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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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Asikainen J, Rannio T, Kautiainen H, Hannonen P, Sokka T. THU0056 Women, Men, and Rheumatoid Arthritis: Radiographic Progression over Ten Years in The Current Millennium. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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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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Sokka-Isler T, Kautiainen H, Rannio T, Asikainen J, Hannonen P. AB0297 Does Delay of Therapy Affect Outcomes of Early RA in A T2T Clinic?: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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Sokka-Isler T, Haugeberg G, Rannio T, Widding Hansen I, Soldal D, Asikainen J, Hannonen P. FRI0221 More Health for Lower Costs – Data from Two Clinics Treating RA in 2012-13: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2604] [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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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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Sokka T, Haugeberg G, Asikainen J, Widding Hansen I, Kokko A, Rannio T, Soldal D, Hannonen P. FRI0095 Similar clinical outcomes in rheumatoid arthritis with more vs. Less expensive treatment strategies. Results from two rheumatology clinics with standard monitoring of all patients:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rannio T, Asikainen J, Hannonen P, Sokka T. SAT0023 High Remission Rates in Patients with Early RA (ERA) in Usual Care. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sokka T, Puolakka K, Rannio T, Asikainen J, Kautiainen H, Hannonen P. SAT0092 Determinants of Perceived Risk of Work Disability in Patients with Rheumatoid Arthritis (RA). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Asikainen J, Kaarela K, Geborek P, Lindqvist E, Häkkinen A, Hannonen P, Rannio T, Sokka T. FRI0056 Joint damage in patients with rheumatoid arthritis over 15-20 years – are there differences between women and men? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1183] [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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Sokka T, Haugeberg G, Rannio T, Hansen IJ, Soldal DM, Asikainen J, Hannonen P. SAT0024 Use of Biologic Drugs and Clinical Effectiveness of Care of Early RA in Two Clinics with Different Treatment Tradition in Their T2T Approach. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1750] [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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Hakala M, Kröger H, Valleala H, Hienonen-Kempas T, Lehtonen-Veromaa M, Heikkinen J, Tuomiranta T, Hannonen P, Paimela L. Once-monthly oral ibandronate provides significant improvement in bone mineral density in postmenopausal women treated with glucocorticoids for inflammatory rheumatic diseases: a 12-month, randomized, double-blind, placebo-controlled trial. Scand J Rheumatol 2013; 41:260-6. [PMID: 22803768 DOI: 10.3109/03009742.2012.664647] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To study the efficacy and safety of once-monthly oral ibandronate in the prevention of glucocorticoid (GC)-induced osteoporosis (GIOP) in postmenopausal women with inflammatory rheumatic diseases. METHOD A randomized, double-blind, placebo-controlled, parallel-group study of 140 postmenopausal women was conducted. At baseline, the mean lumbar spine (LS) (L1-L4) bone mineral density (BMD) was normal or osteopaenic (T-score ≥ -2.0) and the patients were receiving treatment with 5-15 mg/day of prednisone equivalent. Patients were randomized 1:1 to receive either monthly oral ibandronate 150 mg or placebo for 12 months. All patients received vitamin D and calcium supplements. The primary endpoint was the relative change in mean LS BMD from baseline to 12 months. RESULTS Mean LS BMD increased significantly by 2.6% and 3.2% from baseline to 6 and 12 months with ibandronate compared to 0.3% and -0.1% with placebo, respectively (p < 0.001). Comparable significant mean increases were also found in trochanter, femoral neck and total hip BMDs at 12 months. Reductions in the serum levels of bone turnover markers C-terminal telopeptide of type I collagen (sCTX), N-terminal propeptide of type I procollagen (P1NP), and tartrate-resistant acid phosphatase (TRACP) were significantly more marked in the ibandronate group than in the placebo group at 1, 6, and 12 months. Adverse events (AEs) were reported at a similar frequency in both groups. A higher proportion of serious AEs (SAEs) were reported in the ibandronate group without emergence of any single SAE. CONCLUSIONS Once-monthly oral ibandronate provides a significant increase in LS and total hip BMD with an acceptable safety profile in postmenopausal women treated with low-dose GCs for inflammatory rheumatic diseases.
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Affiliation(s)
- M Hakala
- Department of Musculoskeletal Medicine and Rehabilitation, Medical School, University of Tampere, Tampere, Finland.
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Mustila A, Korpela M, Haapala AM, Kautiainen H, Laasonen L, Möttönen T, Leirisalo-Repo M, Ilonen J, Järvenpää S, Luukkainen R, Hannonen P. Anti-citrullinated peptide antibodies and the progression of radiographic joint erosions in patients with early rheumatoid arthritis treated with FIN-RACo combination and single disease-modifying antirheumatic drug strategies. Clin Exp Rheumatol 2011; 29:500-505. [PMID: 21640044] [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: 06/24/2010] [Accepted: 02/03/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate the impact of antibodies to cyclic citrullinated peptide (ACPAs) on radiographic progression in patients with early rheumatoid arthritis (RA) initially treated either with a combination of 3 disease-modifying antirheumatic drugs (DMARDs) or with a single DMARD. METHODS This study included 129 patients with early active RA initially randomised to treatment either with a combination of methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone (FIN-RACo) (n=69) or with a single DMARD (initially sulfalasalazine) with or without prednisolone (SINGLE) (n=60). After 2 years, the use of DMARDs and prednisolone became unrestricted. Radiographic progression in hands and feet was assessed at baseline and at 1, 2, 3, 4 and 5 years. ACPAs at baseline were determined with enzyme immunoassay. RESULTS ACPAs were positive in 92 (71%) patients. ACPA-positive vs. negative patients were more frequently rheumatoid factor (RF) positive (83% vs. 22%, p<0.001) and had an erosive disease (54% vs. 22%, p<0.001) at baseline. The presence of ACPA was associated with radiographic progression in FIN-RACo group even when the impact of RF was controlled; the radiographic progression was remarkably slower in ACPA-negative than in ACPA-positive cases (RF adjusted change over time between groups p=0.034). In the SINGLE group, the radiographic changes progressed parallel in ACPA-negative and positive patients. CONCLUSIONS Most ACPA-positive RA patients have joint erosions already at diagnosis. ACPA positivity in early RA was related to radiographic progression even in patients treated initially with the FIN-RACo regimen. The initial FIN-RACo therapy seems to slow down the progression of joint damage in ACPA-negative patients.
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Affiliation(s)
- A Mustila
- Centre for Laboratory Medicine, Pirkanmaa Hospital District, Tampere, Finland.
