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Hokkanen AM, Aaltonen K, Relas H, Rutanen J, Kononoff A, Taimen K, Kauppi M, Puolakka K, Trokovic N, Nordström D. Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study. Rheumatol Adv Pract 2023; 7:rkad050. [PMID: 37332300 PMCID: PMC10272299 DOI: 10.1093/rap/rkad050] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.
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Affiliation(s)
- Anna-Mari Hokkanen
- Correspondence to: Anna-Mari Hokkanen, ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland. E-mail:
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Heikki Relas
- Division of Rheumatology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Jarno Rutanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | | | - Kirsi Taimen
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markku Kauppi
- Division of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- Division of Rheumatology, Helsinki University, Helsinki, Finland
| | - Kari Puolakka
- Helsinki Rheumatic Diseases and Inflammation Research Group, University of Helsinki, Helsinki, Finland
| | - Nina Trokovic
- ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Dan Nordström
- ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
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Kerola AM, Rollefstad S, Kazemi A, Wibetoe G, Sexton J, Mars N, Kauppi M, Kvien TK, Haavardsholm EA, Semb AG. Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents. Scand J Rheumatol 2023; 52:42-50. [PMID: 35014920 DOI: 10.1080/03009742.2021.1997436] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.
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Affiliation(s)
- A M Kerola
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Rollefstad
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A Kazemi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - G Wibetoe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - N Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - M Kauppi
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Clinicum, University of Helsinki, Helsinki, Finland
| | - T K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A G Semb
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Paakinaho A, Koponen M, Tiihonen M, Kauppi M, Hartikainen S, Tolppanen AM. Disease-Modifying Antirheumatic Drugs and Risk of Parkinson Disease: Nested Case-Control Study of People With Rheumatoid Arthritis. Neurology 2022; 98:e1273-e1281. [PMID: 35064025 PMCID: PMC8967329 DOI: 10.1212/wnl.0000000000013303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Epidemiological studies have suggested a link between rheumatoid arthritis and Parkinson's disease (PD). Disease-modifying anti-rheumatic drugs (DMARDs) might explain this association. OBJECTIVE To evaluate the association between DMARDs and risk of PD in persons with rheumatoid arthritis. METHODS Nested nationwide case-control study was conducted within the Finnish Parkinson's disease (FINPARK) cohort that includes 22,189 Finnish persons with clinically verified PD diagnosed in 1996-2015. The cases had recorded diagnosis of PD in the Special Reimbursement Register and had no exclusion diagnoses whose symptoms may be confused with PD within two years of PD diagnosis. This study included cases with PD diagnosed during 1999-2015 and rheumatoid arthritis diagnosed >3 years before PD. Rheumatoid arthritis was identified using Finnish Care Register for Health Care and Special Reimbursement Register. Cases were matched with up to seven control persons by age, sex, duration of rheumatoid arthritis and region. DMARDs were categorised into five classes and data on purchased prescriptions was identified from the Prescription Register since 1995. Associations were studied with conditional logistic regression adjusted for confounders. RESULTS Altogether 315 cases with PD and 1,571 matched controls were included. Majority (> 60%) were women and median duration of rheumatoid arthritis on matching date was 11.6 years for controls and 12.6 years for cases. Use of DMARDs was not associated with risk of PD with three-year lag period applied between exposure and outcome, except chloroquine/hydroxychloroquine which associated with decreased risk (adjusted odds ratio 0.74; 95% confidence interval 0.56-0.97). Other DMARDs, including sulfasalazine, methotrexate, gold preparations and immunosuppressants, were not associated with PD. DISCUSSION Our results suggest that the lower risk of PD in people with rheumatoid arthritis is not explained by DMARD use as these drugs in general did not modify the risk of PD among persons with rheumatoid arthritis. Association between chloroquine/hydroxychloroquine and lower risk of PD as well as the possible underlying mechanisms should be further investigated. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in individuals with rheumatoid arthritis using DMARDs, only chloroquine/hydroxychloroquine was associated with a potentially decreased risk of developing PD (adjusted OR 0.74, 95% CI 0.56-0.97).
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Affiliation(s)
- Anne Paakinaho
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.,Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Markku Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, 15850 Lahti, Finland.,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
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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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Kauppi M, Virtanen M, Pentti J, Aalto V, Kivimäki M, Vahtera J, Stenholm S. Social network ties before and after retirement: a cohort study. Eur J Ageing 2021; 18:503-512. [PMID: 34786012 PMCID: PMC8563893 DOI: 10.1007/s10433-021-00604-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Social networks are associated with individual's health and well-being. Working life offers opportunities to create and maintain social networks, while retirement may change these networks. This study examined how the number of ties in social network changes across the retirement transition. The study population consisted of 2319 participants (84% women, mean age 63.2 years) from the Finnish Retirement and Aging study. Information about social network ties, including the number of ties in the inner, middle and outer circles of the social convoy model, was gathered using annual postal surveys before and after retirement. Three repeat surveys per participant covered the retirement transition and the post-retirement periods. Mean number of network ties was 21.6 before retirement, of which 5.6 were situated in the inner, 6.9 in the middle and 9.1 in the outer circle. The number of ties in the outer circle decreased by 0.67 (95% CI - 0.92, - 0.42) during the retirement transition period, but not during the post-retirement period (0.11, 95% CI - 0.33, 0.12) (interaction period * time, p = 0.006). The pattern of change in these ties did not differ by gender, occupational status, marital status, number of chronic diseases and mental health during the retirement transition period. The number of ties in the inner and middle circles overall did not decrease during these periods. The number of peripheral relationships decreased during the retirement transition but not after that, suggesting that the observed reduction is more likely to be associated with retirement rather than aging.
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Affiliation(s)
- M. Kauppi
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
| | - M. Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - J. Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - V. Aalto
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
| | - M. Kivimäki
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London Medical School, London, UK
| | - J. Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - S. Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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Kauppi M, Prakash KC, Virtanen M, Pentti J, Aalto V, Oksanen T, Kivimäki M, Vahtera J, Stenholm S. Social relationships as predictors of extended employment beyond the pensionable age: a cohort study. Eur J Ageing 2021; 18:491-501. [PMID: 34786011 PMCID: PMC8563924 DOI: 10.1007/s10433-021-00603-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/29/2022] Open
Abstract
The aim is to examine whether characteristics of social relationships predict extended employment beyond the pensionable age among Finnish public sector workers. The study population consisted of 4014 participants (83% women, age 62.56 ± 1.21) of the Finnish Retirement and Aging Study followed between 2014 and 2019. Extended employment was defined as the difference between actual retirement date and individual age-related pensionable date and classified into three groups: no extension (retired on pensionable age or extended by < 3 months), short extension (3 months–< 1 year), and long extension (≥ 1 year) beyond the pensionable date. Characteristics of social relationships and engagement were assessed 18 months prior to the pensionable date. Social engagement was classified into consumptive social participation, formal social participation, informal social participation, and other social participation. Data were analyzed using multinomial regression analysis. Of total study participants, 17.8% belonged to short- and 16.5% belonged to long-extension group. Adjusted for age, occupational status, self-rated health and depression, and having a working spouse (OR 2.34, 95% CI 1.39–3.95) were associated with long extension of employment beyond the pensionable age when compared to no extension among men. Likewise, among women, living alone (OR 1.60, 95% CI 1.28–2.00), having a working spouse (1.85, 1.39–2.45), and high consumptive (1.32, 1.07–1.65), high formal (1.47, 1.17–1.85), and other social participation (0.79, 0.63–0.98) were associated with long extension. Having a working spouse, living alone, and high consumptive social participation were associated with short extension. Several characteristics of social relationships, such as having a working spouse, living alone, and high frequency of social engagement, predicted an extension of employment beyond the pensionable age.
