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EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2016; 76:17-28. [DOI: 10.1136/annrheumdis-2016-209775] [Citation(s) in RCA: 683] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/24/2016] [Accepted: 09/08/2016] [Indexed: 12/28/2022]
Abstract
Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.
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Abstract
In twenty-six patients injected with metrizoate during urography, plasma was analyzed for iodine concentration using x-ray fluorescence analysis, and total plasma clearance of contrast medium was calculated. Total plasma clearance of 51Cr-EDTA was also determined, but not simultaneously, in order to find out if the urographic procedure would influence the kidneys to such an extent that the contrast medium clearance value would differ much from the 51Cr-EDTA clearance value. The errors in the method were assessed and the total error of the contrast medium clearance determination was calculated. When comparing 51Cr-EDTA and metrizoate clearance a correlation of 0.94 and a mean ratio of 1.046 (SD 0.138) was found. The assessable errors cannot fully explain the standard deviation, which might indicate a transient change in kidney function related to elements of the urographic procedure such as laxation with possible dehydration and/or the contrast medium dose.
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Glomerular Filtration Rate Estimated after Multiple Injections of Contrast Medium during Angiography. Acta Radiol 2016. [DOI: 10.1177/028418518802900612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In twenty-six patients referred for angiography, clearance of contrast medium was determined with x-ray fluorescence analysis after multiple injections of contrast medium. A formula for correction of the injected amount, which takes into consideration the different times of contrast medium injections, approximating the total injected amount into one injection, was used. A single injection clearance of 51Cr-EDTA was determined at the same time. The results showed a good correlation between the clearance of contrast medium after multiple injections and the 51Cr-EDTA clearance after a single injection (r=0.945). The correlation between contrast medium clearance calculated without correction for the different injection times, and “Cr-EDTA clearance was the same (r=0.946), due to short angiography time and rather low clearance values in our patients. It is concluded that total plasma clearance of contrast medium can easily be estimated after multiple injections. In this way patients with a risk of developing post-angiographic renal failure can be found.
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Cardiac Output Determination during Intravenous Cardioangiography Using X-ray Fluorescence Analysis. Acta Radiol 2016. [DOI: 10.1177/028418518802900407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac output was determined with an indicator dilution technique during digital venous angiography of the left ventricle in 11 patients. The contrast medium injected into the right atrium was used as indicator. During and after the injection of contrast medium one blood sample per second was obtained through a catheter placed in the descending aorta. The samples were analyzed for iodine content with x-ray fluorescence analysis and cardiac output determined ad modum Stewart-Hamilton. Thermodilution was used as a reference method. The results indicate that the indicator dilution method with the use of contrast medium might be used for calibration of videodensitometric methods for blood flow measurements.
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AB0098 Shift Work May Be Associated with An Increased Risk of Rheumatoid Arthritis in Women, but Not in Men. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THU0158 Which Patient Characteristics Influence The Choice of Biological Therapy after First TNF Inhibitor Therapy in RA? A Nationwide Study of Channeling in Sweden 2010-2012:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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THU0523 Comorbidity Pattern at The Time of Gout Diagnosis: A Population- and Register-Based Case-Control Study from Western Sweden. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THU0520 Treatment of Gout – Factors Affecting Initiation and Persistence of Urate Lowering Therapy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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THU0522 Increasing Incidence of Gout in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB0180 Smoking and Persistent Disease Activity Are Associated with An Increased Risk of Rapid Joint Destruction in Patients with Early Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THU0521 Prevalence of Gout and ULT Treatment in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The complement receptor 2 (CR2, CD21) is part of a complex (CD21/CD19/CD81) acting as a co-receptor to the B cell receptor (BCR). Simultaneous triggering of the BCR and CD21 lowers the threshold for B cell activation. Although CD21 is important, B cells that express low amounts or lack surface CD21 (CD21(-/low) ) are increased in conditions with chronic inflammation, e.g. autoimmune diseases. However, little is known about the CD21(-/low) B cell subset in peripheral blood from healthy donors. Here, we show that CD21(-/low) cells represent approximately 5% of B cells in peripheral blood from adults but are barely detectable in cord blood, after excluding transitional B cells. The CD21(-/low) subset can be divided into CD38(-) 24(+) and CD38(-) 24(low) cells, where most of the CD38(-) 24(+) are CD27(+) immunoglobulin (Ig)M(+) IgD(+) and the CD38(-) 24(low) are switched CD27(-) . Expression levels of additional markers, e.g. CD95 and CD62L, are similar to those on classical memory B cells. In contrast to naive cells, the majority of CD21(-/low) cells lack expression of the ABCB1 transporter. Stimulation with a combination of BCR, Toll-like receptor (TLR)-7/8 and interleukin (IL)-2 induces proliferation and differentiation of the CD21(-/low) B cells comparable to CD21(+) CD27(+) memory B cells. The response excluding BCR agonist is not on par with that of classical memory B cells, although clearly above that of naive B cells. This is ascribed to a weaker response by the CD38(-) 24(low) subset, implying that some memory B cells require not only TLR but also BCR triggering. We conclude that the CD21(-/low) cells in healthy donors are memory B cells.