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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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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Korpela M, Hakala M, Luukkainen R, Vuori K, Blåfield H, Leirisalo‐Repo M, for the FIN‐RACo Trial Group. Use of the Stanford Health Assessment Questionnaire in estimation of long‐term productivity costs in patients with recent‐onset rheumatoid arthritis. Scand J Rheumatol 2009; 38:96-103. [DOI: 10.1080/03009740902756515] [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: 10/21/2022]
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Hakala M, Risteli J, Åman S, Kautiainen H, Korpela M, Hannonen P, Leirisalo‐Repo M, Laasonen L, Paimela L, Möttönen T, for the FIN‐RACo Trial Group. Combination drug strategy in recent‐onset rheumatoid arthritis suppresses collagen I degradation and is associated with retardation of radiological progression. Scand J Rheumatol 2009; 37:90-3. [DOI: 10.1080/03009740701753689] [Citation(s) in RCA: 5] [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: 10/22/2022]
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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Pohjolainen T, Korpela M, Vuori K, Ilva K, Yli-Kerttula U, Järvinen P, Leirisalo-Repo M. Cost of Finnish statutory inpatient rehabilitation and its impact on functional and work capacity of patients with early rheumatoid arthritis: experience from the FIN‐RACo trial. Scand J Rheumatol 2009; 36:270-7. [PMID: 17763204 DOI: 10.1080/03009740701286847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
OBJECTIVE To explore the cost of the statutory inpatient rehabilitation system in Finland and its impact on the functional and work capacity of patients with early rheumatoid arthritis (RA). METHODS In the Finnish Rheumatoid Arthritis Combination-Therapy trial (FIN-RACo), 195 patients with recent-onset RA, 162 of them available for the work force, were randomly assigned to two different drug treatment strategies for 2 years. Otherwise, the patients received routine multidisciplinary care and, if their functional or work capacity was endangered, were referred to inpatient rehabilitation. After a 5-year follow-up, data on rehabilitation, sick leave, and RA-related disability pensions were obtained from official registers. RESULTS Of the 162 patients, 49 (30%) underwent inpatient rehabilitation at an average cost of EURO5400. The rehabilitated patients more often worked in white-collar jobs and had more pain and a worse Health Assessment Questionnaire (HAQ) score (1.0 vs. 0.78; p = 0.01) at baseline. Their HAQ scores remained higher throughout follow-up (p<0.001); no change appeared over inpatient periods [mean 0.01; 95% confidence interval (CI) -0.13 to 0.16]. No independent impact of rehabilitation on the HAQ score emerged in an adjusted generalized estimating equations (GEE) model (p = 0.55). Nor did any improvement in work capacity appear: average lost productivity (human capital approach) per patient-year was EURO10 155 (95% CI 6994-14 196) before and EUR 12 839 (95% CI 8589-19 139) after the start of rehabilitation. CONCLUSION For patients with recent-onset RA, the Finnish statutory inpatient rehabilitation system had no positive impact on either functional or work capacity during the first few years, despite its considerable cost.
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Affiliation(s)
- K Puolakka
- Department of Medicine, Lappeenranta Central Hospital, Lappeenranta, Finland.
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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Korpela M, Hakala M, Viikari-Juntura E, Solovieva S, Arkela-Kautiainen M, Leirisalo-Repo M. A mismatch between self-reported physical work load and the HAQ: early identification of rheumatoid arthritis patients at risk for loss of work productivity. Clin Exp Rheumatol 2009; 27:422-429. [PMID: 19604434] [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: 05/28/2023]
Abstract
OBJECTIVE To explore the combination of data on functioning and work load for early identification of patients at risk for diminished work productivity in rheumatoid arthritis (RA). PATIENTS AND METHODS In the FIN-RACo trial, 162 patients with recent onset RA and available for the workforce were treated with either a combination of disease-modifying antirheumatic drugs (DMARDs) or a single DMARD for 2 years. Otherwise, they received routine care and were followed up for 5 years. Data on their individual income and lost work days came from official registers. Loss of productivity was computed by the human capital approach. Self-reported data on physical work demand (Finnish Institute for Occupational Health Questionnaire) at baseline and on functioning (HAQ) at 6 months were linked according to the International Classification of Functioning, Disability and Health. RESULTS Data on 112 patients were analyzable at 6 months; 35 (31%) of them had diminished capacity in functions required at paid work. Any mismatch between perceived abilities and requirements predicted future (7 through 60 months) loss of productivity - on average Euro 14,040 (95% confidence interval (CI): 9,143-20,511) per year in patients with the mismatch compared to Euro 3,043 (1,623-5,534) in those without any mismatch - and was associated with RA-related permanent work disability (hazard ratio: 11.6; 95%CI: 4.0-33.4). CONCLUSION Linking together self-reported data about functioning and work load helps in early identification of the RA patients at risk for loss of working days.
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Affiliation(s)
- K Puolakka
- Department of Medicine, Lappeenranta Central Hospital, FI-53130 Lappeenranta, Finland.
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Uutela T, Hannonen P, Kautiainen H, Hakala M, Paananen ML, Häkkinen A. Positive treatment response improves the health-related quality of life of patients with early rheumatoid arthritis. Clin Exp Rheumatol 2009; 27:108-111. [PMID: 19327237] [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: 05/27/2023]
Abstract
OBJECTIVE To examine treatment induced changes in health-related quality of life (HR-QoL) in patients with early rheumatoid arthritis (RA). METHODS Changes in HR-QoL were assessed by the Nottingham Health Profile (NHP) instrument in 62 consecutive working age patients with recent onset RA with duration of symptoms of less than two years and naive with regard to disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids. Treatment-response was assessed by the criteria of the European League against Rheumatism (EULAR; 28-joint score; DAS28) at 6 months. RESULTS NHP mean scores for pain (p=0.029) and emotional reaction (p=0.035) at baseline were related to EULAR response at 6 months, i.e. non-responders had the poorest baseline HR-QoL scores. When the patients were grouped according to EULAR response at 6 months there was a statistically significant mean linear change to better HR-QoL in NHP energy (p=0.0023), pain (p<0.001) and mobility (p=0.0085) from baseline to 6 months from the lowest to highest treatment-response level. CONCLUSION Our results show that good treatment-response as measured by the EULAR response criteria translates into improved HR-QoL dimensions for energy, pain and mobility.
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Affiliation(s)
- T Uutela
- Department of Medicine, Central Hospital of Lapland, Rovaniemi, Finland.
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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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Makinen H, Hannonen P, Sokka T. Sex: a major predictor of remission as measured by 28-joint Disease Activity Score (DAS28) in early rheumatoid arthritis? Ann Rheum Dis 2008; 67:1052-3. [DOI: 10.1136/ard.2007.084897] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Valkeinen H, Häkkinen A, Alen M, Hannonen P, Kukkonen-Harjula K, Häkkinen K. Physical Fitness in Postmenopausal Women with Fibromyalgia. Int J Sports Med 2008; 29:408-13. [DOI: 10.1055/s-2007-965818] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Eklund KK, Leirisalo-Repo M, Ranta P, Mäki T, Kautiainen H, Hannonen P, Korpela M, Hakala M, Järvinen P, Möttönen T. Serum IL-1beta levels are associated with the presence of erosions in recent onset rheumatoid arthritis. Clin Exp Rheumatol 2007; 25:684-689. [PMID: 18078614] [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: 05/25/2023]
Abstract
OBJECTIVE To study interleukin (IL)-1beta levels in recent onset RA patients treated either with combination DMARD therapy (sulfasalazine, methotrexate, hydroxychloroquine) or a single DMARD therapy. METHODS Serum IL-1beta levels were measured before the treatment and 6 months after the institution of either single or combination DMARD therapy using a high sensitivity ELISA method. Radiographic evaluation of the hands and feet was performed at 0 and 24 months. RESULTS Significant correlations (r = 0.28, 95% CI 0.10-0.45) were found between IL-1beta levels measured at 0 and 6 months. The IL-1beta levels at 0 months correlated significantly (r = 0.23, 95% CI 0.03-0.4, p= 0.021) with the baseline number of eroded joints at 0 months but not with radiographic joint damage at 24 months. The baseline level of IL-1beta was a better indicator for the presence of eroded joints than the baseline level of serum CRP. No significant changes in IL-1beta levels were observed during the first 6 months of anti-rheumatic treatment in either group. No statistically significant difference between IL-1beta levels in the patients with or without the shared epitope could be observed. CONCLUSIONS The serum IL-1beta level is significantly associated with the presence of erosions at the onset of RA but its predictive value is attenuated or lost when single or combination DMARD medication is instituted. Measuring IL-1beta at the time of diagnosis in a single patient cannot be used to estimate the erosive nature of the disease or the prognosis.
