 868 patients with spondyloarthritis. Rheumatology (Oxford) 2021; 59:2455-2461. [PMID: 31960053 DOI: 10.1093/rheumatology/kez656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/06/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess the impact of 'patient's minus evaluator's global assessment of disease activity' (ΔPEG) at treatment initiation on retention and remission rates of TNF inhibitors (TNFi) in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) patients across Europe. METHODS Real-life data from PsA and axSpA patients starting their first TNFi from 11 countries in the European Spondyloarthritis Research Collaboration Network were pooled. Retention rates were compared by Kaplan-Meier analyses with log-rank test and by Cox regression, and remission rates by χ2 test and by logistic regression across quartiles of baseline ΔPEG, separately in female and male PsA and axSpA patients. RESULTS We included 14 868 spondyloarthritis (5855 PsA, 9013 axSpA) patients. Baseline ΔPEG was negatively associated with 6/12/24-months' TNFi retention rates in female and male PsA and axSpA patients (P <0.001), with 6/12/24-months' BASDAI < 2 (P ≤0.002) and ASDAS < 1.3 (P ≤0.005) in axSpA patients, and with DAS28CRP(4)<2.6 (P ≤0.04) and DAPSA28 ≤ 4 (P ≤0.01), but not DAS28CRP(3)<2.6 (P ≥0.13) in PsA patients, with few exceptions on remission rates. Retention and remission rates were overall lower in female than male patients. CONCLUSION High baseline patient's compared with evaluator's global assessment was associated with lower 6/12/24-months' remission as well as retention rates of first TNFi in both PsA and axSpA patients. These results highlight the importance of discordance between patient's and evaluator's perspective on disease outcomes.
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Affiliation(s)
- Brigitte Michelsen
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand.,Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lykke Midtbøll Ørnbjerg
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karel Pavelka
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Dan Nordström
- ROB-FIN Registry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Maria José Santos
- Reuma.pt Registry and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Suleyman Serdar Koca
- TURKBIO Registry and Division of Rheumatology, School of Medicine, Firat University, Elazig, Turkey
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ziga Rotar
- BioRx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Anne Gitte Loft
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Eirik Klami Kristianslund
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Herman F Mann
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Kari K Eklund
- Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Elsa Vieira-Sousa
- Reuma.pt Registry and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ayten Yazici
- TURKBIO Registry and Division of Rheumatology, School of Medicine, Kocaeli University, Izmit, Turkey
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matija Tomšič
- BioRx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Thorvardur Jón Löve
- University of Iceland, Faculty of Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Ruxandra Ionescu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - I E van der Horst-Bruinsma
- Department Rheumatology & Immunology Center (ARC), Amsterdam University Medical Centres, Location VU University Medical Centre, Amsterdam, the Netherlands
| | - Florenzo Iannone
- GISEA Registry, Rheumatology Unit - DETO, University of Bari, Italy
| | - Manuel Pombo-Suarez
- Rheumatology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Lise Hejl Hyldstrup
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | | | - Merete Lund Hetland
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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16
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Glintborg B, Lindstrom U, Di Giuseppe D, Provan SA, Gudbjornsson B, Hetland ML, Michelsen B, Wallman J, Aaltonen K, Hokkanen A, Nordström D, Jørgensen TS, Hansen RL, Jon Geirsson A, Grøn K, krogh NS, Askling J, Kristensen LE, Jacobsson L. One‐year treatment outcomes of secukinumab versus tumor necrosis factor inhibitors in Spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 74:748-758. [DOI: 10.1002/acr.24523] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre of Head and Orthopedics, Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Ulf Lindstrom
- Department of Rheumatology and Inflammation Research Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | | | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine University of Iceland Iceland
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre of Head and Orthopedics, Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Brigitte Michelsen
- Department of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway
- Division of Rheumatology, Department of Medicine Sørlandet Sykehus Kristiansand Norway
| | - Johan Wallman
- Clinical Sciences Lund, Rheumatology Lund University, Skane University Hospital Lund Sweden
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board Ministry of Social Affairs and Health Helsinki Finland
| | - Anna‐Mari Hokkanen
- Department of Medicine Helsinki University and Helsinki University Hospital Helsinki Finland
| | - Dan Nordström
- Department of Medicine and Rheumatology Helsinki University and Helsinki University Hospital Helsinki Finland
| | - Tanja Schjødt Jørgensen
- The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Rebekka Lund Hansen
- The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | | | - Kathrine Grøn
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre of Head and Orthopedics, Rigshospitalet Copenhagen Denmark
| | | | - Johan Askling
- Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Lars Erik Kristensen
- The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
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17
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Dehlin M, Kapetanovic M, Svärd A, Bengtsson Boström K, Wändell P, Sigurdardottir V, Forsblad d'Elia H, Jacobsson L. [Consequences of Gout and Hyperuricemia]. Lakartidningen 2020; 117:F3HI. [PMID: 32852770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hyperuricemia (HU) and gout are strongly associated with CVD, associations that are most likely due to shared etiologies rather than causality. HU is for example causally related to the metabolic syndrome and in particular to obesity. Gout and HU can both be caused by and lead to decreased kidney function. On the other hand, there are observational data suggesting that HU may protect against neurodegenerative diseases such as Alzheimer and Parkinson's disease. Ongoing RCTs with urate and urate lowering therapy (ULT) will help to resolve some of these controversies. Nevertheless, gout is a "curable disease" by ULT, a treatment which in adequate doses may also have positive effect on several associated co-morbidities.
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Affiliation(s)
| | | | - Anna Svärd
- med dr, överläkare, Falu lasarett; Centrum för klinisk forskning Dalarna, Uppsala universitet; institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
| | - Kristina Bengtsson Boström
- adjungerad professor, distriktsläkare, institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
| | | | - Valgerdur Sigurdardottir
- specialistläkare, Falu lasarett; Centrum för klinisk forskning Dalarna, Uppsala universitet; institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
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18
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Jacobsson L. [Not Available]. Lakartidningen 2020; 117:F3Y4. [PMID: 32852771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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19
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Sigurdardottir V, Svärd A, Bengtsson Boström K, Wändell P, Jacobsson L, Forsblad d'Elia H, Kapetanovic M, Dehlin M. [Gout - a common and well known disease]. Lakartidningen 2020; 117:F3M3. [PMID: 32852773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hyperuricemia is defined by a blood urate level > 405 µmol/L, the cut-off value at which urate forms crystals in vivo. In 15-20% these individuals develop gout, clinically characterized by attacks of acute arthritis, initially and most commonly affecting MTP 1 or other joints, tendons and soft tissues of the foot. These attacks usually subside within 1 to 2 weeks. Over time attacks occur more frequently and can transform into chronic arthritis characterized by tophi. The gold standard for diagnosis relies on identification of urate crystals by polarization microscopy in aspirated joint fluid. This procedure is rarely performed in primary care where the majority of patients are seen, and gout is usually diagnosed by clinical criteria. New imaging technologies (ultrasound, dual-energy CT) can be helpful when aspiration is not available and when the diagnosis is unclear. Gout has a prevalence of 1.7% and incidence rate of approximately 200 per 100000 person-years in Sweden, figures that increase over time.