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Affiliation(s)
- M Kauppi
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
| | - K C Prakash
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - M Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - J Pentti
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - V Aalto
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland
| | - T Oksanen
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - M Kivimäki
- Finnish Institute of Occupational Health, Turku and Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, London, UK
| | - J Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - S Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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Sokka-Isler T, Paalanen K, Kauppi M, Nikiphorou E. SAT0056 INITIAL PRESENTATION OF RHEUMATOID ARTHRITIS (RA) – IS IT STILL “SYMMETRIC POLYARTHRITIS”? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:RA is traditionally described as a symmetric polyarthritis. The ACR/EULAR 2010 criteria are met if patient has high positive ACPA, symptoms >=6 wks and one small joint swollen. The public and all steps of health care have been informed for many years that RA should be found early.Objectives:To study variations in pattern on first presentation of RA.Methods:All patients with the new diagnosis of RA were extracted from the GoTreatIT clinical database between 2008 to 2019 at a single RA clinic that covers a population of 250.000. Demographic data, clinical variables, labs, x-rays, joint status and PROs at baseline were included in the analysis. Appropriate parametric/non-parametric tests were used to study differences between groups.Results:A total of 1044 (73.5% CCP+) patients with no prior diagnosis of RA were included; 683 (65%) female, mean age 56; 361 (35%) male, mean age 61. At initial presentation in 2008, 60% had >=6 swollen joints (Figure) and a mean DAS28 of 4.4 compared to 22% and 3.8 respectively, in 2019 (p<0.007). Duration of symptoms prior to diagnosis decreased from 6 to 4 months (p=0.033), and the proportion of patients with erosions from 20% in 2008 to 14% in 2019 (ns). Symptoms (PROs) such as pain, fatigue and global health were similar/slightly worse in 2019 compared to 2008.Conclusion:RA cannot be marketed as “symmetric polyarthritis”, as more than half of the patients have a maximum of 2 swollen joints at the time of the diagnosis at the most recent years. Patients with RA can be identified earlier, with less disease activity and damage, compared to previous years.Figure:Disclosure of Interests:None declared
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Parajuli A, Hui N, Puhakka R, Oikarinen S, Grönroos M, Selonen VAO, Siter N, Kramna L, Roslund MI, Vari HK, Nurminen N, Honkanen H, Hintikka J, Sarkkinen H, Romantschuk M, Kauppi M, Valve R, Cinek O, Laitinen OH, Rajaniemi J, Hyöty H, Sinkkonen A. Yard vegetation is associated with gut microbiota composition. Sci Total Environ 2020; 713:136707. [PMID: 32019041 DOI: 10.1016/j.scitotenv.2020.136707] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Gut microbes play an essential role in the development and functioning of the human immune system. A disturbed gut microbiota composition is often associated with a number of health disorders including immune-mediated diseases. Differences in host characteristics such as ethnicity, living habit and diet have been used to explain differences in the gut microbiota composition in inter-continental comparison studies. As our previous studies imply that daily skin contact with organic gardening materials modify gut microflora, here we investigated the association between living environment and gut microbiota in a homogenous western population along an urban-rural gradient. We obtained stool samples from 48 native elderly Finns in province Häme in August and November 2015 and identified the bacterial phylotypes using 16S rRNA Illumina MiSeq sequencing. We assumed that yard vegetation and land cover classes surrounding homes explain the stool bacterial community in generalized linear mixed models. Diverse yard vegetation was associated with a reduced abundance of Clostridium sensu stricto and an increased abundance of Faecalibacterium and Prevotellaceae. The abundance of Bacteroides was positively and strongly associated with the built environment. Exclusion of animal owners did not alter the main associations. These results suggest that diverse vegetation around homes is associated with health-related changes in gut microbiota composition. Manipulation of the garden diversity, possibly jointly with urban planning, is a promising candidate for future intervention studies that aim to maintain gut homeostasis.
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Affiliation(s)
- Anirudra Parajuli
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
| | - Nan Hui
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland; School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, China
| | - Riikka Puhakka
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
| | - Sami Oikarinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Mira Grönroos
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
| | - Ville A O Selonen
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
| | - Nathan Siter
- School of Architecture, Tampere University of Technology, Tampere, Finland
| | - Lenka Kramna
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marja I Roslund
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
| | - Heli K Vari
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
| | - Noora Nurminen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hanna Honkanen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | | | - Martin Romantschuk
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland
| | | | - Raisa Valve
- Division of Food and Nutrition Sciences, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Ondřej Cinek
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olli H Laitinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Juho Rajaniemi
- School of Architecture, Tampere University of Technology, Tampere, Finland
| | - Heikki Hyöty
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Aki Sinkkonen
- Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Lahti, Finland; Natural Resources Institute Finland, Turku, Finland.
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9
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Sandström T, Rantalaiho V, Yli-Kerttula T, Kautiainen H, Malmi T, Karjalainen A, Uusitalo T, Julkunen H, Kaipiainen-Seppänen O, Paimela L, Puolakka K, Uutela T, Möttönen T, Hannonen P, Leirisalo-Repo M, Laasonen L, Kauppi M. Cervical Spine Involvement among Patients with Rheumatoid Arthritis Treated Actively with Treat-to-target Strategy: 10-year Results of the NEO-RACo Study. J Rheumatol 2019; 47:1160-1164. [DOI: 10.3899/jrheum.190139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the development of radiological changes of the cervical spine in patients with rheumatoid arthritis (RA) in the NEO-RACo trial treated with an intensive, remission-targeted combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and additional infliximab (IFX) or placebo (PLA) for the first 6 months.Methods.Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARD and prednisolone, and randomized to double-blindly receive either IFX (FIN-RACo+IFX) or PLA (FIN-RACo+PLA) infusions during the first 6 months. After 2 years the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At the 10-year visit, radiographs of the cervical spine were taken of 85 patients (38 in the FIN-RACo+IFX group and 47 in the FIN-RACo+PLA group). The study was registered at ClinicalTrials.gov (NCT 00908089).Results.There were 4/85 patients (4.7%) with cervical spine involvement (CSI) by 10 years. Atlantoaxial subluxation was found in 2/85 patients (2.4%), both in the FIN-RACo+IFX group, and none in the FIN-RACo+PLA group. Atlantoaxial impaction was found in 1/85 patients (1.2%) in the FIN-RACo+IFX group. Subaxial subluxation was found in 1/85 patients (1.2%).Conclusion.Early and intensive remission-targeted treatment has reduced the incidence of CSI and our results show that intensive treatment also prevents its development in the long run.
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10
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Pänkäläinen M, Fogelholm M, Valve R, Kampman O, Kauppi M, Lappalainen E, Hintikka J. Pessimism, diet, and the ability to improve dietary habits: a three-year follow-up study among middle-aged and older Finnish men and women. Nutr J 2018; 17:92. [PMID: 30322387 PMCID: PMC6190558 DOI: 10.1186/s12937-018-0400-8] [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: 12/30/2017] [Accepted: 10/01/2018] [Indexed: 01/12/2023] Open
Abstract
Background Dietary habits have a great influence on physiological health. Even though this fact is generally recognized, people do not eat as healthily as they know they should. The factors that support a healthy diet, on the other hand, are not well known. It is supposed that there is a link between personal traits and dietary habits. Personal traits may also partially explain why some people manage to make healthy dietary changes while some fail to do so or are not able to try to make changes even when they desire to do so. There is some information suggesting that dispositional optimism plays a role in succeeding in improving dietary habits. The aim of this study was to determine the role of optimism and pessimism in the process of dietary changes. Methods Dispositional optimism and pessimism were determined using the revised Life Orientation Test in 2815 individuals (aged 52–76 years) participating in the GOAL study in the region of Lahti, Finland. The dietary habits of the study subjects were analysed. After 3 years, the subjects’ dietary habits and their possible improvements were registered. The associations between dispositional optimism and pessimism, dietary habits at baseline, and possible changes in dietary habits during the follow-up were studied with logistic regression. We also studied if the dietary habits or certain lifestyle factors (e.g. physical exercising and smoking) at baseline predicted success in improving the diet. Results Pessimism seemed to correlate clearly negatively with the healthiness of the dietary habits at baseline – i.e. the higher the level of pessimism, the unhealthier the diet. Optimism also showed a correlation with dietary habits at baseline, although to a lesser extent. Those who managed to improve their dietary habits during follow-up or regarded their dietary habits as healthy enough even without a change were less pessimistic at baseline than those who failed in their attempts to improve their diet or did not even try, even when they recognized the need for a change. Conclusions Pessimistic people are more likely to eat an unhealthy diet than others. Pessimism reduces independently the possibilities to improve dietary patterns.
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Affiliation(s)
- Mikko Pänkäläinen
- Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850, Lahti, Finland.