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Affiliation(s)
- K K Eklund
- Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Helsinki, Finland.
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Sokka T, Mäkinen H, Hannonen P, Pincus T. Most people over age 50 in the general population do not meet ACR remission criteria or OMERACT minimal disease activity criteria for rheumatoid arthritis. Rheumatology (Oxford) 2007; 46:1020-3. [PMID: 17405761 DOI: 10.1093/rheumatology/kem051] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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: 11/13/2022] Open
Abstract
OBJECTIVE To analyse the proportion of individuals in the general population over age 50 who do not meet American College of Rheumatology (ACR) criteria for rheumatoid arthritis (RA) remission, and OMERACT criteria for minimal disease activity (MDA), and to compare results to RA patients. METHODS A self-report questionnaire was completed by 1400 community control subjects and 1705 RA patients, including the Health Assessment Questionnaire (HAQ), gradual rating scales for pain, fatigue and global health, duration of morning stiffness and painful joints. The prevalence of 4/6 ACR remission criteria and 4/7 OMERACT criteria for MDA was analysed in community control subjects and patients with RA over age 50. RESULTS For ACR criteria, 76% of control subjects reported painful joints, 37% morning stiffness, 62% pain and 66% fatigue, vs 94, 65, 84 and 84% of patients with RA. MDA criteria were not met by 64% of control subjects for painful joints, 38% for pain, 45% for global health and 18% for HAQ, vs 89, 60, 69 and 52% of RA patients. The four ACR remission criteria were met by only 15% of control subjects over age 50 and 3% of RA patients, and MDA criteria by 28% of controls and 7% of patients. CONCLUSIONS The majority of community population over age 50 did not meet criteria for remission or MDA in RA. Although a self-report format may differ from results involving an assessor, the current criteria may not be accurate to identify remission or MDA in people with RA who are older than age 50.
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Affiliation(s)
- T Sokka
- Jyvaskyla Central Hospital, 40620 Jyvaskyla, Finland.
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Mäkinen H, Hannonen P, Sokka T. Definitions of remission for rheumatoid arthritis and review of selected clinical cohorts and randomised clinical trials for the rate of remission. Clin Exp Rheumatol 2006; 24:S-22-8. [PMID: 17083758] [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: 05/12/2023]
Abstract
Various definitions of remission in rheumatoid arthritis (RA) have been proposed. The ACR (American College of Rheumatology--formerly ARA, American Rheumatism Association) remission criteria are strict and include nonspecific symptoms such as fatigue. More recently remission according to the Disease Activity Index (DAS) and DAS28 has been described. However, patients who meet the DAS28 remission cut point of < 2.6 may nonetheless have tender and/or swollen joints. The ACR remission criteria are more rigorous than the requirement of DAS28 <2.6. Newer tools for evaluation of RA activity include the Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI), and cut points for remission according to these new indices have been defined. However, all available remission criteria may ignore important aspects of RA, including physical function and radiographic damage.
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Affiliation(s)
- H Mäkinen
- Jyväskylä Central Hospital, Jyväskylä, Finland.
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Laivoranta-Nyman S, Möttönen T, Hannonen P, Korpela M, Kautiainen H, Leirisalo-Repo M, Julkunen H, Luukkainen R, Hakala M, Vuori K, Laine AP, Toivanen A, Ilonen J. Association of tumour necrosis factor a, b and c microsatellite polymorphisms with clinical disease activity and induction of remission in early rheumatoid arthritis. Clin Exp Rheumatol 2006; 24:636-42. [PMID: 17207378] [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 study the associations of tumor necrosis factor (TNF) a, b and c microsatellite markers with 1) the clinical disease activity and 2) the induction of remissions in patients with early rheumatoid arthritis (RA) treated with two treatment strategies. METHODS In the FIN-RACo (FINnish Rheumatoid Arthritis Combination therapy) trial of two years, 195 patients with recent-onset RA were randomly assigned to receive either a combination (COMBI) (sulphasalazine, methotrexate, hydroxychloroquine, and prednisolone) or a single (SINGLE) (initially sulphasalazine with or without prednisolone) disease modifying antirheumatic drug (DMARD) therapy. TNF a, b and c microsatellite and HLA-DRB1 typings were carried out in 165 (79 COMBI; 86 SINGLE) study completers. RESULTS At baseline the 28 joint disease activity scores (DAS28) of the patients positive for TNFa2, a13 or b1 microsatellite markers were significantly higher than in the other patients. In the SINGLE patients the DAS28 improved comparably in patients with (n = 31) or without (n = 53) the TNFb1 marker (NS), while the DAS28 of the TNFb1-positive COMBI patients (n = 22) improved significantly more than that of the TNFb1-negative cases (n = 57) (p = 0.014). Respective 31.8% (7/22) and 28.1% (16/57) of the COMBI patients with or without TNFb1 allele achieved remission at one year. The corresponding figure in SINGLE patients were 0% (0/31) and 20.8% (11/53) (p = 0.006). At two years the remission frequencies in the TNFb1+/TNFb1- patients in the COMBI and SINGLE were 50.0%/38.6% and 9.7%/22.6%, respectively. CONCLUSION Early TNFb1+ RA patients have more active disease but respond more favourably to COMBI treatment than the patients without this microsatellite allele. The finding may be of clinical relevance for the choice of DMARDs in early RA.
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Affiliation(s)
- S Laivoranta-Nyman
- Turku Immunology Centre and Department of Virology, University of Turku.
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Sokka T, Mäkinen H, Puolakka K, Möttönen T, Hannonen P. Remission as the treatment goal--the FIN-RACo trial. Clin Exp Rheumatol 2006; 24:S-74-6. [PMID: 17083766] [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: 05/12/2023]
Abstract
The Finnish Rheumatoid Arthritis Combination Therapy (FIN-RACo) trial is the first rheumatoid arthritis (RA) clinical trial in which remission served as the primary outcome measure. This chapter reviews the philosophical background, study design, and results of the FIN-RACo trial. The study showed that a third of patients with active early RA may achieve remission with a combination of methotrexate (MTX), sulfasalazine (SSZ), hydroxychloroquine (HCQ), and prednisolone.
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Affiliation(s)
- T Sokka
- Jyväskylä Central Hospital, Jyväskylä, Finland.