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Affiliation(s)
- Valgerdur Sigurdardottir
- specialistläkare, Falu lasarett; Centrum för klinisk forskning Dalarna, Uppsala universitet; institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
| | - Anna Svärd
- med dr, överläkare, Falu lasarett; Centrum för klinisk forskning Dalarna, Uppsala universitet; institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
| | - Kristina Bengtsson Boström
- adjungerad professor, distriktsläkare, institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
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20
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Svärd A, Kapetanovic M, Bergsten U, Bengtsson Boström K, Wändell P, Sigurdardottir V, Jacobsson L, Dehlin M. [Large health benefits can be achieved by better treatment of gout]. Lakartidningen 2020; 117:F3L7. [PMID: 32852772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Urate lowering therapy (ULT) should, according to recent guidelines, be initiated in the majority of cases already after the first attack of gout. Allopurinol is the first line choice of ULT and should be started with low dose, which is increased until the treatment target is reached. The treatment target should be a blood urate of < 360 µmol/l or < 300 µmol/l (in the presence of topfi), which should be maintained until topfi have resolved. NSAID/cox-inhibitors, colchicine and glucocorticoids are all valid short-term treatments of gout attacks. ULT should not be paused/terminated during attacks and can be initiated during an attack that is adequately treated. Recent RCTs of ULT treatment have demonstrated the importance of thorough and adequate information to the patient and regular follow-up until treatment targets are reached. Such a strategy improve both compliance and outcomes of ULT treatment.
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Affiliation(s)
- Anna Svärd
- med dr, överläkare, Falu lasarett; Centrum för klinisk forskning Dalarna, Uppsala universitet; institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
| | | | | | - Kristina Bengtsson Boström
- adjungerad professor, distriktsläkare, institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
| | | | - Valgerdur Sigurdardottir
- specialistläkare, Falu lasarett; Centrum för klinisk forskning Dalarna, Uppsala universitet; institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet
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21
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Sigurdardottir V, Jacobsson L, Schiöler L, Svärd A, Dehlin M, Toren K. Occupational exposure to inorganic dust and risk of gout: a population-based study. RMD Open 2020; 6:rmdopen-2020-001178. [PMID: 32683325 PMCID: PMC7425113 DOI: 10.1136/rmdopen-2020-001178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/04/2020] [Accepted: 06/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background Risk factors operating independently of hyperuricemia could be of importance in determining why only a minority of people with hyperuricemia develop gout. Exposure to inorganic dust has been linked to other inflammatory diseases and could influence the development of gout. Objectives To evaluate if occupational exposure to inorganic dust increases the risk of gout. Methods Individuals aged 30–65 years with a first gout diagnosis in 2006–2012 in the population-based healthcare database of the Western Swedish Healthcare Region (VEGA) and population controls matched by age and sex were included. Data on occupation was collected from the Swedish occupational register. Exposure status was assigned by means of a job exposure matrix. Data on gout-related comorbidities was collected from VEGA. Alcohol use disorder and obesity were related both to gout and exposure to inorganic dust and were adjusted for in multivariate analyses. ORs were calculated using conditional logistic regression. Results 5042 gout cases and 20 682 controls were included. Exposure to inorganic dust was associated with gout in both unadjusted (OR 1.12, 95% CI 1.04 to 1.20) and multivariate (OR 1.08, 95% CI 1.00 to 1.16) analyses of the whole population. In sex-stratified multivariate analyses, dust exposure was significantly associated with gout in women (adjusted OR 1.26, 95% CI 1.05 to 1.51), but not in men (adjusted OR 1.05, 95% CI 0.97 to 1.13). Conclusions We describe for the first time an association between exposure to inorganic dust and gout. After adjusting for confounders, the findings were statistically significant for women but not for men.
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Affiliation(s)
- Valgerdur Sigurdardottir
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden .,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Anna Svärd
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kjell Toren
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
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22
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Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol 2020; 16:380-390. [PMID: 32541923 DOI: 10.1038/s41584-020-0441-1] [Citation(s) in RCA: 455] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
Gout is the most common inflammatory arthritis and occurs when hyperuricaemia, sustained elevation of serum urate levels resulting in supersaturation of body tissues with urate, leads to the formation and deposition of monosodium urate crystals in and around the joints. Recent reports of the prevalence and incidence of gout vary widely according to the population studied and methods employed but range from a prevalence of <1% to 6.8% and an incidence of 0.58-2.89 per 1,000 person-years. Gout is more prevalent in men than in women, with increasing age, and in some ethnic groups. Despite rising prevalence and incidence, suboptimal management of gout continues in many countries. Typically, only a third to half of patients with gout receive urate-lowering therapy, which is a definitive, curative treatment, and fewer than a half of patients adhere to treatment. Many gout risk factors exist, including obesity, dietary factors and comorbid conditions. As well as a firmly established increased risk of cardiovascular disease and chronic kidney disease in those with gout, novel associations of gout with other comorbidities have been reported, including erectile dysfunction, atrial fibrillation, obstructive sleep apnoea, osteoporosis and venous thromboembolism. Discrete patterns of comorbidity clustering in individuals with gout have been described. Increasing prevalence and incidence of obesity and comorbidities are likely to contribute substantially to the rising burden of gout.
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Affiliation(s)
- Mats Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK. .,Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK.
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23
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van Lunteren M, van der Heijde D, Sepriano A, Berg IJ, Dougados M, Gossec L, Jacobsson L, Ramonda R, Rudwaleit M, Sieper J, Landewé R, van Gaalen FA. Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known? Rheumatology (Oxford) 2020; 58:1649-1654. [PMID: 30938446 PMCID: PMC6735817 DOI: 10.1093/rheumatology/kez095] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/23/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known. Methods In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis. Results In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis. Conclusion In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.