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Raisa Valve
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Olli Kampman
- Department of Psychiatry, Seinäjoki Hospital District, Seinäjoki, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - Markku Kauppi
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Erja Lappalainen
- Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850, Lahti, Finland
| | - Jukka Hintikka
- Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850, Lahti, Finland.,School of Medicine, University of Tampere, Tampere, Finland
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11
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Aaltonen KJ, Ylikylä S, Tuulikki Joensuu J, Isomäki P, Pirilä L, Kauppi M, Rannio T, Eklund K, Blom M, Nordström D. Efficacy and effectiveness of tumour necrosis factor inhibitors in the treatment of rheumatoid arthritis in randomized controlled trials and routine clinical practice. Rheumatology (Oxford) 2017; 56:725-735. [PMID: 28064209 DOI: 10.1093/rheumatology/kew467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/15/2016] [Indexed: 12/30/2022] Open
Abstract
Objective Efficacy of TNF inhibitors in the treatment of RA assessed in randomized controlled trials (RCTs) may not be fully comparable to routine care owing to the stringent inclusion criteria. The objective of this study was to observe the effectiveness of TNF inhibitors in real-world patients and assess the patients' potential eligibility for the RCTs. Methods RA patients starting a TNF-inhibitor treatment between 2004 and 2014 were identified from the National Register for Biologic Treatment in Finland, which is a longitudinal observational cohort study. Effectiveness was measured using the ACR and EULAR response criteria and by studying the proportion of patients reaching DAS28 remission. The patients' baseline characteristics were compared against the inclusion criteria of 27 RCTs. Results EULAR moderate and good treatment responses at 6 months were achieved by 69 and 40% of the users of the first TNF inhibitor, respectively. ACR20, ACR50 and ACR70 responses were reached by 48, 27 and 13%, respectively. DAS28 remission was reached by 47%. Only 7.6-44% of the patients would have been potentially eligible for the RCTs. The eligible patients had better treatment responses compared with the non-eligible patients. Different TNF inhibitors were mostly equipotent, but the usage of MTX co-therapy had a major influence on treatment response. Conclusion Only a small proportion of patients would have been eligible for RCTs, and the efficacy of TNF inhibitors assessed in them cannot be generalized directly into Finnish routine health care.
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Affiliation(s)
| | - Suvi Ylikylä
- Faculty of Pharmacy, University of Helsinki, Helsinki
| | | | - Pia Isomäki
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital.,School of Medicine, University of Tampere, Tampere
| | - Laura Pirilä
- Department of Rheumatology, Turku University Hospital, Turku
| | - Markku Kauppi
- School of Medicine, University of Tampere, Tampere.,Department of Rheumatology, Päijät-Häme Central Hospital, Lahti
| | - Tuomas Rannio
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä.,Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Kari Eklund
- Department of Medicine, Helsinki University Central Hospital.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marja Blom
- Faculty of Pharmacy, University of Helsinki, Helsinki
| | - Dan Nordström
- Department of Medicine, Helsinki University Central Hospital.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
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12
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Nikiphorou E, Galloway J, van Riel P, Yazici Y, Haugeberg G, Ostor A, Gogus F, Kauppi M, Sokka T. The spectrum of early rheumatoid arthritis practice across the globe: results from a multinational cross sectional survey. Clin Exp Rheumatol 2017; 35:477-483. [PMID: 28134086] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To explore patterns of real-world early RA (ERA) care across countries. METHODS An online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and treatment, patient monitoring, guideline use and data recording. RESULTS A total of 212 rheumatologists from 39 countries (76% European) completed the survey. 62% had an ERA clinic based at a university hospital. Patient referral to rheumatology was mainly (78%) via primary care; 44% had an agreed ERA local referral pathway, 15% a national pathway. Only 16% had dedicated ERA clinics, the majority being practitioners in Northern Europe with access to a local or national referral pathway. Data for research were collected by 42%. Treatment guidelines were followed by the majority, especially rheumatologists practising in Europe. Variations existed in the use of initial DMARDs with treatment decisions reported to be influenced by international/national guidelines in 71%/61%. No significant relationship between country gross national income and the availability of ERA clinics was seen. CONCLUSIONS This study provides comparative benchmark information regarding the global provision of ERA care. Substantial variations exist in referral and early assessment pathways with guidelines having a most apparent impact in Northern Europe. Provision of an ERA service does not appear to be constrained by cost, with conceptual factors, e.g. clinician engagement, perhaps playing a role. These initial insights could potentially help harmonise ERA management across countries.
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Affiliation(s)
- Elena Nikiphorou
- Department of Rheumatology, Whittington Hospital, London, UK; and Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland
| | - James Galloway
- King's College London, Academic Rheumatology Department, London, UK
| | - Piet van Riel
- Department of Rheumatology, Bernhoven, Uden, The Netherlands
| | - Yusuf Yazici
- NYU Hospital for Joint Diseases, New York, NY, USA
| | - Glenn Haugeberg
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | - Andrew Ostor
- Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Markku Kauppi
- Medical School, Tampere University, Tampere, Finland
| | - Tuulikki Sokka
- Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland.
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13
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Pirilä L, Kuusalo L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Aaltonen K, Kautiainen H, Sokka T. Three out of four disease-modifying anti-rheumatic drug-naïve rheumatoid arthritis patients meet 28-joint Disease Activity Score remission at 12 months: results from the FIN-ERA cohort. Scand J Rheumatol 2017; 46:425-431. [DOI: 10.1080/03009742.2016.1266029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Rannio
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - J Asikainen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - P Hannonen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - T Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - P Ekman
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - L Pirilä
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - L Kuusalo
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Mali
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Puurtinen-Vilkki
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - S Kortelainen
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - J Paltta
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - K Taimen
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - K Laiho
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - S Nyrhinen
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - H Mäkinen
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - P Isomäki
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - T Uotila
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - K Aaltonen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - T Sokka
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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14
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Aaltonen KJ, Joensuu JT, Pirilä L, Kauppi M, Uutela T, Varjolahti-Lehtinen T, Yli-Kerttula T, Isomäki P, Nordström D, Sokka T. Drug survival on tumour necrosis factor inhibitors in patients with rheumatoid arthritis in Finland. Scand J Rheumatol 2016; 46:359-363. [DOI: 10.1080/03009742.2016.1234641] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- KJ Aaltonen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - JT Joensuu
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - L Pirilä
- Department of Medicine, Turku University Hospital, Turku, Finland
| | - M Kauppi
- Department of Medicine, Lahti Central Hospital, Lahti, Finland
- Faculty of Medicine, University of Tampere, Tampere, Finland
| | - T Uutela
- Department of Medicine, Lapland Central Hospital, Rovaniemi, Finland
| | | | - T Yli-Kerttula
- Department of Medicine, Satakunta Central Hospital, Rauma, Finland
| | - P Isomäki
- Faculty of Medicine, University of Tampere, Tampere, Finland
- Department of Medicine, Tampere University Hospital, Tampere, Finland
| | - D Nordström
- Department of Medicine, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, Clinicum, University of Helsinki, Helsinki, Finland
| | - T Sokka
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
- Faculty of Health Science, University of Eastern Finland, Kuopio, Finland
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15
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Pänkäläinen M, Kerola T, Kampman O, Kauppi M, Hintikka J. Pessimism and risk of death from coronary heart disease among middle-aged and older Finns: an eleven-year follow-up study. BMC Public Health 2016; 16:1124. [PMID: 27852243 PMCID: PMC5112655 DOI: 10.1186/s12889-016-3764-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 07/07/2016] [Accepted: 10/12/2016] [Indexed: 01/18/2023] Open
Abstract
Background Mortality from coronary heart disease (CHD) remains at quite notable levels. Research on the risk factors and the treatment of CHD has focused on physiological factors, but there is an increasing amount of evidence connecting mental health and personality traits to CHD, too. The data concerning the connection of CHD and dispositional optimism and pessimism as personality traits is relatively scarce. The aim of this study was to investigate the connection between optimism, pessimism, and CHD mortality. Methods This was an 11-year prospective cohort study on a regional sample of three cohorts, aged 52–56, 62–66, and 72–76 years at baseline (N = 2815). The levels of dispositional optimism and pessimism of the study subjects were determined at baseline using a revised version of the Life Orientation Test (LOT-R). Eleven years later, those results and follow-up data about CHD as a cause of death were used to calculate odds. Adjustments were made for cardiovascular disease risk. Results Those who died because of CHD were significantly more pessimistic at baseline than the others. This finding applies to both men and women. Among the study subjects in the highest quartile of pessimism, the adjusted risk of death caused by CHD was approximately 2.2-fold (OR 2.17, 95 % CI 1.21–3.89) compared to the subjects in the lowest quartile. Optimism did not seem to have any connection with the risk of CHD-induced mortality. Conclusions Pessimism seems to be a substantial risk factor for death from CHD. As an easily measured variable, it might be a very useful tool together with the other known risk factors to determine the risk of CHD-induced mortality.