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Puolakka K, Kautiainen H, Pekurinen M, Möttönen T, Hannonen P, Korpela M, Hakala M, Arkela-Kautiainen M, Luukkainen R, Leirisalo-Repo M. Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients' sickness absence and gross income: experience from the FIN-RACo trial. Ann Rheum Dis 2006; 65:899-904. [PMID: 16291811 PMCID: PMC1798230 DOI: 10.1136/ard.2005.045807] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the monetary value of rheumatoid arthritis related loss of productivity in patients with early active disease. METHODS In a prospective cohort substudy of the FIN-RACo Trial, 162 patients with recent onset rheumatoid arthritis, aged 18 to 65 years and available to the workforce, were followed up for five years. Loss of work productivity in euros 2002 was estimated by data on absence for sickness and on income (human capital approach) from official databases. Treatment responses were evaluated by area under the curve (AUC) of the ACR-N measure and by increase in number of erosions in radiographs of hands and feet. The health assessment questionnaire (HAQ) at six months was linked to the International Classification of Functioning, Disability and Health (ICF). RESULTS In all, 120 (75%) patients, women more often (82%) than men (61%) (p=0.002), lost work days. The mean lost productivity per patient-year was euro7217 (95% confidence interval (CI), 5561 to 9148): for women, euro6477 (4858 to 8536) and for men, euro8443 (5389 to 12,898). There was an inverse correlation with improvement: euro1101 (323 to 2156) and euro14 952 (10,662 to 19,852) for the highest and lowest quartiles of AUC of ARC-N, respectively. Lost productivity was associated with increase in the number of erosions and with disability in "changing and maintaining body position" subcategory of the ICF. CONCLUSIONS Despite remission targeted treatment with disease modifying antirheumatic drugs, early rheumatoid arthritis results in substantial loss of productivity. A good improvement in the disease reduces the loss markedly.
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Affiliation(s)
- K Puolakka
- Department of Medicine, Lappeenranta Central Hospital, Valto Käkelän katu 1, Lappeenranta FIN-53130, and Department of Medicine, Turku University Central Hospital, Finland.
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Kuuliala K, Orpana A, Leirisalo-Repo M, Kautiainen H, Hurme M, Hannonen P, Korpela M, Möttönen T, Paimela L, Puolakka K, Karjalainen A, Repo H. Polymorphism at position +896 of the toll-like receptor 4 gene interferes with rapid response to treatment in rheumatoid arthritis. Ann Rheum Dis 2006; 65:1241-3. [PMID: 16606645 PMCID: PMC1798301 DOI: 10.1136/ard.2006.055137] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 12/15/2022]
Abstract
The aim of this study was to determine whether the +896 A-->G substitution of the Toll-like receptor 4 (TLR4) gene, causing the Asp299-->Gly change in the extracellular domain of TLR4, influences treatment response in recent-onset rheumatoid arthritis. 169 patients with rheumatoid arthritis were genotyped from the Finnish Rheumatoid Arthritis Combination Therapy trial, in which they were treated either with only one disease-modifying antirheumatic drug (DMARD) with or without prednisolone (single group), or with three DMARDs and prednisolone (combination group). Patients homozygotic for the wild-type +896A allele were compared with those having the polymorphic G allele in terms of early clinical response (at 6 months) by the 28-joint Disease Activity Score (DAS28). 1 of 20 (5%; (95% (confidence interval (CI) 1 to 5)) patients of the single group with TLR4 +896AG or GG and 29 of 67 (43%; (95% CI 31 to 56)) patients with AA were in remission (p = 0.001). DAS28 of the single group with TLR4 +896AG or GG was higher than with AA (p = 0.019). In the combination group, remission rates and DAS28 values were comparable between the genotypes. The polymorphic TLR4 +896G allele may impair treatment response to single DMARD treatment in recent-onset rheumatoid arthritis.
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Affiliation(s)
- K Kuuliala
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, PO Box 21 (Haartmaninkatu 3), FIN-00014 Helsinki, Finland.
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Valkeinen H, Häkkinen K, Pakarinen A, Hannonen P, Häkkinen A, Airaksinen O, Niemitukia L, Kraemer WJ, Alén M. Muscle hypertrophy, strength development, and serum hormones during strength training in elderly women with fibromyalgia. Scand J Rheumatol 2005; 34:309-14. [PMID: 16195165 DOI: 10.1080/03009740510018697] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [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: 10/25/2022]
Abstract
OBJECTIVE To examine the effects of strength training on maximal force, cross-sectional area (CSA), and electromyographic (EMG) activity of muscles and serum hormone concentrations in elderly females with fibromyalgia (FM). METHODS Twenty-six patients with FM were randomly assigned to a training (FMT; n = 13; mean age 60 years) or a control (FMC; n = 13; 59 years) group. FMT performed progressive strength training twice a week for 21 weeks. The measurements included maximal isometric and concentric leg extension forces, EMG activity of the vastus lateralis and medialis, CSA of the quadriceps femoris, and serum concentrations of testosterone (T), free testosterone (FT), growth hormone (GH), insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone sulfate (DHEAS), and cortisol. Subjectively perceived symptoms of FM were also assessed. RESULTS All patients were able to complete the training. In FMT strength training led to increases of 36% (p<0.001) and 33% (p<0.001) in maximal isometric and concentric forces, respectively. The CSA increased by 5% (p<0.001) and the EMG activity in isometric action by 47% (p<0.001) and in concentric action by 57% (p<0.001). Basal serum hormone concentrations remained unaltered during strength training. The subjective perceived symptoms showed a minor decreasing tendency (ns). No statistically significant changes occurred in any of these parameters in FMC. CONCLUSION Progressive strength training increases strength, CSA, and voluntary activation of the trained muscles in elderly women with FM, while the measured basal serum hormone concentrations remain unaltered. Strength training benefits the overall physical fitness of the patients without adverse effects or any exacerbation of symptoms and should be included in the rehabilitation programmes of elderly patients with FM.
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Affiliation(s)
- H Valkeinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, FIN-40 014, Finland.
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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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Häkkinen A, Pakarinen A, Hannonen P, Kautiainen H, Nyman K, Kraemer WJ, Häkkinen K. Effects of prolonged combined strength and endurance training on physical fitness, body composition and serum hormones in women with rheumatoid arthritis and in healthy controls. Clin Exp Rheumatol 2005; 23:505-12. [PMID: 16095120] [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: 05/03/2023]
Abstract
OBJECTIVE The effects of a 21-week combined strength and endurance training period on physical fitness, serum hormone concentrations, and subcutaneous fat in 23 women with rheumatoid arthritis (RA) and in 12 matched healthy subjects was studied. METHODS The measurements included leg extension forces and EMG activity, muscle and fat thickness on thigh, maximal oxygen uptake (VO2max) and serum concentrations of testosterone, free testosterone, growth hormone, insulin-like growth factor-I (IGF-I), dehydroepiandrosterone sulphate (DHEAS), and cortisol. RESULTS During the training period significant increases took place in VO2max, muscle strength and EMG activity in both groups. The increases of the quadriceps femoris thickness were 6.5% (p < 0.001) in the healthy controls and 7.4% (p < 0.001) in the RA cases. The decreases in subcutaneous fat thicknesses were 9.9% (p < 0.001) and 12.3% (p < 0.001), respectively. No significant changes were found in serum hormone concentrations, but RA women showed lower levels of IGF-I during the whole follow-up. CONCLUSIONS In RA women with stable disease the combined strength and endurance training increases physical fitness. Further the training increases muscle mass and decreases subcutaneous fat. It may decrease risks of cardiovascular diseases in RA patients. The intensive training had minor effects on serum hormone concentrations.