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Affiliation(s)
- Miranda van Lunteren
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inger J Berg
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris
| | - Laure Gossec
- Rheumatology Department, Sorbonne Université, Paris.,Rheumatology Department, Pitié Salpêtrière Hospital, Paris, France
| | - Lennart Jacobsson
- Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Martin Rudwaleit
- Department of Rheumatology, Charité Campus Benjamin Franklin, Berlin.,Department of Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld
| | - Joachim Sieper
- Department of Rheumatology, Charité Campus Benjamin Franklin, Berlin.,German Rheumatism Research Centre, Berlin, Germany
| | - Robert Landewé
- Department of Rheumatology, Amsterdam Rheumatology & Immunology Center, Amsterdam.,Department of Rheumatology, Zuyderland Hospital, Heerlen, the Netherlands
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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Hameed M, Turkiewicz A, Englund M, Jacobsson L, Kapetanovic MC. Prevalence and incidence of non-gout crystal arthropathy in southern Sweden. Arthritis Res Ther 2019; 21:291. [PMID: 31847885 PMCID: PMC6918617 DOI: 10.1186/s13075-019-2077-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/29/2019] [Indexed: 01/30/2023] Open
Abstract
Objective To estimate the prevalence and incidence of non-gout crystal arthropathy in relation to socioeconomic factors in southern Sweden. Methods All patients (age ≥ 18 years) with at least one visit to a physician with the diagnosis of interest in the Skåne region (population of 1.3 million) in 1998–2014 were identified. Non-gout crystal arthropathy (ICD-10 codes M11.0–M11.9) was subclassified in four different groups: calcium pyrophosphate crystal deposition related arthropathy (CPPD), unspecified non-gout arthropathies, chondrocalcinosis, and hydroxyapatite crystal deposition disease. The crude and age-adjusted point prevalence on December 31, 2014, and the cumulative incidence during 2014 were calculated for all non-gout crystal arthropathies, CPPD, and other unspecified non-gout arthropathies overall and in relation to occupation, income, and level of education. Results The crude 2014 point prevalence (95% CI) and 2014 cumulative incidence (95% CI) of all non-gout crystal arthropathies were 0.23% (0.23–0.24) and 21.5 (19–25) cases/100,000 persons. Mean age (range) among all prevalent cases in 2014 was 71 (20–102) years and 56% were males. The point prevalence and cumulative incidence of CPPD were 0.09% (0.08–0.09) and 8 (7–10)/100,000 persons, respectively. The corresponding data for unspecified non-gout crystal deposition disease was 0.16% (0.16–0.17) and 15.6 (13–18)/100,000 persons, respectively. The prevalence and incidence of CPPD and unspecified non-gout crystal arthropathies were slightly higher in men and increased with age irrespective of gender. Unspecified non-gout crystal arthropathy but not CPPD was less prevalent in persons with ≥ 15 years of education, whereas there were no clear associations with occupation and income. Conclusion The prevalence of all diagnosed non-gout crystal arthropathies was 0.23%, thus considerably less prevalent than gout in southern Sweden. CPPD and other unspecified non-gout crystal arthropathies are the predominant diagnoses, increasing with age and in men. With the exception for unspecified non-gout crystal arthropathies being inversely correlated to a higher level of education, no convincing association with the socioeconomic factors was found.
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Affiliation(s)
- Mohaned Hameed
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Sweden. .,Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Gothenburg, Sweden.
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Lennart Jacobsson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Meliha C Kapetanovic
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Gothenburg, Sweden
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25
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Bursill D, Taylor WJ, Terkeltaub R, Kuwabara M, Merriman TR, Grainger R, Pineda C, Louthrenoo W, Edwards NL, Andrés M, Vargas-Santos AB, Roddy E, Pascart T, Lin CT, Perez-Ruiz F, Tedeschi SK, Kim SC, Harrold LR, McCarthy G, Kumar N, Chapman PT, Tausche AK, Vazquez-Mellado J, Gutierrez M, da Rocha Castelar-Pinheiro G, Richette P, Pascual E, Fisher MC, Burgos-Vargas R, Robinson PC, Singh JA, Jansen TL, Saag KG, Slot O, Uhlig T, Solomon DH, Keenan RT, Scire CA, Biernat-Kaluza E, Dehlin M, Nuki G, Schlesinger N, Janssen M, Stamp LK, Sivera F, Reginato AM, Jacobsson L, Lioté F, Ea HK, Rosenthal A, Bardin T, Choi HK, Hershfield MS, Czegley C, Choi SJ, Dalbeth N. Gout, Hyperuricemia, and Crystal-Associated Disease Network Consensus Statement Regarding Labels and Definitions for Disease Elements in Gout. Arthritis Care Res (Hoboken) 2019; 71:427-434. [PMID: 29799677 DOI: 10.1002/acr.23607] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/22/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The language currently used to describe gout lacks standardization. The aim of this project was to develop a consensus statement on the labels and definitions used to describe the basic disease elements of gout. METHODS Experts in gout (n = 130) were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach consensus on the labeling and definitions for the basic disease elements of gout. Disease elements and labels in current use were derived from a content analysis of the contemporary medical literature, and the results of this analysis were used for item selection in the Delphi exercise and face-to-face consensus meeting. RESULTS There were 51 respondents to the Delphi exercise and 30 attendees at the face-to-face meeting. Consensus agreement (≥80%) was achieved for the labels of 8 disease elements through the Delphi exercise; the remaining 3 labels reached consensus agreement through the face-to-face consensus meeting. The agreed labels were monosodium urate crystals, urate, hyperuric(a)emia, tophus, subcutaneous tophus, gout flare, intercritical gout, chronic gouty arthritis, imaging evidence of monosodium urate crystal deposition, gouty bone erosion, and podagra. Participants at the face-to-face meeting achieved consensus agreement for the definitions of all 11 elements and a recommendation that the label "chronic gout" should not be used. CONCLUSION Consensus agreement was achieved for the labels and definitions of 11 elements representing the fundamental components of gout etiology, pathophysiology, and clinical presentation. The Gout, Hyperuricemia, and Crystal-Associated Disease Network recommends the use of these labels when describing the basic disease elements of gout.
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Affiliation(s)
- David Bursill
- University of Auckland, Auckland, New Zealand, and Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - William J Taylor
- University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Robert Terkeltaub
- Veterans Affairs Medical Center and University of California, San Diego
| | - Masanari Kuwabara
- Toranomon Hospital, Tokyo, Japan, and University of Colorado Denver, Aurora
| | | | - Rebecca Grainger
- University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Carlos Pineda
- Instituto Nacional Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | | | - Mariano Andrés
- Hospital Universitario de Alicante and Universidad Miguel Hernández, Alicante, Spain
| | | | | | - Tristan Pascart
- Lille Catholic University and Saint-Philibert Hospital, Lomme, France
| | | | - Fernando Perez-Ruiz
- University of the Basque Country, Biscay, and Cruces University Hospital and Biocruces Health Research Institute, Baracaldo, Spain
| | - Sara K Tedeschi
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Seoyoung C Kim
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Leslie R Harrold
- Corrona, LLC, Waltham, and University of Massachusetts Medical School, Worcester
| | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | | | - Anne-Kathrin Tausche
- University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | | | | | - Pascal Richette
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Eliseo Pascual
- Hospital Universitario de Alicante and Universidad Miguel Hernández, Alicante, Spain
| | - Mark C Fisher
- Harvard Medical School and Massachusetts General Hospital Boston
| | - Ruben Burgos-Vargas
- Hospital General de México and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Philip C Robinson
- University of Queensland School of Medicine and Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jasvinder A Singh
- Veterans Affairs Medical Center, Birmingham, and University of Alabama at Birmingham
| | | | | | - Ole Slot
- Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Daniel H Solomon
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Carlo Alberto Scire
- University of Ferrara, Ferrara, and Italian Society for Rheumatology, Milan, Italy
| | | | - Mats Dehlin
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | | - Anthony M Reginato
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | | | - Frédéric Lioté
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Hang-Korng Ea
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Ann Rosenthal
- Medical College of Wisconsin and the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee
| | - Thomas Bardin
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Hyon K Choi
- Harvard Medical School and Massachusetts General Hospital Boston
| | | | - Christine Czegley
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sung Jae Choi
- University of California, San Diego, and Korea University Ansan Hospital, Ansan, South Korea
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26
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Brahe CH, Ørnbjerg LM, Jacobsson L, Nissen MJ, Kristianslund EK, Mann H, Santos MJ, Reino JG, Nordström D, Rotar Z, Gudbjornsson B, Onen F, Codreanu C, Lindström U, Möller B, Kvien TK, Pavelka K, Barcelos A, Sánchez-Piedra C, Eklund KK, Tomšič M, Love TJ, Can G, Ionescu R, Loft AG, van der Horst-Bruinsma IE, Macfarlane GJ, Iannone F, Hyldstrup LH, Krogh NS, Østergaard M, Hetland ML. Retention and response rates in 14 261 PsA patients starting TNF inhibitor treatment—results from 12 countries in EuroSpA. Rheumatology (Oxford) 2019; 59:1640-1650. [DOI: 10.1093/rheumatology/kez427] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/09/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Objective
To investigate TNF inhibitor (TNFi) retention and response rates in European biologic-naïve patients with PsA.