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Affiliation(s)
- Mikko Pänkäläinen
- Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850, Lahti, Finland.
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Olli Kampman
- Department of Psychiatry, Seinäjoki Hospital District, Seinäjoki, Finland.,University of Tampere, School of Medicine, Tampere, Finland
| | - Markku Kauppi
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,University of Tampere, School of Medicine, Tampere, Finland
| | - Jukka Hintikka
- Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850, Lahti, Finland.,University of Tampere, School of Medicine, Tampere, Finland
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16
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Soini I, Kotaniemi A, Kautiainen H, Kauppi M. US assessment of hip joint synovitis in rheumatic diseases: A comparison with MR imaging. Acta Radiol 2016. [DOI: 10.1258/rsmacta.44.1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: To assess the significance of ultrasonography (US) in detecting hip joint synovitis in patients with rheumatic diseases. Material and Methods: Forty patients with rheumatic disease and suspected hip joint synovitis underwent MRI and US of the hip joint. In addition to the throughout MRI evaluation, the anterior collum-capsule distance (CCD) was determined by both MRI and US. Thirteen healthy volunteers were examined with MRI to establish the criteria for normal findings in MRI when classifying hip joints to those with synovitis and those without. MRI was used as a gold standard. Results: Synovitis was found using MRI in 31 hips of 22 patients (9 patients had bilateral synovitis). The intraclass correlation was 0.61 between MRI and US in measuring CCD. In classifying hip joint synovitis with US, the sensitivity of the method was 87% and specificity 42%, when the CCD criterion for synovitis was determined to be ≥7 mm. If the cut-off point was raised to 9 mm, the sensitivity decreased to 61% while specificity increased to 94%. A difference in CCD of ≥1 mm between the hips as an additional criterion for synovitis increased the number of false-positive findings. Conclusion: Measurement of CCD with US proved to be a rather inaccurate method to point out synovitis in rheumatic patients when using MRI as a reference. The main reason for this result was the thickened capsule, which US could not differentiate from a thickened synovium.
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Affiliation(s)
- I. Soini
- Department of Radiology, Rheumatism Foundation Hospital, Heinola, Finland
| | - A. Kotaniemi
- Department of Rheumatology, Rheumatism Foundation Hospital, Heinola, Finland
| | - H. Kautiainen
- Department of Rheumatology, Rheumatism Foundation Hospital, Heinola, Finland
| | - M. Kauppi
- Department of Rheumatology, Rheumatism Foundation Hospital, Heinola, Finland
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17
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Aaltonen K, Joensuu J, Pirilä L, Kauppi M, Uutela T, Varjolahti-Lehtinen T, Yli-Kerttula T, Isomäki P, Nordström D, Sokka T. FRI0194 Drug Survival on TNF Inhibitors in Patients with Rheumatoid Arthritis in Finland. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4158] [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: 11/03/2022]
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18
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Aaltonen K, Ylikylä S, Joensuu J, Isomäki P, Pirilä L, Kauppi M, Rannio T, Eklund K, Blom M, Nordström D. FRI0156 Effectiveness of Tumor Necrosis Factor-Inhibitors in The Treatment of Rheumatoid Arthritis: A Comparison between Randomized Controlled Trials and Routine Clinical Practice. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4179] [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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19
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Pirilä L, Kuusalo L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Aaltonen K, Kautiainen H, Sokka T. SAT0090 Three out of Every Four Patients with Dmard-Naive Early Rheumatoid Arthritis Meet DAS28 Remission at 12 Months in Finland. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4894] [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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20
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Kuusela L, Pirilä L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Sokka T. FRI0057 Two Thirds of Patients with Early Rheumatoid Arthritis (ERA) Meet DAS28 Remission at 3 Months-Results from the Finnish Early Rheumatoid Arthritis Study (FIN-ERA). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3010] [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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21
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Vuolteenaho K, Kautiainen H, Möttönen T, Hannonen P, Korpela M, Kauppi M, Kaipiainen-Seppänen O, Luosujärvi R, Nieminen R, Leirisalo-Repo M, Moilanen E. FRI0254 Predictive Value of Pretreatment Resistin Levels for Erosive Disease in Early RA Treated with DMARDS and Infliximab. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1680] [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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22
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Kauppi M, Stenholm S, Impivaara O, Mäki J, Heliövaara M, Jula A. Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample. Osteoporos Int 2014; 25:1685-95. [PMID: 24658297 DOI: 10.1007/s00198-014-2674-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 02/22/2014] [Indexed: 12/22/2022]
Abstract
UNLABELLED Maximal walking speed and quantitative ultrasound index (QUI) were significant and independent predictors of hip fracture among subjects aged ≥ 55 years. A model including readily available variables along with simple fall-related factors may be clinically useful in the assessment of hip fracture risk even without a QUI measurement. INTRODUCTION This study assessed fall-related risk factors along with heel bone quantitative ultrasound (QUS) measurements for the prediction of hip fracture during a mean follow-up of 9.8 years in a nationally representative population sample. METHODS The study population consisted of 2,300 subjects (1,331 women and 969 men) aged 55 years or over, who had participated in a comprehensive health survey in 2000-2001. Information on the subjects’ health and fall-related risk factors was obtained with interviews, questionnaires and tests carried out by specially trained professionals. QUS measurements were made by means of the Hologic Sahara device. First emerging cases of hip fracture were identified from the National Hospital Discharge Register. RESULTS During the follow-up, 96 subjects sustained a hip fracture. Slow maximal walking speed, low quantitative ultrasound index (QUI), high age, tallness, short waist circumference, Parkinson's disease and the number of central nervous system active medication were significant and independent predictors of hip fracture. The model including all of these risk factors explained 68 % of the variation in hip fracture risk. Excluding QUI from this model reduced the percentage to 66%. CONCLUSIONS Maximal walking speed and QUI were significant and independent predictors of hip fracture. A model including readily available variables such as age, gender, height and waist circumference along with simple fall-related factors may be of clinical use in the assessment of hip fracture risk even without a QUS measurement.
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23
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Rantalaiho V, Korpela M, Hannonen P, Kaipiainen-Seppänen O, Möttönen T, Kauppi M, Karjalainen A, Laiho K, Kautiainen H, Leirisalo-Repo M. OP0147 Targeted treatment with combination DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of the neo-raco trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.1830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Kotaniemi K, Sihto-Kauppi K, Salomaa P, Säilä H, Ristolainen L, Kauppi M. The frequency and outcome of uveitis in patients with newly diagnosed juvenile idiopathic arthritis in two 4-year cohorts from 1990-1993 and 2000-2003. Clin Exp Rheumatol 2014; 32:143-147. [PMID: 24351424] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/09/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To retrospectively compare the frequency and outcome of uveitis between two cohorts of patients with newly-onset juvenile idiopathic arthritis (JIA) separated by a 10 year interval. METHODS The diagnosis of JIA was made in 239 patients in 1990-1993 and in 240 patients in 2000-2003 by paediatric rheumatologists at the Rheumatism Foundation Hospital, Heinola, Finland. An ophthalmologist examined all the patients regularly and diagnosed uveitis. The demographics of the patients, type of JIA, frequency, medical treatment and outcome of uveitis were documented. RESULTS The main outcome measures were the frequency and outcome of uveitis, the number of complications and the best corrected visual acuity (BCVA), need of corticosteroids and other immunosuppressive treatment. The frequency of uveitis was higher (25% vs. 18%) in the earlier cohort. The visual outcome was ≥0.5 in all JIA-uveitis patients except one in the earlier cohort. Complications were fewer (21% vs. 35%) and uveitis was milder according to the Standardisation of Uveitis Nomenclature (SUN) criteria in the later cohort. Remission of uveitis (33% vs. 42%) and arthritis (20% vs. 23%) in JIA-uveitis patients was similar in both cohorts after a follow-up of 6.6 and 5.9 years, respectively. Systemic corticosteroids were more commonly used (25% vs. 7%) in JIA-uveitis patients of the earlier cohort but the use of methotrexate was equal in both cohorts (65% vs. 67%). CONCLUSIONS In this study with early and aggressive treatment and close monitoring the outcome of JIA-uveitis patients was favourable and visual loss was avoided in most cases.