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Affiliation(s)
- A Häkkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland.
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Abstract
OBJECTIVES To study which cut off point of DAS28 corresponds to fulfilment of the American Rheumatism Association (ARA) preliminary remission criteria, and clinical remission criteria in patients with rheumatoid arthritis (RA). METHODS All adult patients diagnosed with RA at Jyväskylä Central Hospital 1997-98 were assessed for remission at 5 years. Remission was defined as (a) ARA remission; (b) clinical remission (defined as no tender or swollen joints and normal erythrocyte sedimentation rate). DAS28 was used to measure disease activity. A receiver operating characteristics curve analysis was performed to calculate a cut off point of DAS28 that best corresponds to the ARA remission criteria and the clinical remission criteria. RESULTS 161 patients (mean age 57 years, 107 (66%) female, 98 (61%) with positive rheumatoid factor, and 51 (32%) with erosions) were studied. At 5 years, 19 (12%) patients met the ARA remission criteria, and 55 (34%) met the clinical remission criteria. The cut off value of DAS28 was 2.32 for the ARA remission criteria, and 2.68 for the clinical remission criteria. In patients with DAS28 <2.32, 11/57 (19%) had tender joints, 6/57 (11%) had swollen joints, and 4/57 (7%) had both tender and swollen joints (66 joint count). CONCLUSION In this study the DAS28 cut off point for the ARA remission was lower than in previous studies. The cut off point for DAS28 remission remains controversial. A substantial proportion of patients below the DAS28 cut off point for remission have tender or swollen joints, or both. DAS28 may not be an appropriate tool for assessment of remission in RA.
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Affiliation(s)
- H Mäkinen
- Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
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Häkkinen A, Kautiainen H, Hannonen P, Ylinen J, Mäkinen H, Sokka T. Muscle strength, pain, and disease activity explain individual subdimensions of the Health Assessment Questionnaire disability index, especially in women with rheumatoid arthritis. Ann Rheum Dis 2005; 65:30-4. [PMID: 15901635 PMCID: PMC1797977 DOI: 10.1136/ard.2004.034769] [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: 12/25/2022]
Abstract
OBJECTIVE To study the extent to which muscle strength and performance, pain, and disease activity are associated with the total Health Assessment Questionnaire (HAQ) disability index and its subdimensions in male and female patients with rheumatoid arthritis. METHODS HAQ for functional capacity was completed by 135 patients with rheumatoid arthritis referred for orthopaedic surgery (74% women; mean (SD) age 62 (10) years; disease duration 19 (13) years, 70% positive for rheumatoid factor). Knee extension, trunk extension and flexion, grip strength, walking speed, and sit-to-stand test were measured to mirror physical function. Radiographs of hands and feet, pain, and the modified 28 joint disease activity score (DAS28) were also assessed. RESULTS Mean total HAQ was 1.08 (0.68) in women and 0.67 (0.70) in men (p = 0.0031). Women had greater disability than men in five of the eight subdimensions of the HAQ. Grip strength was 48%, knee extension strength 46%, trunk extension strength 54%, and trunk flexion strength 43% lower in women than in men. Knee extension strength was inversely correlated with walking time (r = -0.63 (95% confidence interval, -0.73 to -0.51)) and with sit-to-stand test (r = -0.47 (-0.60 to -0.31)). In an ordered logistic regression analysis in female rheumatoid patients, DAS28, pain, knee extension strength, and grip strength were associated with the total HAQ disability index. CONCLUSIONS Women reported greater disability than men both in the total HAQ and in the majority of its eight subdimensions. In addition to disease activity and pain, muscle strength has a major impact on disability especially in female rheumatoid patients.
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Affiliation(s)
- A Häkkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Finland.
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Abstract
OBJECTIVE To determine to what extent health status impairment in rheumatoid arthritis (RA) measured by self report of pain, global assessment, and functional disability is attributable to age and other comorbid conditions as opposed to the disease itself. METHODS Pain, global assessment, and Health Assessment Questionnaire Disability Index (HAQ-DI) were measured in a random sample of 1530 adults in the Central Finland District, Finland. Median regressions were used for multivariable analyses. RESULTS The mean age was 55.4 years and 72% were women. A large majority of the population reported some pain (76%) and less than perfect general health (83%). The overall mean values of pain, HAQ-DI, and general health were 20 mm, 0.25 units, and 21 mm, respectively. The most common self reported musculoskeletal comorbidities were osteoarthritis (24%) and chronic back pain (25%). Age and number of comorbidities were the only statistically significant correlates of pain and general health in multivariable analyses. CONCLUSIONS Self reported disability, pain, and poor health were widely prevalent in the general population and are related to age and comorbid conditions. This needs to be taken into account when interpreting remission and response rates using current criteria and for future development of definitions for these end points in RA and other rheumatic diseases.
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Affiliation(s)
- E Krishnan
- Arthritis and Osteoporosis Centre, 401 Buttonwood, West Reading, PA 19611, USA.
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Kuuliala A, Leirisalo-Repo M, Möttönen T, Hannonen P, Nissilä M, Kautiainen H, Korpela M, Julkunen H, Hakola M, Repo H. Serum soluble interleukin-2 receptor predicts early remission in patients with recent-onset rheumatoid arthritis treated with a single disease-modifying antirheumatic drug. Clin Exp Rheumatol 2005; 23:243-6. [PMID: 15895898] [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 study the value of baseline serum levels of circulating soluble interleukin-2 receptor (sIL-2R) and soluble E-selectin as predictors of early remission in patients with recent-onset rheumatoid arthritis (RA) receiving a single disease-modifying anti-rheumatic drug (DMARD) (SINGLE) or therapy with a combination of DMARDs (COMBI). METHODS Baseline (n = 157) serum samples originate from the FIN-RACo (FINnish Rheumatoid Arthritis Combination therapy) trial, in which 195 patients with early and clinically active RA were randomly assigned to receive either SINGLE (initially sulfasalazine) with or without prednisolone, or COMBI therapy (sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone). Of the samples, 76 were from SINGLE patients and 81 from COMBI patients. sIL-2R was measured by automated immunoassay analyzer and sE-selectin by enzyme-linked immunosorbent assay. RESULTS At six months, 7 (9% [95% CI: 4 to 18]) SINGLE and 19 (23% [95% CI: 15 to 34]) COMBI patients were in remission. In multivariate logistic regression analysis, sIL-2R <442 U/ml and COMBI therapy were the only predictors of remission. The area under receiver operating characteristic curve for sIL-2R level was 0.86 (95% CI: 0.62 to 0.95) in SINGLE and 0.57 (95% CI: 0.42 to 0.71) in COMBI (p = 0.006). In SINGLE, the optimal cut offpoint was 442 U/ml, lower levels predicting remission with sensitivity of 83% (95% CI: 73% to 91%) and specificity of 86% (95% CI: 42% to 100%). Likelihood ratio for positive test was 5.9 (95% CI: 1.6 to 32.8). In multivariate logistic regression analysis, sIL-2R <442 U/ml and COMBI therapy were the only predictors of remission. CONCLUSION Low baseline serum sIL-2R level predicts early remission of patients with active early RA treated with a single DMARD.
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Affiliation(s)
- A Kuuliala
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland.