Methods
Prospectively collected data on PsA patients in routine care from 12 European registries were pooled. Heterogeneity in baseline characteristics between registries were explored (analysis of variance and pairwise comparison). Retention rates (Kaplan–Meier), clinical remission [28-joint count DAS (DAS28) <2.6; 28 joint Disease Activity index for Psoriatic Arthritis ⩽4] and ACR criteria for 20% improvement (ACR20)/ACR50/ACR70 were calculated, including LUNDEX adjustment.
Results
Overall, 14 261 patients with PsA initiated a first TNFi. Considerable heterogeneity of baseline characteristics between registries was observed. The median 12-month retention rate (95% CI) was 77% (76, 78%), ranging from 68 to 90% across registries. Overall, DAS28/28 joint Disease Activity index for Psoriatic Arthritis remission rates at 6 months were 56%/27% (LUNDEX: 45%/22%). Six-month ACR20/50/70 responses were 53%/38%/22%, respectively. In patients initiating a first TNFi after 2009 with registered fulfilment of ClASsification for Psoriatic ARthritis (CASPAR) criteria (n = 1980) or registered one or more swollen joint at baseline (n = 5803), the retention rates and response rates were similar to those found overall.
Conclusion
Approximately half of >14 000 patients with PsA who initiated first TNFi treatment in routine care were in DAS28 remission after 6 months, and three-quarters were still on the drug after 1 year. Considerable heterogeneity in baseline characteristics and outcomes across registries was observed. The feasibility of creating a large European database of PsA patients treated in routine care was demonstrated, offering unique opportunities for research with real-world data.
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Affiliation(s)
- Cecilie Heegaard Brahe
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lykke Midtbøll Ørnbjerg
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | | | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria José Santos
- Reuma.pt registry and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Dan Nordström
- ROB-FIN Registry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Ziga Rotar
- biorx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Slovenia, Ljubljana
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Fatos Onen
- TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University, Izmir, Turkey
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Burkhard Möller
- Leitender Arzt der Universitätsklinik für Rheumatologie, Immunologie und Allergologie Inselspital, Bern, Switzerland
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karel Pavelka
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anabela Barcelos
- Rheuma.pt registry, Rheumatology Department—Centro Hospitalar do Baixo Vouga and Ibimed—Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
| | | | - Kari K Eklund
- Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Matija Tomšič
- biorx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Slovenia, Ljubljana
| | - Thorvardur Jon Love
- University of Iceland, Faculty of Medicine, and Landspitali University Hospital, Reykjavik, Iceland
| | - Gercek Can
- TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University, Izmir, Turkey
| | - Ruxandra Ionescu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Anne Gitte Loft
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - I E van der Horst-Bruinsma
- Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam
- Department of Rheumatology, Amsterdam UMC, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Florenzo Iannone
- GISEA registry, Rheumatology Unit – DETO, University of Bari, Bari, Italy
| | - Lise Hejl Hyldstrup
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup
| | | | - Mikkel Østergaard
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Thorarinsdottir K, Camponeschi A, Jonsson C, Granhagen Önnheim K, Nilsson J, Forslind K, Visentini M, Jacobsson L, Mårtensson IL, Gjertsson I. CD21 -/low B cells associate with joint damage in rheumatoid arthritis patients. Scand J Immunol 2019; 90:e12792. [PMID: 31141193 DOI: 10.1111/sji.12792] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/03/2019] [Accepted: 05/24/2019] [Indexed: 12/24/2022]
Abstract
Depletion of B cells is beneficial in rheumatoid arthritis (RA) patients with autoantibodies to citrullinated proteins (ACPA) and/or the Fc portion of immunoglobulins (rheumatoid factor [RF]), suggesting a role for B cells in disease pathogenesis. To date, however, the identity of specifically pathogenic B cell subsets has not been discovered. One candidate population is identified by the low expression or absence of complement receptor 2 (CD21-/low B cells). In this study, we sought to determine whether there was any correlation between CD21-/low B cells and clinical outcome in patients with established RA, either ACPA+ /RF+ (n = 27) or ACPA- /RF- (n = 10). Healthy donors (n = 17) were included as controls. The proportion of the CD21-/low CD27- IgD- memory B cell subset in peripheral blood (PB) was significantly increased in ACPA+ /RF+ RA patients compared with healthy donors, and the frequency of this subset correlated with joint destruction (r = 0.57, P < 0.04). The levels of the chemokines CXCL-9 and CXCL-10 were higher in synovial fluid than in plasma, and PB CD21-/low cells expressed the receptor, CXCR3. In synovial fluid, most of the B cells were CD21-/low , approximately 40% of that population was CD27- IgD- , and a third of those expressed the pro-osteoclastogenic factor receptor activator of the nuclear factor κB ligand (RANKL). This subset also secreted RANKL, in addition to other factors such as IL-6, even in the absence of stimulation. We interpret these data as reason to propose the hypothesis that the CD27- IgD- subset of CD21-/low B cells may mediate joint destruction in patients with ACPA+ /RF+ RA.