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Affiliation(s)
- Kaisu Kotaniemi
- Helsinki University Hospital, ORTON Rehabilitation Centre, Helsinki, Finland.
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Kauppi M, Impivaara O, Mäki J, Heliövaara M, Jula A. Quantitative ultrasound measurements and vitamin D status in the assessment of hip fracture risk in a nationally representative population sample. Osteoporos Int 2013; 24:2611-8. [PMID: 23595563 DOI: 10.1007/s00198-013-2355-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
Abstract
SUMMARY Adjusted for age, gender, height and weight, calcaneal quantitative ultrasound (QUS) and serum 25-hydroxyvitamin D (S-25(OH)D) proved to be significant predictors of hip fracture among subjects aged ≥50 years. Even if their contribution to the predictive power was modest, they may be useful in the assessment of hip fracture risk in the elderly. INTRODUCTION This study assessed calcaneal QUS measurements, S-25(OH)D and several other factors for the prediction of hip fracture risk in a nationally representative population sample. METHODS The study population consisted of 3,305 subjects (1,872 women), aged 50 years or over, who had participated in a comprehensive health survey. QUS measurements were made by means of the Hologic Sahara device. S-25(OH)D was measured by radioimmunoassay. Emerging cases of hip fracture were identified from the National Hospital Discharge Register. RESULTS During a mean follow-up of 8.4 years, 95 subjects sustained a hip fracture. After adjusting for age, gender, height, weight and each other, a 1 standard deviation increment in the quantitative ultrasound index (QUI) (21.7) and in S-25(OH)D (17.5 nmol/L) reduced the risk of hip fracture by 40 % (hazard ratio [HR] = 0.60, 95 % confidence interval [CI] = 0.42-0.86) and by 31 % (HR = 0.69, 95 % CI = 0.55-0.87), respectively. The predictive power of a model including age, gender, height and weight was improved by about 8 % after the addition of QUI and S-25(OH)D. Among subjects aged 75 years or over, the corresponding improvement was about 130 %. CONCLUSIONS QUI and S-25(OH)D were significant and independent predictors of hip fracture. However, their ability to increase the predictive power of a statistical model including readily available simple variables such as age, gender, height and weight was rather modest. Still, our findings suggest that QUI and S-25(OH)D may be of clinical use in the assessment of hip fracture risk particularly in the elderly.
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Affiliation(s)
- M Kauppi
- Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Peltolantie 3, 20720, Turku, Finland,
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Rantalaiho V, Kautiainen H, Korpela M, Hannonen P, Kaipiainen-Seppänen O, Möttönen T, Kauppi M, Karjalainen A, Laiho K, Laasonen L, Hakola M, Peltomaa R, Leirisalo-Repo M. Targeted treatment with a combination of traditional DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of a randomised clinical trial, the NEO-RACo trial. Ann Rheum Dis 2013; 73:1954-61. [DOI: 10.1136/annrheumdis-2013-203497] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Salonen PH, Leirisalo-Repo M, Repo H, Säilä H, Salonen JH, Kauppi M, Vuorela M, Lyytikäinen O, Kautiainen H. SAT0479 Bloodstream Infections (BSI) in Finnish Children with Juvenile Idiopathic Arthritis in 2004-2011. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2203] [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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Elo P, Laasonen L, Soini I, Luosujärvi R, Lohman M, Paimela L, Mikkonen R, Alasaarela E, Hannila I, Vidqvist KL, Kauppi M, Nordstöm D. [Imaging of inflammatory back pain]. Duodecim 2013; 129:741-752. [PMID: 23720943] [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: 06/02/2023]
Abstract
We recommend magnetic resonance imaging of the sacroiliac joints as the first line imaging method in suspected inflammatory back disorder. Plain X-ray can be taken from those over 35 years of age. A nonconclusive finding in plain X-ray should be verified by MR imaging. For the present, diagnostic criteria for spondylarthritis do not take into account spinal changes. Typical spinal findings can, however, be helpful in making treatment decisions. In case the spinal region MR imaging should be utilized if possible, because radiography is particularly insensitive for thoracic spine. After a confirmed diagnosis, the inflammatory nature of the condition can usually be assessed clinically.
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Affiliation(s)
- Petra Elo
- TAYS, kuvantamiskeskus, radiologian osasto
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Puolakka K, Blåfield H, Kauppi M, Luosujärvi R, Peltomaa R, Leikola-Pelho T, Sennfalt K, Beresniak A. Cost-effectiveness modelling of sequential biologic strategies for the treatment of moderate to severe rheumatoid arthritis in Finland. Open Rheumatol J 2012; 6:38-43. [PMID: 22582103 PMCID: PMC3349947 DOI: 10.2174/1874312901206010038] [Citation(s) in RCA: 18] [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: 12/21/2011] [Revised: 02/20/2012] [Accepted: 02/28/2012] [Indexed: 11/25/2022] Open
Abstract
Objective:
The main objective was to compare the cost-effectiveness of therapeutic options in moderate or severe rheumatoid arthritis (RA) when a clinical response to a first TNF-blocker, either etanercept (ETA), adalimumab (ADA), or infliximab (INF), is insufficient. Methods:
Effectiveness criteria were defined as remission (RS), low disease activity (LDAS), and moderate to high disease activity (MHDAS). Cost-effectiveness was derived as cost per day in RS and in LDAS using simulation modelling to assess six sequential biologic strategies over 2 years. Each sequential treatment strategy was composed of three biologic agents and included a first anti-TNF agent, ETA, ADA or INF, followed by either abatacept (ABA) or rituximab (RTX) as a second therapeutic option in case of an insufficient response, followed by another anti-TNF agent in case of further insufficient response. Results:
Over two years and taking into account biologic costs, the following estimated mean costs per day in RS and LDAS were respectively of €829 and €428 for the biologic sequence composed of ADA-ABA-ETA, €1292 and €516 for the sequence ADA-RTX-ETA, €829 and €429 for the sequence ETA-ABA-ADA, €1292 and €517 for the sequence ETARTX- ADA, €840 and €434 for the sequence INF-ABA-ETA, and €1309 and €523 for the sequence INF-RTX-ETA. Conclusion:
The treatment sequences including ABA as the second biologic option appear more cost-effective than those including RTX in a patients with moderate to severe RA and an insufficient response to a first anti-TNF agent.
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Affiliation(s)
- K Puolakka
- Lappeenranta Central Hospital, Lappeenranta, Finland
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Luoto S, Riikonen K, Siivola M, Laiho K, Kauppi M, Mikkelsson M. Impaired postural control is associated with worse scores of the Health Assessment Questionnaire disability index among women with rheumatoid arthritis. J Rehabil Med 2011; 43:900-5. [PMID: 21947181 DOI: 10.2340/16501977-0851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore the relationship between functional status and different domains of postural control, and to make recommendations about the use of postural control tests in clinical practice among women with rheumatoid arthritis. SUBJECTS A total of 91 women with rheumatoid arthritis and 110 controls. The patients were grouped according to the total score of the Health Assessment Questionnaire (HAQ):HAQ1 = 0 (good, n = 21); HAQ2 = 0.1 to < 1 (impaired, n = 44);HAQ3 = 1–3 (severely impaired, n = 26). METHODS Postural control tests: timed one-leg stance test(OLST), timed up and go test (TUG), and posturography tests on a force-plate. RESULTS A poorer performance in the OLST and TUG tests was associated with higher, i.e. worse, HAQ scores. The results of the force-plate measurements were more complex.The results for healthy controls provided some clarifying information,but did not alter the main results. CONCLUSION It is recommended that both OLST and TUG tests are included in the postural control assessment design for patients with arthritis. It seems that the force-plate measurements are not as good for screening postural control impairments associated with functional disability, but they may still have their use in, for example, monitoring the effect of intervention or rehabilitation.
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Affiliation(s)
- Satu Luoto
- Rheumatism Foundation Hospital, Heinola.