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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Hakala M, Korpela M, Ilva K, Yli-Kerttula U, Piirainen H, Leirisalo-Repo M. Predictors of productivity loss in early rheumatoid arthritis: a 5 year follow up study. Ann Rheum Dis 2005; 64:130-3. [PMID: 15608311 PMCID: PMC1755184 DOI: 10.1136/ard.2003.019034] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [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: 11/04/2022]
Abstract
OBJECTIVE To explore baseline risk factors for productivity loss and work disability over 5 years in patients with early, active RA. PATIENTS AND METHODS In the FIN-RACo trial, 195 patients with recent onset RA were randomised to receive either a combination of DMARDs with prednisolone or a single DMARD for 2 years. At baseline, 162 patients were working or available for work. After 5 years' follow up, data on sick leave and retirement were obtained from social insurance registers or case records. The cumulative duration of sick leaves and RA related disability pensions was counted for each patient. To analyse predictors of productivity loss, the patients were divided into four groups according to duration of work disability per patient year. RESULTS Patient's and physician's global assessment of RA severity > or =50 and HAQ score > or =1.0 were risk factors for extension of productivity loss (OR (95% (CI) 1.77 (1.00 to 3.16), 1.85 (1.03 to 3.32), and 1.78 (1.01 to 3.14), respectively). Additional risk factors were low education level (2.40 (1.18 to 4.88)) and older age (1.03 (1.00 to 1.06)); combination treatment was a protective factor (0.59 (0.35 to 0.99)). CONCLUSION At baseline, the risk of future productivity loss is best predicted by education level, age, global assessments of RA severity, and HAQ score.
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Affiliation(s)
- K Puolakka
- Department of Medicine, Lappeenranta Central Hospital, Valto Käkelän katu 1, FIN-53130 Lappeenranta, Finland.
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Kaarela K, Hakala M, Hannonen P, Kautiainen H, Korpela M, Leirisalo-Repo M, Luosujärvi R, Luukkainen R, Möttönen T, Puolakka K. How aggressive should initial therapy for rheumatoid arthritis be? The Finnish experience. Rheumatology (Oxford) 2005; 44:134-5; author reply 135-6. [PMID: 15611310 DOI: 10.1093/rheumatology/keh394] [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] [Indexed: 11/15/2022] Open
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Laivoranta-Nyman S, Möttönen T, Hermann R, Tuokko J, Luukkainen R, Hakala M, Hannonen P, Korpela M, Yli-Kerttula U, Toivanen A, Ilonen J. HLA-DR-DQ haplotypes and genotypes in Finnish patients with rheumatoid arthritis. Ann Rheum Dis 2004; 63:1406-12. [PMID: 15479890 PMCID: PMC1754800 DOI: 10.1136/ard.2003.009969] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [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: 11/04/2022]
Abstract
OBJECTIVES To elucidate the contribution of HLA-DR-DQ haplotypes and their genotypic combinations to susceptibility to rheumatoid arthritis, and to evaluate the various models for HLA associated risk for the disease in a series of Finnish patients. METHODS 322 Finnish patients with rheumatoid arthritis were typed for common north European HLA-DR-DQ haplotypes and compared with a series of 1244 artificial family based control haplotypes. RESULTS The association of the so called shared epitope (SE) haplotypes (DRB1*0401, *0404, *0408, and *01) with rheumatoid arthritis was confirmed. The DRB1*0401 haplotypes carried a far stronger risk for the disease than the (DRB1*01/10)-(DQA1*01)-DQB1*0501 haplotypes. Seven protective HLA haplotypes--(DRB1*15)-(DQA1*01)-DQB1*0602; (DRB1*08)-(DQA1*04)-DQB1*04; (DRB1*11/12)-DQA1*05-DQB1*0301; (DRB1*1301)-(DQA1*01)-DQB1*0603; (DRB1*1302)-(DQA1*01)-DQB1*0604; (DRB1*07)-DQA1*0201-DQB1*0303; and (DRB1*16)- (DQA1*01)-DQB1*0502--were identified. In accordance with the reshaped shared epitope hypothesis, all the protective DRB1 alleles in these haplotypes share either isoleucine at position 67 or aspartic acid at position 70 in their third hypervariable region motif. However, differences in the disease risk of haplotypes carrying the same DR but different DQ alleles were also found: (DRB1*07)-DQA1*0201-DQB1*0303 was protective, while (DRB1*07)-DQA1*0201-DQB1*02 was neutral. The same haplotypes carried different risks for rheumatoid arthritis depending on their combination in genotypes. CONCLUSIONS When assessing the influence of HLA genes on the susceptibility to rheumatoid arthritis, not only should the HLA-DR or -DQ alleles or haplotypes be unravelled but also the genotype. The effect of HLA class II region genes is more complicated than any of the existing hypotheses can explain.
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Affiliation(s)
- S Laivoranta-Nyman
- Turku Immunology Centre, University of Turku, Tykistökatu 6A, FIN-20520 Turku, Finland.
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Häkkinen A, Sokka T, Kautiainen H, Kotaniemi A, Hannonen P. Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Ann Rheum Dis 2004; 63:910-6. [PMID: 15249317 PMCID: PMC1755099 DOI: 10.1136/ard.2003.013003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [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 investigate at 5 years whether an initial 2 year home based strength training period imposes sustained effects on muscle strength, bone mineral density (BMD), structural joint damage, and on disease activity in patients with early rheumatoid arthritis (RA). METHODS Seventy patients were randomised either to perform home based strength training with loads of 50-70% of repetition maximum (EG) or range of motion exercises (CG). Both groups were encouraged to take part in aerobic activities 2-3 times a week. Maximal muscle strength of different muscle groups was measured by dynamometers, and BMD at the femoral neck and lumbar spine by dual x ray densitometry. Disease activity was assessed by the 28 joint disease activity score, and joint damage by x ray findings. RESULTS 62 patients completed 2 years' training and 59 patients attended check up at 5 years. Mean (SD) maximum muscle strength indices increased from baseline to 2 years-in EG from 212 (78) kg by a mean (95% CI) of 68 (55 to 80) and in CG from 195 (72) kg by 35 (13 to 60) kg-and remained at that level for the next 3 years. Development of BMD in EG tended to be more favourable than that in CG. Muscle strength training was not detrimental to joint structures or disease activity. CONCLUSION The patients' exercise induced muscle strength gains during a 2 year training period were maintained throughout a subsequent self monitored training period of 3 years. Despite substantial training effects in muscle strength, BMD values remained relatively constant. Radiographic damage remained low even at 5 years.
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Affiliation(s)
- A Häkkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Keskussairaalantie 19, FIN-40620 Jyväskylä, Finland.