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Affiliation(s)
- Katrin Thorarinsdottir
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Alessandro Camponeschi
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Jonsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Karin Granhagen Önnheim
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Nilsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Forslind
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Helsingborg, Sweden.,Section of Rheumatology, Department of Research and Education, Helsingborg's Hospital, Helsingborg, Sweden
| | - Marcella Visentini
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Inga-Lill Mårtensson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
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28
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Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d'Elia H, Carlsten H, Eliasson B, Larsson I. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther 2019; 21:17. [PMID: 30635024 PMCID: PMC6330463 DOI: 10.1186/s13075-019-1810-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022] Open
Abstract
Background Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m2). Methods VLED (640 kcal/day) was taken during 12–16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up. Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline. Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria. Results Totally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48–62). At baseline increased BMI was associated with higher disease activity and poorer function. The median weight loss was 18.7 kg (IQR 14.6–26.5) or 18.6% (IQR 14.7–26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p = 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively. Conclusions Short-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA. Trial registration ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016—retrospectively registered Electronic supplementary material The online version of this article (10.1186/s13075-019-1810-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Annelie Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sofia Björkman
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Martin Hedberg
- Department of Rheumatology, Hospital of Borås, Borås, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - Hans Carlsten
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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29
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Kapetanovic MC, Nilsson P, Turesson C, Englund M, Dalbeth N, Jacobsson L. The risk of clinically diagnosed gout by serum urate levels: results from 30 years follow-up of the Malmö Preventive Project cohort in southern Sweden. Arthritis Res Ther 2018; 20:190. [PMID: 30157929 PMCID: PMC6116499 DOI: 10.1186/s13075-018-1697-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/06/2018] [Indexed: 01/06/2023] Open
Abstract
Background Hyperuricemia (HU) is in the causal pathway for developing clinical gout. There are few population-based assessments of the absolute and relative risk of clinically diagnosed incident gout in subjects with HU. We aimed to explore the long-term risk of developing incident gout among asymptomatic adults with different levels of serum urate (SU). Methods Malmö Preventive Project was a population-based screening program for cardiovascular risk factors, alcohol abuse, and breast cancer in Malmö, Sweden. The study population was screened between 1974 and 1992. At baseline, subjects were assessed with a questionnaire, physical examination, and laboratory tests. Follow-up ended at first gout diagnosis, death, moving from area, or December 31, 2014. Incident gout (using ICD10 codes) was diagnosed based on national registers for specialized inpatient and outpatient care, and from 1998 onward in the Skåne Healthcare Register including primary healthcare. Incidence rates, absolute risk, hazard ratios (HRs) and potentially associated factors were analyzed by baseline SU levels, i.e. normal levels (≤ 360 μmol/L); 361–405 (levels below tissue solubility of SU), and > 405 (HU), overall, and by sex. Results Overall, 1275 individuals [3.8%; 1014 men (4.5%) and 261 women (2.4%)] of the 33,346 study participants (mean age: 45.7 (SD: 7.4), 67% men), developed incident gout during follow-up (mean 28.2 years). Of those with HU, 14.7% of men and 19.5% of women developed gout. Compared to subjects in the lowest SU category, the age-adjusted HR in men increased from 2.7 to 6.4, and in women from 4.4 to 13.1 with increasing baseline SU category, and with a statistically significant interaction of sex (p < 0.001). Body mass index, estimated glomerular filtration rate (negative), triglycerides, alcohol risk behavior (only in men), and comorbidities such as hypertension, cardiovascular disease, and diabetes were strongly associated with SU at baseline in both sexes. Conclusions The absolute risk for developing clinically diagnosed gout over 30 years in middle-aged subjects was 3.8%, and increased progressively in both men and women in relation to baseline SU. This risk increase was significantly higher in women than in men, whereas the associations between baseline risk markers and SU levels were similar in both sexes.
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Affiliation(s)
- Meliha C Kapetanovic
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Kioskgatan 5, SE-221 85, Lund, Sweden.
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Carl Turesson
- Department of Clinical Sciences, Malmö, Lunds University and Skåne University Hospital, Malmö, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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30
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31
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Chatzidionysiou K, Hetland ML, Frisell T, Di Giuseppe D, Hellgren K, Glintborg B, Nordström D, Aaltonen K, Törmänen MRK, Klami Kristianslund E, Kvien TK, Provan SA, Guðbjörnsson B, Dreyer L, Kristensen LE, Jørgensen TS, Jacobsson L, Askling J. Opportunities and challenges for real-world studies on chronic inflammatory joint diseases through data enrichment and collaboration between national registers: the Nordic example. RMD Open 2018; 4:e000655. [PMID: 29682328 PMCID: PMC5905834 DOI: 10.1136/rmdopen-2018-000655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/22/2022] Open
Abstract
There are increasing needs for detailed real-world data on rheumatic diseases and their treatments. Clinical register data are essential sources of information that can be enriched through linkage to additional data sources such as national health data registers. Detailed analyses call for international collaborative observational research to increase the number of patients and the statistical power. Such linkages and collaborations come with legal, logistic and methodological challenges. In collaboration between registers of inflammatory arthritides in Sweden, Denmark, Norway, Finland and Iceland, we plan to enrich, harmonise and standardise individual data repositories to investigate analytical approaches to multisource data, to assess the viability of different logistical approaches to data protection and sharing and to perform collaborative studies on treatment effectiveness, safety and health-economic outcomes. This narrative review summarises the needs and potentials and the challenges that remain to be overcome in order to enable large-scale international collaborative research based on clinical and other types of data.
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Affiliation(s)
- Katerina Chatzidionysiou
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Merete Lund Hetland
- DANBIO Registry, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Frisell
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Hellgren
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bente Glintborg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Copenhagen, Denmark
- Department of Rheumatology, Gentofte and Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dan Nordström
- Department of Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Minna RK Törmänen
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sella A Provan
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bjorn Guðbjörnsson
- Centre for Rheumatology Research, Faculty of Medicine, University Hospital, University of Iceland, Reykjavik, Iceland
| | - Lene Dreyer
- Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tanja Schjødt Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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van Lunteren M, Ez-Zaitouni Z, de Koning A, Dagfinrud H, Ramonda R, Jacobsson L, Landewé R, van der Heijde D, van Gaalen FA. In Early Axial Spondyloarthritis, Increasing Disease Activity Is Associated with Worsening of Health-related Quality of Life over Time. J Rheumatol 2018; 45:779-784. [PMID: 29545448 DOI: 10.3899/jrheum.170796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE In early axial spondyloarthritis (axSpA), data are lacking about the relationship between disease activity and health-related quality of life (HRQOL). We assessed and quantified the association between change in Ankylosing Spondylitis Disease Activity Score (ASDAS) and HRQOL over time in early axSpA. METHODS Baseline and 1-year data of patients with axSpA fulfilling the Assessment of Spondyloarthritis international Society (ASAS) classification criteria from the SPondyloArthritis Caught Early (SPACE) cohort were analyzed. Associations between change in ASDAS and in physical (PCS) or mental component summary (MCS) of the Medical Outcomes Study Short Form-36 were tested by linear regression models. Age, sex, ASAS criteria arm, and blue- versus white-collar work were tested for effect modification. Subsequently, these factors and medication were tested for confounding. RESULTS There were 161 patients with axSpA [53% male, mean (± SD) age 29.7 (± 7.5) yrs, symptom duration 13.6 (± 7.2) months, HLA-B27-positive 91%, radiographic sacroiliitis 22%] who had ASDAS of 2.5 (± 1.0) and 2.0 (± 0.8), PCS of 28.4 (± 14.3) and 36.9 (± 13.1), and MCS of 48.2 (± 13.8) and 49.3 (± 12.0) at baseline and 1 year, respectively. Per unit increase in ASDAS between baseline and 1 year, PCS worsened by 9.5 points. The same level of disease activity had fewer adverse effects on physical HRQOL in women and white-collar workers. CONCLUSION To our knowledge, our data are the first to show that in a broad group of patients with early axSpA, increasing ASDAS is associated with worsening of physical HRQOL, but not mental HRQOL, over time.