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Abstract
UNLABELLED Hip fracture risk was assessed according to parity among postmenopausal women. Compared with nulliparous women, the fracture risk was lower in women with three or more births. INTRODUCTION Parity was assessed for long-term prediction of hip fracture in postmenopausal women. METHODS Postmenopausal women (n= 2,028) aged 45 or over with no history of hip fracture were studied. From 1978 to 1980, all of them had participated in a comprehensive health survey based on a nationally representative population sample. Emerging cases of hip fracture were identified from the National Hospital Discharge Register during a follow-up period extending up to 17 years. RESULTS The risk of hip fracture was lower among parous women compared with nulliparous women. The model adjusted for age showed a significant inverse association between parity as a continuous variable and the risk of hip fracture [RR = 0.74; 95% confidence interval (CI), 0.61-0.90] per an increment of one standard deviation (2.4 births). Adjusted for age, menopausal age, level of education, body mass index, vitamin D status, alcohol consumption, smoking history, leisure time physical activity, and self-rated health, the relative risk was 0.50 (95% CI, 0.32-0.79) for women with three or more births and 0.85 (95% CI, 0.55-1.32) for women with one to two births as compared with nulliparous women. CONCLUSION Parity, three or more births in particular, predicts a lowered risk of hip fracture in the long run.
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Affiliation(s)
- M Kauppi
- Division of Welfare and Health Promotion, National Institute for Health and Welfare, Peltolantie 3, 20720 Turku, Finland.
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Kontunen P, Vuolteenaho K, Nieminen R, Lehtimäki L, Kautiainen H, Kesäniemi YA, Ukkola O, Kauppi M, Hakala M, Moilanen E. Resistin is linked to inflammation, and leptin to metabolic syndrome, in women with inflammatory arthritis. Scand J Rheumatol 2011; 40:256-62. [DOI: 10.3109/03009742.2010.548827] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Immonen K, Kauppi M, Hakala M. Experiences on the use of biological drugs in psoriatic arthritis-associated amyloidosis. Scand J Rheumatol 2011; 40:236-8. [DOI: 10.3109/03009742.2010.530294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nordström D, Kauppi M. [Axial spondyloarthritis and ankylosing spondylitis]. Duodecim 2010; 126:1467-1474. [PMID: 20617750] [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: 05/29/2023]
Abstract
Current classification criteria for ankylosing spondylitis do not allow diagnosis before radiographic changes are visible in sacroiliacal joints. The the new axial spondyloarthropathy (SpA) criteria include axial SpA without radiographic changes as well as established ankylosing spondylitis, recognizing them as a continuum of the same disease. This is of major importance as the burden of early SpA is comparable to that of later stage disease. Diagnosis relies on inflammatory MRI findings which is the most significant change compared to earlier criteria. Emerging data on the efficacy of tumor necrosis factor (TNF) alpha blocking therapies already in early but also in established disease have given new promising alternatives for treatment of this often very cumbersome disease, that rarely responds to classic DMARDs.
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Affiliation(s)
- Dan Nordström
- HYKS:n yleissisätautien ja reumatologian klinikka, PL 340, 00029 HUS
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Valleala H, Korpela M, Möttönen T, Hienonen-Kempas T, Kauppi M, Hannonen P, Leirisalo-Repo M. Rituximab therapy in patients with rheumatoid arthritis refractory or with contraindication to anti-tumour necrosis factor drugs: real-life experience in Finnish patients. Scand J Rheumatol 2009; 38:323-7. [DOI: 10.1080/03009740902946355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Endén K, Laiho K, Kautiainen H, Arkela-Kautiainen M, Belt E, Kauppi M. Subaxial cervical vertebrae in patients with juvenile idiopathic arthritis – Something special? Joint Bone Spine 2009; 76:519-23. [DOI: 10.1016/j.jbspin.2008.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/06/2008] [Indexed: 11/30/2022]
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Pointon JJ, Chapman K, Harvey D, Sims AM, Bradbury L, Laiho K, Kauppi M, Kaarela K, Tuomilehto J, Brown MA, Wordsworth BP. Toll-like receptor 4 and CD14 polymorphisms in ankylosing spondylitis: evidence of a weak association in Finns. J Rheumatol 2008; 35:1609-1612. [PMID: 18634146] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the association of CD14 and Toll-like receptor (TLR4) with ankylosing spondylitis (AS). METHODS A promoter variant in CD14 and 2 coding polymorphisms in TLR4 were investigated in UK and Finnish families with AS and in a UK case-control study. A metaanalysis of published TLR4 and CD14 studies was performed. RESULTS In the Finnish study the CD14-260bp T variant showed an association (p = 0.006), and the common 2-marker TLR4 haplotype showed a weak association (global p = 0.03), with AS. No associations were seen in the UK based studies or in the metaanalyses. CONCLUSION CD14 and TLR4 showed an association with AS in the Finns only.
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Affiliation(s)
- Jennifer J Pointon
- NIHR OxfordMusculoskeletal Biomedical Research Unit and BotnarResearch Centre, Oxford, UK.
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Hakkinen A, Makinen H, Ylinen J, Hannonen P, Sokka T, Neva M, Kautiainen H, Kauppi M. Stability of the upper neck during isometric neck exercises in rheumatoid arthritis patients with atlantoaxial disorders. Scand J Rheumatol 2008; 37:343-7. [PMID: 18609259 DOI: 10.1080/03009740802007522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the effect of isometric neck strength exercises on upper cervical stability in patients with rheumatoid arthritis (RA). METHODS Twenty patients with a mean (SD) age of 58 (9) years and duration of RA of 27 (10) years volunteered for the study. Lateral radiographs of the cervical spine were taken to measure the current atlantoaxial distance (AAD) in flexion and extension. Maximal isometric neck flexion and extension strength values were measured by a dynamometer. Thereafter, AADs were measured from radiographs taken at 80-90% resistance of maximal strength. RESULTS According to the full flexion radiographs at baseline, the patients were classified into three groups: eight patients without anterior atlantoaxial subluxation (aAAS) [AAD = 2.1 (2-3) mm], seven with unstable aAAS [AAD = 6.6 (5-8) mm], and five with stable aAAS [AAD = 5.5 (5-7) mm]. During resisted flexion the AAD decreased by 5 (3-7) mm (p<0.001) in the unstable aAAS group, while in the other two groups the changes were minor. During resisted extension the AAD increased by 3 (2-6) mm (p<0.001) in the cases with unstable aAAS only. CONCLUSION Isometric exercising towards flexion decreases the AAD in cases with unstable aAAS. Submaximal loading of the neck extensors by pushing the back of the head against the resistance even in the neutral position of the cervical spine leads to a decrease in the width of the cervical spine canal and is not recommended in unstable aAAS.
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Affiliation(s)
- A Hakkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland.
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Sims AM, Timms AE, Bruges-Armas J, Burgos-Vargas R, Chou CT, Doan T, Dowling A, Fialho RN, Gergely P, Gladman DD, Inman R, Kauppi M, Kaarela K, Laiho K, Maksymowych W, Pointon JJ, Rahman P, Reveille JD, Sorrentino R, Tuomilehto J, Vargas-Alarcon G, Wordsworth BP, Xu H, Brown MA. Prospective meta-analysis of interleukin 1 gene complex polymorphisms confirms associations with ankylosing spondylitis. Ann Rheum Dis 2007; 67:1305-9. [DOI: 10.1136/ard.2007.081364] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [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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40
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Airio A, Kauppi M, Kautiainen H, Hakala M, Kinnula V. High association of mycobacterial infections with polymyositis in a non-endemic country for tuberculosis. Ann Rheum Dis 2007; 66:1404-5. [PMID: 17881668 PMCID: PMC1994311 DOI: 10.1136/ard.2007.070177] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
We studied the extent to which exocrine dysfunction of the pancreas is seen among patients with severe chronic polyarthritis and whether it might account for some gastrointestinal symptoms. Our series consisted of 50 such chronic polyarthritis cases; most had rheumatoid arthritis but had neither diagnosed or suspected pancreatitis nor primary Sjögren's syndrome. They were asked about gastrointestinal (GI) and sicca symptoms. The exocrine function of each pancreas was evaluated by the fecal elastase-1-enzyme test. Thirty-two patients had GI symptoms at least weekly. Forty had sicca eye syndrome and 26 had dry mouth. There were two cases (4%; 95% confidence interval, 1-14%) with abnormally low fecal elastase-1-enzyme test level. Chronic GI and sicca symptoms are frequent among patients with severe chronic polyarthritis. Secondary Sjögren's syndrome may cause exocrine insufficiency in the pancreas. That circumstance was not common here, but it is worth remembering because it can be diagnosed by a noninvasive method, and enzyme preparation treatment is available for the symptoms, especially for postprandial pain and distention of the stomach.