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Sokka T, Häkkinen A, Krishnan E, Hannonen P. Similar prediction of mortality by the health assessment questionnaire in patients with rheumatoid arthritis and the general population. Ann Rheum Dis 2004; 63:494-7. [PMID: 15082478 PMCID: PMC1754988 DOI: 10.1136/ard.2003.009530] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [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: 11/04/2022]
Abstract
BACKGROUND The self report health assessment questionnaire (HAQ) quantifies disability in activities of daily living (ADL). In patients with rheumatoid arthritis, the HAQ predicts mortality, work disability, and hip replacement surgery. It has been widely used in rheumatology, but population based data are rare. OBJECTIVE To determine whether the HAQ predicts mortality in patients with rheumatoid arthritis (n = 1095) and community controls (n = 1490). METHODS A mailed questionnaire including the HAQ, visual analogue scales for pain and global health, comorbidities, education level, height, weight, and smoking status was administered in June 2000. Two years later, the vital status of the subjects was ascertained from the Finnish Population Register database. RESULTS There were 41 deaths (10.1%) among the 404 patients with rheumatoid arthritis who had a baseline HAQ > or =1 (indicating at least some difficulty in most ADL), and 16 (2.3%) among 691 patients with HAQ <1 (p<0.001); in the community controls the values were 20 (13.6%) among 147 with HAQ > or =1, and 14 (1.0%) among 1343 with HAQ <1 (p<0.001). A higher HAQ score was an independent predictor of mortality in patients with rheumatoid arthritis (hazard ratio 2.73 (95% confidence interval, 1.86 to 4.02); p<0.001) and in community controls (2.75 (1.61 to 4.70); p<0.001). CONCLUSIONS The HAQ predicts mortality in the community population as well as in patients with rheumatoid arthritis. People with similar levels of disability appear to have a similar likelihood of mortality over two years.
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Affiliation(s)
- T Sokka
- Jyväskylä Central Hospital, Jyväskylä, Finland.
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Häkkinen A, Kautiainen H, Hannonen P, Ylinen J, Arkela-Kautiainen M, Sokka T. Pain and joint mobility explain individual subdimensions of the health assessment questionnaire (HAQ) disability index in patients with rheumatoid arthritis. Ann Rheum Dis 2004; 64:59-63. [PMID: 15130901 PMCID: PMC1755197 DOI: 10.1136/ard.2003.019935] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [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: 11/04/2022]
Abstract
OBJECTIVE To explore the associations between individual subdimensions of the health assessment questionnaire (HAQ) and clinical variables in patients with rheumatoid arthritis. METHODS 304 patients with rheumatoid arthritis (73% female, mean (SD) age, 58 (13) years; disease duration 6 (9) years, 69% rheumatoid factor positive) completed the HAQ for functional capacity (0-3) and a 100 mm visual analogue scale for pain. Grip strength, range of motion of the large joints, Larsen score for radiographic damage of hand and foot joints, and the number of tender and swollen joints were recorded. A logit regression model was used to study associations between subdimensions of the HAQ and other variables. RESULTS Mean (range) total HAQ score was 0.92 (0 to 2.88) and varied from 0.73 to 1.04 in the subdimensions. Disability was lowest in the "walking" and highest in the "reach" subdimension. Pain was an explanatory variable in all individual subdimensions. Decreased grip strength, limitation of shoulder and wrist motion, and a larger number of swollen and tender joints in the upper extremities were related to several subdimensions. A higher pain score and swollen joint count in the upper extremities, decreased grip strength, and limited motion of wrist, shoulder, and knee joints explained increased disability (higher total HAQ scores). CONCLUSIONS In patients with rheumatoid arthritis, pain and range of movements of joints have the greatest impact on individual subdimensions of the HAQ. Extent of radiographic damage in peripheral joints and the number of swollen and tender joints are of lesser importance for function.
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Affiliation(s)
- A Häkkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, 40620 Jyväskylä, Finland.
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Valkeinen H, Alen M, Hannonen P, Häkkinen A, Airaksinen O, Häkkinen K. Changes in knee extension and flexion force, EMG and functional capacity during strength training in older females with fibromyalgia and healthy controls. Rheumatology (Oxford) 2004; 43:225-8. [PMID: 13130154 DOI: 10.1093/rheumatology/keh027] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [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: 12/28/2022] Open
Abstract
OBJECTIVE To investigate the effects of strength training on neuromuscular functions in elderly females with fibromyalgia (FM). METHODS Thirteen females with fibromyalgia [group FMt; mean age (s.d.) 60.2 (2.5) years] and 11 healthy controls [group HCt; 64.2 (2.7) yr] carried out supervised strength training twice a week for 21 weeks. Thirteen FM patients [group FMc; 59.1 (3.5) yr] served as non-training controls. Maximal isometric force and electromyographic (EMG) activity of the right quadriceps femoris in knee extension and flexion actions, maximal 10-m walking speed, and 10-step stair-climbing time were measured. Tender points were assessed by palpation, subjectively perceived symptoms with a visual analogue scale, and the self-reported physical function capacity by Health Assessment Questionnaire (HAQ). RESULTS The mean (s.d.) increases in maximal extension force during the training period in groups FMt and in HCt were 32 (33)% (P < 0.001) and 24 (12)% (P < 0.001) respectively and those of flexion were 13 (20)% (P < 0.05) and 24 (17)% (P < 0.01). Explosive force of the extensors increased in both FMt and in HCt. The integrated EMGs of the vastus lateralis and medialis muscles increased in both FMt and HCt. Muscle forces and EMGs in group FMc remained at the basal level. Walking speed, stair-climbing time and the HAQ index improved in group FMt. The changes in the number of tender points and in perceived symptoms were in favour of the training group FMt. CONCLUSIONS The data support the hypothesis that elderly female FM patients have normal neuromuscular function. Supervised strength training also suits elderly FM patients, has positive effects on perceived symptoms and improves functional capacity without complications.
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Affiliation(s)
- H Valkeinen
- Department of Health Sciences, University of Jyväsklä, Jyväsklä, Finland.
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Häkkinen A, Hannonen P, Nyman K, Lyyski T, Häkkinen K. Effects of concurrent strength and endurance training in women with early or longstanding rheumatoid arthritis: Comparison with healthy subjects. Arthritis Care Res (Hoboken) 2003; 49:789-97. [PMID: 14673965 DOI: 10.1002/art.11466] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [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: 11/11/2022]
Abstract
OBJECTIVE To investigate the effects of a 21-week concurrent strength and endurance training protocol on physical fitness profile in women with early or longstanding rheumatoid arthritis (RA) compared with healthy subjects. METHODS Twenty-three female patients with RA volunteered for the study. Twelve had early RA and eleven had longstanding RA. Twelve healthy women served as controls. Maximal strength of different muscle groups was measured by dynamometers, walking speed with light cells, and vertical squat jump on the force platform to mirror explosive force. Maximal oxygen uptake was measured by gas analyzer. Six training sessions (3 strength training and 3 endurance training) were carried out in a 2-week period for 21 weeks. RESULTS The training led to large gains in maximal strength both in women with RA and in healthy women (P < 0.043-0.001). The strength gains were accompanied by increases in walking speed (P < 0.034-0.001) and vertical squat jump (P < 0.034-0.001). Significant improvements also occurred in maximal aerobic capacity in all groups (P < 0.023-0.014). CONCLUSIONS Both early and longstanding RA patients with stable disease can safely improve all characteristics of their physical fitness profile using a progressive concurrent strength and endurance training protocol.
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Affiliation(s)
- A Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Central Hospital, Keskussairaalantie 19, Jyväskylä, Finland 40620.