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Affiliation(s)
- Miranda van Lunteren
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden. .,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center.
| | - Zineb Ez-Zaitouni
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Anoek de Koning
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Hanne Dagfinrud
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Roberta Ramonda
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Lennart Jacobsson
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Robert Landewé
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Désirée van der Heijde
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Floris A van Gaalen
- From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.,M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center
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Rydholm M, Book C, Wikström I, Jacobsson L, Turesson C. Course of Grip Force Impairment in Patients With Early Rheumatoid Arthritis Over the First Five Years After Diagnosis. Arthritis Care Res (Hoboken) 2018; 70:491-498. [PMID: 28692794 DOI: 10.1002/acr.23318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/06/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Objective measures of function are important in rheumatoid arthritis (RA). The objective of this study was to investigate grip strength in patients with early RA. METHODS An inception cohort of 225 patients with early RA was followed in accordance with a structured protocol. Average and peak grip force values of the dominant hand (measured using a Grippit device [AB Detektor]) were evaluated and compared to expected age- and sex-specific reference values from the literature. Separate analyses were performed for those with limited self-reported disability (Health Assessment Questionnaire disability index [HAQ DI] score ≤0.5) and clinical remission (Disease Activity Score in 28 joints <2.6). RESULTS Baseline average grip force among RA patients was significantly lower than the corresponding expected value (mean 105N versus 266N; P < 0.001). Observed average and peak grip force values were significantly reduced compared to those expected in women as well as in men over time and at all time points. The average grip force improved significantly from inclusion to the 12-month visit (age-corrected mean change 34N [95% confidence interval 26-43]). At 5 years, the average grip force was still lower than that expected overall (mean 139N versus 244N; P < 0.001), and also among those with HAQ DI scores ≤0.5 and those in clinical remission. CONCLUSION Grip strength improved in early RA patients, particularly during the first year. However, it was still significantly impaired 5 years after diagnosis, even among those with limited self-reported disability and those in clinical remission. This suggests that further efforts to improve hand function are important in early RA.
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Affiliation(s)
- Maria Rydholm
- Lund University and Skåne University Hospital, Malmö, Sweden
| | | | | | - Lennart Jacobsson
- Lund University, Malmö, Sweden, and Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Carl Turesson
- Lund University and Skåne University Hospital, Malmö, Sweden
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Olsson P, Turesson C, Mandl T, Jacobsson L, Theander E. Cigarette smoking and the risk of primary Sjögren's syndrome: a nested case control study. Arthritis Res Ther 2017; 19:50. [PMID: 28270185 PMCID: PMC5341180 DOI: 10.1186/s13075-017-1255-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/09/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Smoking is reported to affect the risk of a number of chronic disorders, including rheumatic diseases. Previous cross-sectional studies have shown a lower frequency of smoking in patients with primary Sjögren's syndrome (pSS). The aim of this study was to investigate the impact of smoking and socioeconomic status on the risk of subsequent diagnosis of pSS in a nested case-control study. METHOD Participants in two large population-based health surveys who were later diagnosed with pSS were identified through linkage with the Malmö Sjögren's Syndrome Register. Matched controls were obtained from the health surveys. RESULTS Sixty-three patients with pSS with pre-diagnostic data from the health surveys were identified. Current smoking was associated with a significantly lower risk of later being diagnosed with pSS (odds ratio (OR) 0.3; 95% CI 0.1-0.6). Furthermore, former smoking was associated with an increased risk of subsequent pSS diagnosis (OR 4.0; 95% CI 1.8-8.8) compared to never smoking. Similar results were found in a sub-analysis of patients with reported symptom onset after inclusion in the health surveys. Socioeconomic status and levels of formal education had no significant impact on the risk of later being diagnosed with pSS. CONCLUSION In this nested case-control study, current smoking was associated with a reduced risk of subsequent diagnosis of pSS. In addition, former smoking was associated with an increased risk. Whether this reflects a biological effect of cigarette smoking or other mechanisms should be further investigated in future studies.
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Affiliation(s)
- Peter Olsson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden.
| | - Carl Turesson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
| | - Thomas Mandl
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
| | - Lennart Jacobsson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology and Inflammation research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elke Theander
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
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Kapetanovic MC, Hameed M, Turkiewicz A, Neogi T, Saxne T, Jacobsson L, Englund M. Prevalence and incidence of gout in southern Sweden from the socioeconomic perspective. RMD Open 2016; 2:e000326. [PMID: 27933209 PMCID: PMC5133407 DOI: 10.1136/rmdopen-2016-000326] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and cumulative incidence of gout in southern Sweden with respect to socioeconomic status. METHODS Among residents of Skåne region in the year 2013 (total population 1.3 million), adult persons (age 18 years +) who between 1998 and 2013 received a diagnosis of gout (International Classification of Disease 10th Edition (ICD-10) code M10) by any physician were identified using the Skåne Healthcare Register. We calculated the point prevalence by end of 2013 and annual cumulative incidence in 2013 standardised to the whole Skåne population according to sex, individual information on occupation (white collar/blue collar), income (low/middle/high) and level of education (primary school/high school/university). RESULTS The crude 2013 point prevalence of gout and 2013 cumulative incidence (95% CI) were 1.69% (1.66% to 1.71%) and 24 cases per 10 000 persons (23-25), respectively. Compared to women, men had higher point prevalence (2.44% (2.40% to 2.49%) vs 0.96% (0.93% to 0.98%)) and higher annual cumulative incidence (33 cases per 10 000 (32-35)) versus 15 (14-16)). These figures increased with higher age but decreased with higher level of education, being the lowest in individuals with a university degree. Persons with middle income had highest point prevalence and cumulative incidence of gout, while those with white collar occupations had the lowest. CONCLUSIONS Gout is the most common inflammatory arthritis in southern Sweden with a prevalence of ∼1.7% in the adult population. There is a socioeconomic gradient with more gout present in the lower level of education and with more manual labour.