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Affiliation(s)
- M Kauppi
- The Rheumatism Foundation Hospital, Heinola, Finland.
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Hämäläinen H, Kaarela K, Kröger H, Kauppi M, Järvenpää S, Hakala M, Kotaniemi A. Changes in bone mineral density in premenopausal women with rheumatoid arthritis during a two-year follow-up. Joint Bone Spine 2007; 74:482-7. [PMID: 17905634 DOI: 10.1016/j.jbspin.2007.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 01/04/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To ascertain changes in axial bone mineral in premenopausal women with severe rheumatoid arthritis (RA) treated with and without prednisolone (PRED), we conducted a two-year follow-up study of axial bone mineral density (BMD) and bone mineral content (BMC). METHODS Premenopausal RA women (n=74) attending wards in the Rheumatism Foundation Hospital, Heinola, Finland were consecutively recruited for a follow-up study of BMD. BMD measurements in the lumbar spine and left proximal femur (femoral neck) were performed using dual X-ray absorptiometry at baseline and after two years. BMD is expressed as BMC per projectional area g/cm2. The Larsen score of 0-100 was assessed at the check-ups. Two RA groups were analyzed: patients receiving prednisolone (n=48), RA with PRED group and without prednisolone (n=26), RA without PRED group. The control group (n=43) comprised age-matched, premenopausal healthy women. RESULTS The patients in the RA with PRED group had lower BMD values than those in the RA without PRED group at commencement of follow-up. The mean weight-adjusted BMD percentage change in the lumbar spine to two years was -1.5% in the RA with PRED group, +0.6% in the RA without PRED group and -0.6% among the controls; a significant difference (P=0.030) was found between the RA groups. The mean BMC percentage change to two years in the lumbar spine was -2.2% in the RA with PRED-group (P=0.003), +0.0 in the RA without PRED-group and -0.6% in the control group. Accordingly, the mean weight-adjusted BMD percentage change in the femoral neck to two years was -2.6% in the RA with PRED group, +0.4% in the RA without PRED group and -0.9% among the controls; the difference between the RA groups being again significant (P=0.049). The mean BMC percentage change to two years in the femoral neck was -1.9% (P=0.006), -0.4% and -0.8%, respectively. Mean BMD decreased significantly in both lumbar spine (P=0.002) and femoral neck (P<0.001) only in the RA with PRED group. However, in spite of statistical findings above, when BMD is expressed as BMC per projectional area there was no statistically significant difference between the three groups in the change in BMC or projectional area in the lumbar spine or femoral neck. There was no significant correlation between the change in BMD in lumbar spine or femoral neck and the change in Larsen score among the RA groups. CONCLUSIONS We conclude that according to BMC, premenopausal RA women both with and without prednisolone treatment and controls lost bone statistically similarly. It seems that the role of RA itself in the multifactorial development of axial bone mass during the first decade of severe RA is not the most essential issue. We assume that this role will be less important with better treatment of RA than our patients received. The amount of bone loss during treatment with low-grade prednisolone remains controversial.
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Affiliation(s)
- Harri Hämäläinen
- Department of Physical Medicine and Rehabilitation, Heinola, Finland.
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Luukkainen R, Sokka T, Kautiainen H, Hannonen P, Laasonen L, Leirisalo-Repo M, Korpela M, Julkunen H, Puolakka K, Blåfield H, Kauppi M, Möttönen T. Prognosis of 5-year radiographic erosions of the wrist according to early, late, and persistent wrist swelling or tenderness in patients with early rheumatoid arthritis. J Rheumatol 2007; 34:50-3. [PMID: 17216677] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To determine whether early inflammatory activity in the first year of disease compared to persistent or later occurrence of swelling or tenderness in the wrist joints is associated with 5-year erosions in the same joint in patients with early rheumatoid arthritis (RA). METHODS A cohort of 195 patients with early active RA was enrolled in the Finnish RA Combination Trial. Swelling and tenderness of wrists were assessed at baseline and at 3, 6, 12, 24, 36, and 48 months. Radiographs of the wrists were taken at the baseline and at 5 years. The 237 wrist joints of 125 patients without erosions at baseline were classified according to wrist swelling, i.e., I: never swollen; II: swollen during first year only; III: swollen during the second to fourth year only; and IV: swollen during the first year and followup, and similarly according to tenderness. RESULTS Thirty percent of the wrists were never swollen in all clinical examinations; 43% were swollen only during the first year; 11% were not swollen in the first year, but were swollen at some time during 24-48 months; and 16% of wrists were swollen during the first year and at some time during 24-48 months. At 5 years, 64% of 237 wrists remained free of erosions. Erosions developed in 82% of wrists that were swollen during both the first year and 24-48 months, versus 56% of wrists that were not swollen at first year but were swollen during 24-48 months, 31% of wrists that were swollen during the first year only, and 11% of wrists that were never swollen. Similar results were seen for joint tenderness. CONCLUSION Wrist swelling during the first year only is associated with less future wrist radiographic damage than persistent swelling or swelling only during the followup. Our results emphasize the value of early and continuous suppression of inflammatory activity in early RA.
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Seldin MF, Shigeta R, Laiho K, Li H, Saila H, Savolainen A, Leirisalo-Repo M, Aho K, Tuomilehto-Wolf E, Kaarela K, Kauppi M, Alexander HC, Begovich AB, Tuomilehto J. Finnish case-control and family studies support PTPN22 R620W polymorphism as a risk factor in rheumatoid arthritis, but suggest only minimal or no effect in juvenile idiopathic arthritis. Genes Immun 2006; 6:720-2. [PMID: 16107870 DOI: 10.1038/sj.gene.6364255] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Several studies have identified the PTPN22 allelic variant 1858 C/T that encodes the R620W amino-acid change as a putative susceptibility factor in autoimmune diseases. The current study was undertaken to examine a large cohort of Finnish rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) subjects using both population control and, importantly, family-based association methods. The latter is particularly important when, as is the case for the 1858 C/T polymorphism, the frequency of the variant allele (T) differs in both major ancestral populations and in subpopulations. The analysis of rheumatoid factor-positive 1030 RA probands from Finland provides strong support for association of this variant in both population studies (allele specific odds ratio (OR)=1.47, 95% confidence interval (CI)=1.27-1.70, P=3 x 10(-7)) and in family studies (P<10(-6)). In contrast, no allelic association was seen with JIA (230 probands) and only weak evidence for a genotypic effect of 1858T homozygotes was observed in this population.
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Affiliation(s)
- M F Seldin
- Rowe Program in Genetics, Departments of Biochemistry and Medicine, University of California-Davis, Davis, CA, USA.
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Neva MH, Häkkinen A, Mäkinen H, Hannonen P, Kauppi M, Sokka T. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery. Ann Rheum Dis 2005; 65:884-8. [PMID: 16269427 PMCID: PMC1798218 DOI: 10.1136/ard.2005.042135] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To study the prevalence of cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery, and symptoms that might be associated with the disorders. METHODS 194 patients with rheumatoid arthritis were referred for orthopaedic surgery at Jyväskylä Central Hospital, 154 (79%) of whom volunteered for the present study including clinical examination, laboratory tests, radiographs of the cervical spine, hands, and feet, and self report questionnaires. Definition of anterior atlantoaxial subluxation (aAAS) was >3 mm and of subaxial subluxation (SAS)>or=3 mm. Atlantoaxial impaction (AAI) was analysed following to the Sakaguchi-Kauppi method. RESULTS 67 patients (44%) had cervical spine subluxation or previous surgical fusion. The prevalence of aAAS, AAI, SAS, or previous fusion was 27 (18%), 24 (16%), 29 (19%), and 8 (5%), respectively; 69% of patients with cervical spine subluxations (those with fusions excluded) reported neck pain, compared with 65% of patients without subluxations (p=0.71). The prevalence of occipital, temporal, retro-orbital, and radicular pain in upper extremities was similar in patients with or without cervical spine subluxations (54% v 43%; 17% v 31%; 25% v 24%; 47% v 48%, respectively). However, patients with subluxations were older, had longer disease duration, more active disease, poorer function according to the Health Assessment Questionnaire, and had more often erosive disease. CONCLUSIONS Asymptomatic cervical spine subluxation is common in patients with rheumatoid arthritis waiting for orthopaedic surgery. Regardless of symptoms, the possibility of cervical spine subluxation in patients with severe rheumatoid arthritis should be considered in preoperative evaluation.