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Abstract
OBJECTIVE To study the long term risk of cancer in patients with rheumatoid arthritis (RA) who have been treated with yttrium. METHODS The medical record numbers of 1228 patients with RA who were admitted to hospital in 1979-85 were identified in the database of Jyväskylä Central Hospital. Radiosynovectomy of the knee joint was performed in a total of 143 patients using yttrium-90 silicate during the years 1970-85, while 1075 did not receive yttrium radiosynovectomy; 10 received yttrium treatment later than 1985 and were excluded from the analysis. The Finnish Cancer Registry database was used to examine whether the subjects had cancer during the follow up from 1979 until the end of 1999. RESULTS Nine cases of cancer were found among the patients who had received yttrium, whereas the expected number based on the incidence among the population in the region was 14.9. The standardised incidence ratio of cancer was 0.6 (95% confidence interval (CI) 0.3 to 1.1) for the patients who received yttrium, and 1.1 (95% CI 0.9 to 1.3) for the patients who did not receive yttrium. CONCLUSIONS Yttrium treatment did not increase the risk of cancer.
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Affiliation(s)
- J Vuorela
- Hospital Physics, Jyväskylä Central Hospital, Jyväskylä, Finland
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Kvien TK, Zeidler HK, Hannonen P, Wollheim FA, Førre O, Hafström I, Kaltwasser JP, Leirisalo-Repo M, Manger B, Laasonen L, Prestele H, Kurki P. Long term efficacy and safety of cyclosporin versus parenteral gold in early rheumatoid arthritis: a three year study of radiographic progression, renal function, and arterial hypertension. Ann Rheum Dis 2002; 61:511-6. [PMID: 12006323 PMCID: PMC1754124 DOI: 10.1136/ard.61.6.511] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/03/2022]
Abstract
OBJECTIVE To compare the three year safety and efficacy of cyclosporin and parenteral gold in the treatment of early, active, severe rheumatoid arthritis (RA), and to study the reversibility of cyclosporin associated renal dysfunction in patients who discontinued cyclosporin treatment. METHODS The patients continued to receive cyclosporin or parenteral gold in an 18 month open extension to an 18 month randomised, parallel group study. The main efficacy variable was blinded evaluation of radiographic progression of joint damage. Safety variables included serum creatinine, calculated creatinine clearance, and blood pressure. RESULTS Radiographic progression during follow up was similar in both groups. About 60% of the patients in the intention to treat groups (n=272) and about half of the patients in the completer groups (n=114) had definite radiographic progression in joint damage (increases >6 in the Larsen-Dale score), and about one in three also had substantial progression (>18 increase in Larsen-Dale score). Both systolic and diastolic blood pressure were significantly increased in the cyclosporin group compared with the gold group, and 12/139 (9%) versus 3/139 (2%) (p=0.03) had notably raised blood pressure. The mean serum creatinine increased by 28% at the treatment end point in the cyclosporin group as compared with 7% in the gold group. The mean calculated creatinine clearance was reduced by 16% and increased by 1% in the cyclosporin and gold groups, respectively, at the end of the study. At the final follow up visit after discontinuation of cyclosporin (at least three months after treatment was stopped) the mean serum creatinine was increased by 15% and creatinine clearance reduced by 16%. Sustained increases in serum creatinine at this post-treatment end point were mostly seen in patients with a raised serum creatinine during treatment of at least 50%. CONCLUSION Three year changes in radiographic damage during cyclosporin and parenteral gold were similar in patients with early, active RA. Abnormal renal function and raised blood pressure were often seen in the cyclosporin treated patients.
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Affiliation(s)
- T K Kvien
- Oslo City Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Laivoranta-Nyman S, Luukkainen R, Hakala M, Hannonen P, Möttönen T, Yli-Kerttula U, Ilonen J, Toivanen A. Differences between female and male patients with familial rheumatoid arthritis. Ann Rheum Dis 2001; 60:413-5. [PMID: 11247876 PMCID: PMC1753610 DOI: 10.1136/ard.60.4.413] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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 whether there are genetic differences between female and male patients with familial rheumatoid arthritis (RA). METHODS 45 men and 119 women from 78 families with RA who all had at least one first degree relative with RA were compared. HLA-DRB1 alleles were analysed, including DRB1*04 subtypes and associations of DRB1*04 haplotypes with DQB1*0301 or DQB1*0302 alleles, the age of the patients at disease onset, the presence of rheumatoid factor (RF), joint erosions, and rheumatoid nodules. RESULTS HLA-DRB1*13 allele (the subtype allele of DR6, reported to be protective against the development of RA) was found in 14/119 (12%) of female but in none of the male patients (p=0.036). The HLA-DR4 allele was found slightly more often in men than women patients with familial RA (31/45 (69%) v 75/119 (63%), NS). Men were also more often RF positive than women (44/45 (98%) v 98/117 (84%); p=0.031). On the other hand, the mean age at onset of RA was significantly lower in the female group (40.4 years) than in men (46.6 years, p=0.0044). CONCLUSION The results indicate that there is stronger genetic background in familial male than female patients with RA in the genetic susceptibility defined by the studied HLA antigens. However, the earlier age of onset of the disease in female group and the increased proportion of women with RA indicate that there are additional sex related predisposing factors enhanced in familial cases.
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Affiliation(s)
- S Laivoranta-Nyman
- Turku Immunology Centre, University of Turku, Tykistökatu 6A, FIN-20520 Turku, Finland.
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Häkkinen A, Sokka T, Kotaniemi A, Hannonen P. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis Rheum 2001; 44:515-22. [PMID: 11263764 DOI: 10.1002/1529-0131(200103)44:3<515::aid-anr98>3.0.co;2-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the impact of a 2-year program of strength training on muscle strength, bone mineral density (BMD), physical function, joint damage, and disease activity in patients with recent-onset (<2 years) rheumatoid arthritis (RA). METHODS In this prospective trial, 70 RA patients were randomly assigned to perform either strength training (all major muscle groups of the lower and upper extremities and trunk, with loads of 50-70% of repetition maximum) or range of motion exercises (without resistance) twice a week; all were encouraged to engage in recreational activities 2-3 times a week. All patients completed training diaries (evaluated bi-monthly) and were examined at 6-month intervals. All were treated with medications to achieve disease remission. Maximum strength of the knee extensors, trunk flexors and extensors, and grip strength was measured with dynamometers. BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry. Disease activity was determined by the Disease Activity Score, the extent of joint damage by the Larsen score, and functional capacity by the Health Assessment Questionnaire (HAQ); walking speed was also measured. RESULTS Sixty-two patients (31 per group) completed the study. Strength training compliance averaged 1.4-1.5 times/week. The maximum strength of all muscle groups examined increased significantly (19-59%) in the strength-training group, with statistically significant improvements in clinical disease activity parameters, HAQ scores, and walking speed. While muscle strength, disease activity parameters, and physical function also improved significantly in the control group, the changes were not as great as those in the strength-training group. BMD in the femoral neck and spine increased by a mean +/- SD of 0.51 +/- 1.64% and by 1.17 +/- 5.34%, respectively, in the strength-training group, but decreased by 0.70 +/- 2.25% and 0.91 +/- 4.07% in the controls. Femoral neck BMD in the 17 patients with high initial disease activity (and subsequent use of oral glucocorticoids) remained constantly at a statistically significantly lower level than that in the other 45 patients. CONCLUSION Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function, but not BMD, in patients with early RA, without detrimental effects on disease activity.
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Affiliation(s)
- A Häkkinen
- Central Finland Health Care District, Jyväskylä, Finland
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