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Affiliation(s)
- Meliha C Kapetanovic
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Section for Rheumatology in Lund and Malmö, Lund, Sweden
| | - Mohaned Hameed
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Section for Rheumatology in Lund and Malmö, Lund, Sweden
| | - Aleksandra Turkiewicz
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tore Saxne
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Section for Rheumatology in Lund and Malmö, Lund, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Englund
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
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Lindström U, Exarchou S, Lie E, Dehlin M, Forsblad-d'Elia H, Askling J, Jacobsson L. Childhood hospitalisation with infections and later development of ankylosing spondylitis: a national case-control study. Arthritis Res Ther 2016; 18:240. [PMID: 27770824 PMCID: PMC5075148 DOI: 10.1186/s13075-016-1141-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/29/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The role of environmental exposures in the pathogenesis of ankylosing spondylitis (AS) remains unclear. In particular, two types of exposures have been suspected to play a role: mechanical stress and infections. The objective of this case-control study was to determine if childhood infections are associated with later development of AS. METHODS The cases with AS were identified through the Swedish national outpatient specialised-care register, based on having been given at least one AS diagnosis in the register between 2001 and 2010. Five controls per case were identified in the Swedish population register, matched at the time-point of the index case's first spondyloarthritis diagnosis on sex, birth year, and county. All cases/controls matched prior to the age of 17 years were excluded, as well as all cases/controls given a diagnosis of reactive arthritis or juvenile arthritis at any time point, or any other diagnosis of a rheumatic disease, psoriasis, iridocyclitis, or inflammatory bowel disease before the time-point of matching. All events of hospitalisation with an infection before the age of 17 years were retrieved from the register, and categorised according to the focus of the infection. Odds ratios (ORs) and confidence intervals (CIs) were determined through conditional logistic regression analyses. RESULTS Of the 2453 cases with AS and 10,257 controls, 17.4 % of the cases and 16.3 % of the controls had been hospitalised with an infection before the age of 17 years (OR 1.08, 95 % CI 0.96-1.22). Appendicitis (1.5 % cases; 2.5 % controls; OR 0.59, 95 % CI 0.41-0.83), respiratory tract infections (cases 11.2 %; controls 9.2 %; OR 1.24, 95 % CI 1.07-1.44) and, in particular, tonsillitis (cases 3.7 %; controls 2.8 %; OR 1.31, 95 % CI 1.03-1.67) were associated with AS. There were no associations between AS and any other type of infection, and the point estimates were similar in several sensitivity analyses. CONCLUSIONS Childhood appendicitis was associated with a decreased risk, whereas respiratory tract infections were associated with an increased risk for later development of AS. These findings support a possible relationship between childhood infections and later development of AS, although the study is limited to infections resulting in inpatient care.
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Affiliation(s)
- Ulf Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden.
| | - Sofia Exarchou
- Section of Rheumatology, Department of Clinical Sciences, Lund University, 221 85, Lund, Sweden
| | - Elisabeth Lie
- Diakonhjemmet Hospital, P.O. Box 23 Vinderen, 0319, Oslo, Norway
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Institution of Public Health and Clinical Medicine/Rheumatology, Umeå University, 901 87, Umeå, Sweden
| | - Johan Askling
- Rheumatology Unit & Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Solna, 171 76, Stockholm, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
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Maglio C, Peltonen M, Neovius M, Jacobson P, Jacobsson L, Rudin A, Carlsson LMS. Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial. Ann Rheum Dis 2016; 76:688-693. [PMID: 28076240 PMCID: PMC5530073 DOI: 10.1136/annrheumdis-2016-209958] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/29/2016] [Accepted: 09/11/2016] [Indexed: 12/27/2022]
Abstract
Objectives To assess the long-term effect of bariatric surgery on the incidence of gout and hyperuricaemia in participants of the Swedish Obese Subjects (SOS) study. Methods This report includes 1982 subjects who underwent bariatric surgery and 1999 obese controls from the SOS study, a prospective intervention trial designed to assess the effect of bariatric surgery compared with conventional treatment. None of the subjects had gout at baseline. An endpoint on gout incidence was created based on information on gout diagnosis and use of gout medications through national registers and questionnaires. Median follow-up for the incidence of gout was about 19 years for both groups. Moreover, the incidence of hyperuricaemia over up to 20 years was examined in a subgroup of participants having baseline uric acid levels <6.8 mg/dL. Results Bariatric surgery was associated with a reduced incidence of gout compared with usual care (adjusted HR 0.60, 95% CI 0.48 to 0.75, p<0.001). The difference in absolute risk between groups was 3 percentage points at 15 years, and the number of subjects needed to be treated by bariatric surgery to prevent one incident gout event was 32 (95% CI 22 to 59). The effect of bariatric surgery on gout incidence was not influenced by baseline risk factors, including body mass index. During follow-up, the surgery group had a lower incidence of hyperuricaemia (adjusted HR 0.47, 95% CI 0.39 to 0.58, p<0.001). The difference in absolute risk between groups was 12 percentage points at 15 years, and the number of participants needed to be treated by bariatric surgery to prevent hyperuricaemia was 8 (95% CI 6 to 13). Conclusions Bariatric surgery prevents gout and hyperuricaemia in obese subjects. Trial registration number NCT01479452; Results.
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Affiliation(s)
- Cristina Maglio
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Jacobson
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena M S Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Södergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DPM, Nurmohamed MT. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2016; 76:17-28. [DOI: 10.1136/annrheumdis-2016-209775] [Citation(s) in RCA: 683] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/24/2016] [Accepted: 09/08/2016] [Indexed: 12/28/2022]
Abstract
Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.
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Abstract
In twenty-six patients injected with metrizoate during urography, plasma was analyzed for iodine concentration using x-ray fluorescence analysis, and total plasma clearance of contrast medium was calculated. Total plasma clearance of 51Cr-EDTA was also determined, but not simultaneously, in order to find out if the urographic procedure would influence the kidneys to such an extent that the contrast medium clearance value would differ much from the 51Cr-EDTA clearance value. The errors in the method were assessed and the total error of the contrast medium clearance determination was calculated. When comparing 51Cr-EDTA and metrizoate clearance a correlation of 0.94 and a mean ratio of 1.046 (SD 0.138) was found. The assessable errors cannot fully explain the standard deviation, which might indicate a transient change in kidney function related to elements of the urographic procedure such as laxation with possible dehydration and/or the contrast medium dose.
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Boijsen M, Granerus G, Jacobsson L, Björneld L, Aurell M, Tylén U. Glomerular Filtration Rate Estimated after Multiple Injections of Contrast Medium during Angiography. Acta Radiol 2016. [DOI: 10.1177/028418518802900612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In twenty-six patients referred for angiography, clearance of contrast medium was determined with x-ray fluorescence analysis after multiple injections of contrast medium. A formula for correction of the injected amount, which takes into consideration the different times of contrast medium injections, approximating the total injected amount into one injection, was used. A single injection clearance of 51Cr-EDTA was determined at the same time. The results showed a good correlation between the clearance of contrast medium after multiple injections and the 51Cr-EDTA clearance after a single injection (r=0.945). The correlation between contrast medium clearance calculated without correction for the different injection times, and “Cr-EDTA clearance was the same (r=0.946), due to short angiography time and rather low clearance values in our patients. It is concluded that total plasma clearance of contrast medium can easily be estimated after multiple injections. In this way patients with a risk of developing post-angiographic renal failure can be found.