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Affiliation(s)
- M H Neva
- Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, PL 2000, 33521 Tampere, Finland.
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Jaakkola E, Herzberg I, Laiho K, Barnardo MCNM, Pointon JJ, Kauppi M, Kaarela K, Tuomilehto-Wolf E, Tuomilehto J, Wordsworth BP, Brown MA. Finnish HLA studies confirm the increased risk conferred by HLA-B27 homozygosity in ankylosing spondylitis. Ann Rheum Dis 2005; 65:775-80. [PMID: 16249228 PMCID: PMC1798178 DOI: 10.1136/ard.2005.041103] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the influence of HLA-B27 homozygosity and HLA-DRB1 alleles in the susceptibility to, and severity of, ankylosing spondylitis in a Finnish population. METHODS 673 individuals from 261 families with ankylosing spondylitis were genotyped for HLA-DRB1 alleles and HLA-B27 heterozygosity/homozygosity. The frequencies of HLA-B27 homozygotes in probands from these families were compared with the expected number of HLA-B27 homozygotes in controls under Hardy-Weinberg equilibrium (HWE). The effect of HLA-DRB1 alleles was assessed using a logistic regression procedure conditioned on HLA-B27 and case-control analysis. RESULTS HLA-B27 was detected in 93% of cases of ankylosing spondylitis. An overrepresentation of HLA-B27 homozygotes was noted in ankylosing spondylitis (11%) compared with the expected number of HLA-B27 homozygotes under HWE (4%) (odds ratio (OR) = 3.3 (95% confidence interval, 1.6 to 6.8), p = 0.002). HLA-B27 homozygosity was marginally associated with reduced BASDAI (HLA-B27 homozygotes, 4.5 (1.6); HLA-B27 heterozygotes, 5.4 (1.8) (mean (SD)), p = 0.05). Acute anterior uveitis (AAU) was present in significantly more HLA-B27 positive cases (50%) than HLA-B27 negative cases (16%) (OR = 5.4 (1.7 to 17), p<0.004). HLA-B27 positive cases had a lower average age of symptom onset (26.7 (8.0) years) compared with HLA-B27 negative cases (35.7 (11.2) years) (p<0.0001). CONCLUSIONS HLA-B27 homozygosity is associated with a moderately increased risk of ankylosing spondylitis compared with HLA-B27 heterozygosity. HLA-B27 positive cases had an earlier age of onset of ankylosing spondylitis than HLA-B27 negative cases and were more likely to develop AAU. HLA-DRB1 alleles may influence the age of symptom onset of ankylosing spondylitis.
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Affiliation(s)
- E Jaakkola
- Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford, United Kingdom.
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Häkkinen A, Neva MH, Kauppi M, Hannonen P, Ylinen J, Mäkinen H, Jäppinen I, Sokka T. Decreased Muscle Strength and Mobility of the Neck in Patients With Rheumatoid Arthritis and Atlantoaxial Disorders. Arch Phys Med Rehabil 2005; 86:1603-8. [PMID: 16084814 DOI: 10.1016/j.apmr.2005.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 02/03/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare neck muscle strength and mobility of the cervical spine in rheumatoid arthritis (RA) patients with and without atlantoaxial (AA) disorders (anterior atlantoaxial subluxation [AAS], AA impaction). DESIGN Clinical cross-sectional study. SETTING Outpatient rheumatology and rehabilitation clinics in a Finnish hospital. PARTICIPANTS Patients with RA (N=124; mean age +/- standard deviation, 62+/-12y [corrected]) on a waiting list for orthopedic surgery. Thirty (24%) patients presented with AA disorders (16 with anterior AAS, 8 with AA impaction, 6 with a combination of anterior AAS and AA impaction). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Neck function was measured by isometric neck strength and mobility tests, neck pain by a visual analog scale, erosion of the hands and feet by radiography, and the patients' function by the Health Assessment Questionnaire (HAQ). RESULTS Maximal neck muscle strength against flexion, extension, and rotation was lower in patients with AA disorders compared with the other patients in both women (P=.012) and men (P=.017). Mobility was lowest in the AA impaction group in all measured directions (P<.001). Peripheral erosive disease was more frequent in the group with AA disorders. They also had longer disease duration and were more disabled (HAQ) than the other patients. CONCLUSIONS Neck muscle strength is significantly decreased in patients with AA disorders. Mobility of the cervical spine is most limited in patients with AA impaction, but can be normal in cases with solitary anterior AAS.
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Affiliation(s)
- Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland.
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Laiho K, Kauppi M. Fracture of axial spinous process in a patient with rheumatoid arthritis. Clin Rheumatol 2005; 24:308-9. [PMID: 15940565 DOI: 10.1007/s10067-004-0969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 05/04/2004] [Indexed: 11/26/2022]
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Kauppi M, Sokka T, Hannonen P. Survey nonresponse is associated with increased mortality in patients with rheumatoid arthritis and in a community population. J Rheumatol 2005; 32:807-10. [PMID: 15868613] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To determine whether nonresponse to a mailed health survey predicts mortality in patients with rheumatoid arthritis (RA) and in a community sample in Finland. METHODS A 5-page health questionnaire was administered in 2000. Two years later the vital status of the subjects was ascertained from the Population Registry. RESULTS A total of 1095 (73%) patients with RA and 1530 (77%) community control subjects returned a completed questionnaire. Over the 2-year period, the number of deaths was 57 (5.2%) in RA responders and 37 (9.3%) in RA nonresponders (p = 0.004). The corresponding figures in community controls were 34 (2.2%) and 23 (4.9%) (p = 0.002). In a Cox regression model adjusted for age and sex, RA patient and community control nonresponders were respectively 1.65 (95% CI 1.07 to 2.55) and 2.89 (95% CI 1.69 to 4.94) times more likely to die over the 2 years compared to the responders. CONCLUSION Nonresponders to a mailed health survey were more likely to die over 2 years compared to responders. The possible nonresponse bias should be kept in mind in the interpretation of the results of studies that are based on mail questionnaires only.
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Kauppi M, Hartikainen S, Kautiainen H, Laiho K, Sulkava R. Capability for daily activities in old people with rheumatoid arthritis: a population based study. Ann Rheum Dis 2005; 64:56-8. [PMID: 15608301 PMCID: PMC1755187 DOI: 10.1136/ard.2003.017889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the functional capacity for daily activities in old people with clinical rheumatoid arthritis (including juvenile rheumatoid arthritis (JRA)) in a population based cohort. METHODS A cohort of 700 people was randomly collected from the population older than 75 years in a Finnish town. Altogether 601 persons (86%) participated. Data were collected from clinical records and by interview, clinical examination, and questionnaire. Ability to carry out activities of daily living (ADL) was assessed by the Barthel index, and the IADL (instrumental activities of daily living) by the Lawton and Brody questionnaire. RESULTS 16 people had clinical rheumatoid arthritis (one with JRA). The prevalence was 16/601 (2.7% (95% confidence interval, 1.7% to 4.5%)). Eight patients with rheumatoid arthritis (50%) obtained the best possible ADL figures, while three (19%) had very poor results. Seven (44%) could not dress themselves without help. Three (19%) were unable to walk, and five (31%) could not climb stairs. Sex and age adjusted results showed no statistical difference (ADL and IADL) between patients with clinical rheumatoid arthritis and rest of the cohort. Four patients (25%) had dementia, which was associated with the poor functional capacity. CONCLUSIONS The prevalence of the disease was unexceptional. The ability of old people with rheumatoid arthritis to carry out activities of daily living did not differ from the general population, but the disease may lead to severe disability on an individual level, especially when associated with dementia. It therefore remains a considerable challenge to the health care and social systems.
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Affiliation(s)
- M Kauppi
- Rheumatism Foundation Hospital, Pikijarventie 1, 18120 Heinola, Finland.
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