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Boijsen M, Goss F, Jacobsson L, Lamm C, Schlossman D, Björneld L, Tylén U. Cardiac Output Determination during Intravenous Cardioangiography Using X-ray Fluorescence Analysis. Acta Radiol 2016. [DOI: 10.1177/028418518802900407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac output was determined with an indicator dilution technique during digital venous angiography of the left ventricle in 11 patients. The contrast medium injected into the right atrium was used as indicator. During and after the injection of contrast medium one blood sample per second was obtained through a catheter placed in the descending aorta. The samples were analyzed for iodine content with x-ray fluorescence analysis and cardiac output determined ad modum Stewart-Hamilton. Thermodilution was used as a reference method. The results indicate that the indicator dilution method with the use of contrast medium might be used for calibration of videodensitometric methods for blood flow measurements.
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Jakobsson K, Jacobsson L, Mohammad AJ, Nilsson JÅ, Warrington K, Matteson EL, Turesson C. The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis. BMC Musculoskelet Disord 2016; 17:363. [PMID: 27558589 PMCID: PMC4997683 DOI: 10.1186/s12891-016-1225-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/18/2016] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the effect of baseline clinical characteristics and glucocorticoid treatment on temporal artery biopsy (TAB) findings in patients with giant cell arteritis (GCA). Methods Individuals who developed GCA after inclusion in two population-based health surveys were identified through linkage to the local and the national patient registers. In addition, other patients diagnosed with GCA at the Departments of Internal Medicine and Rheumatology at an area hospital were included. A structured review of medical records and TAB pathology reports was performed. The presence or absence of giant cells, granuloma, fragmented internal elastic lamina, fibrosis and grade of inflammatory infiltrates were recorded. Results In 183 cases with a confirmed clinical diagnosis of GCA, 139 were biopsied after start of glucocorticoids (median treatment duration 3 days; interquartile range 2–5). Patients with a positive TAB (77 %) had significantly higher C-reactive protein (CRP; p = 0.007) and erythrocyte sedimentation rate (ESR; p = 0.03) at the time of clinical diagnosis. A positive TAB tended to more common in women, but there was no difference in the proportion of patients with polymyalgia rheumatica or visual symptoms. Patients biopsied before or on the same day as initial treatment where more likely than those biopsied 1–3 days after treatment start to have positive biopsy [odds ratio (OR) 2.86; 95 % CI 1.06–7.70] as well as inflammatory infiltrates (OR 3.30; 95 % CI 1.15–9.49). There was no significant difference in the proportions of a fragmented internal lamina (p = 0.86), giant cells (p = 0.10), granuloma (p = 0.19), minor inflammatory infiltrates (p = 0.47), major inflammatory infiltrates (p = 0.09), or overall positive biopsy (p = 0.17) report by treatment duration comparing: ≤ 0 days, 1–3 days, 4–6 days, 7–28 days. Among those biopsied 7–28 days after start of treatment, 80 % of TABs were positive, and histopathology features were not substantially different from those biopsied after shorter glucocorticoid treatment. Conclusion Biopsies were more likely to be positive and have characteristic histopathologic features in patients with high CRP and ESR, and prior to start of corticosteroid treatment TABs taken 1–4 weeks after initiation of glucocorticoid treatment reveal changes consistent with GCA and therefore still yields clinically useful information for the diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1225-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin Jakobsson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden.
| | - Lennart Jacobsson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology & Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden.,Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | - Jan-Åke Nilsson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden
| | - Kenneth Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Carl Turesson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden
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Eriksson JK, Jacobsson L, Bengtsson K, Askling J. Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis? Ann Rheum Dis 2016; 76:364-370. [DOI: 10.1136/annrheumdis-2016-209315] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/03/2016] [Accepted: 05/17/2016] [Indexed: 12/13/2022]
Abstract
AimsTo assess and compare the incidence of cardiovascular (CV) events, by CV phenotype, between patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and the general population.MethodsUsing linkages of national and population-based registers, we identified one cohort of prevalent patients with AS (n=5358), one with RA (n=37 245) and one with matched general population subjects (n=25 006). These cohorts were identified in 2006 through 2011 and were followed in 31 December 2012, for first ever occurrence of acute coronary syndromes (ACS), deep venous thromboembolism, pulmonary embolism and stroke, respectively. For each outcome, we calculated incidence rates standardised to the age and sex distribution of the AS cohort, as well as relative risks using Cox proportional hazards models.ResultsBased on 69 ACS events during 20 251 person-years of follow-up of the patients with AS, and 966 events during 127 014 person-years in the RA cohort, the age/sex-adjusted relative risks for ACS compared with the general population was 1.3 (95% CI 1.0 to 1.7) for AS and 1.7 (1.4 to 2.0) for RA. For thromboembolic events, the corresponding risks were 1.4 (1.1 to 1.9) in AS and 1.8 (1.5 to 2.1) in RA. Finally, for stroke, the relative risks were 1.5 (1.1 to 2.0) in AS and 1.5 (1.2 to 1.8) in RA, compared with the general population.ConclusionsPrevalent patients with AS are at a 30%–50% increased risk of incident CV events. When compared with patients with RA, this level of increase was similar for stroke, but only half as high for ACS and thrombotic events.
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Arvidsson L, Bergström U, Pikwer M, Nilsson JÅ, Jacobsson L, Turesson C. AB0098 Shift Work May Be Associated with An Increased Risk of Rheumatoid Arthritis in Women, but Not in Men. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Frisell T, Di Giuseppe D, Ernestam S, Forsblad-d'Elia H, Jacobsson L, Turesson C, van Vollenhoven R, Askling J. THU0158 Which Patient Characteristics Influence The Choice of Biological Therapy after First TNF Inhibitor Therapy in RA? A Nationwide Study of Channeling in Sweden 2010-2012:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Drivelegka P, Jacobsson L, Sigurdardottir V, Svärd A, Dehlin M. THU0523 Comorbidity Pattern at The Time of Gout Diagnosis: A Population- and Register-Based Case-Control Study from Western Sweden. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dehlin M, Hoxha Ekström E, Petzold M, Strömberg U, Telg G, Jacobsson L. THU0520 Treatment of Gout – Factors Affecting Initiation and Persistence of Urate Lowering Therapy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dehlin M, Drivelegka P, Sigurdardottir V, Svärd A, Jacobsson L. THU0522 Increasing Incidence of Gout in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rydell E, Book C, Forslind K, Nilsson JÅ, Jacobsson L, Turesson C. AB0180 Smoking and Persistent Disease Activity Are Associated with An Increased Risk of Rapid Joint Destruction in Patients with Early Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dehlin M, Drivelegka P, Sigurdardottir V, Svärd A, Jacobsson L. THU0521 Prevalence of Gout and ULT Treatment in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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