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Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: A longitudinal study. J Rehabil Med 2016; 48:469-76. [DOI: 10.2340/16501977-2090] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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THU0597 Work Disability in Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis Before and After Start of Anti-Tnf Therapy: A Swedish Observational Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THU0197 Survival on Drug in Patients with Spondyloarthritis Receiving Certolizumab Pegol. Results from the Nationwide Swedish Rheumatology Quality Register. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FRI0033 Despite Early Improvement, Patients with Rheumatoid Arthritis Still Have Impaired Grip Force 5 Years After Diagnosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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SAT0354 Validity of Gout Diagnosis in Swedish Primary and Secondary Care. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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OP0275 Birth Characteristics and Childhood Infections Predict Ankylosing Spondylitis. A National Register Based Nested Case-Control Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Validity of ankylosing spondylitis and undifferentiated spondyloarthritis diagnoses in the Swedish National Patient Register. Scand J Rheumatol 2015; 44:369-76. [DOI: 10.3109/03009742.2015.1010572] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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SAT0098 Validity of Ankylosing Spondylitis and Spondyloarthritis Diagnoses in the Swedish National Patient Register. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THU0496 B-Cell Subpopulations Differ in Rheumatoid Arthritis Patients with and without Autoantibodies. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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THU0182 Tumour Necrosis Factor Inhibitors and the Risk of Acute Coronary Syndromes in Rheumatoid Arthritis Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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OP0278 Sick Leave and Disability Pension in Relation to First Initiation of Biologic Therapy across Indications: A Nationwide Cohort Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FRI0246 Magnetic Resonance Imaging-Assessment of Early Response to Certolizumab Pegol in Rheumatoid Arthritis: A Randomized, Double-Blind, Placebo-Controlled Phase Iiib Study Applying Magnetic Resonance Imaging at Weeks 0, 1, 2, 4, 8 and 16. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FRI0136 Duration between Symptom Onset and Spondyloarthritis Diagnosis – Changes over A Decade. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0271 The Impact of Clinical Features and Corticosteroids on Biopsy Findings in GIANT Cell Arteritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB0399 Reduced Risk of Acute Coronary Syndromes among Rheumatoid Arthritis Patients with Good Response on Tumor Necrosis Factor Inhibition. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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FRI0568-HPR Variations of Fatigue in Persons with Rheumatoid Arthritis- A 1 Year Longitudinal Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A radio-high-performance liquid chromatography dual-flow cell gamma-detection system for on-line radiochemical purity and labeling efficiency determination. J Chromatogr A 2014; 1337:128-32. [PMID: 24630054 DOI: 10.1016/j.chroma.2014.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 11/26/2022]
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FRI0241 Which ra patients end up starting which biologic? a nationwide assessment of differential channelling to biological treatments in sweden 2006-2011. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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SAT0140 The risk of acute coronary syndromes in RA in relation to TNF inhibitors and risks in the general population: A national cohort study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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FRI0159 Severe extra-articular manifestations in rheumatoid arthritis: risk factors and incidence in relation to treatment with tnf-inhibitors. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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FRI0122 Thromboembolism in rheumatoid arthritis: Increased risks unrelated to hospitalization and disease duration. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FRI0087 Early menopause predicts a mild type of rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Biopsy findings in giant cell arteritis: relationship to baseline factors and corticosteroid treatment. Scand J Rheumatol 2013; 42:331-2. [DOI: 10.3109/03009742.2013.775330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ten years with biologics: to whom do data on effectiveness and safety apply? Rheumatology (Oxford) 2010; 50:204-13. [DOI: 10.1093/rheumatology/keq326] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Generalisability of clinical registers used for drug safety and comparative effectiveness research: coverage of the Swedish Biologics Register. Ann Rheum Dis 2010; 70:516-9. [DOI: 10.1136/ard.2010.130914] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectiveTo determine coverage and generalisability of data in the Swedish Biologics Register ARTIS.MethodsPatients with adult onset rheumatoid arthritis (RA) were identified in the National Patient Register and the Swedish Rheumatology Quality Register, including the ARTIS cohort of patients exposed to biological agents. Exposure to etanercept and adalimumab between 2006 and 2008 was determined by register linkage to the Prescribed Drug Register which contains patient-level data on >99% of all etanercept and adalimumab use in Sweden.ResultsOf 62 897 patients with RA, 6510 had received treatment with etanercept or adalimumab according to the Prescribed Drug Register. Of these, 5673 were also registered in ARTIS, resulting in a national coverage of 87%. The regional variation was small with >85% coverage in 18 of 21 counties. In multivariable analysis, ARTIS-registered and non-registered patients did not differ by age (p=0.62), sex (p=0.84) or education level (p=0.24).ConclusionNationwide drug dispensing and demographic data may function as quality metrics for coverage and generalisability assessments. Using such data, the coverage of ARTIS was estimated at 87% with no indications of compromised external generalisability regarding demography.
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Bone mineral density in the hand as a predictor for mortality in patients with rheumatoid arthritis. Rheumatology (Oxford) 2009; 48:1088-91. [DOI: 10.1093/rheumatology/kep169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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External quality assessment of automated blood leukocyte differential counts and other simultaneous measured quantities. Eur J Haematol Suppl 2009; 53:45-8. [PMID: 2279555 DOI: 10.1111/j.1600-0609.1990.tb01526.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An external quality assessment scheme (EQAS) of automated differential counts of leukocytes has been carried out using selected fresh blood specimens. The measurements were carried out one day after blood drawing because of the delay in the mail. Reference laboratories established target values for differential counts. They counted visually 600-700 cells in each specimen on smears. The consensus value among 12 laboratories for manual count of total leukocytes was used as target value, but was found on average 9% smaller than the average instrumental value. H1 results compared favorable with the target value for the differentials. The less advantageous findings on Coulter S + IV are partly explained by the age of the specimen when measured. The data indicated that better calibration of the instruments could decrease the overall variation of platelets counts and haemoglobin determinations. An EQAS involving measurement on fresh specimens is in progress.
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Abstract
Cystic puncture was performed percutaneously in 18 patients with solitary renal cysts and in 22 with multiple, congenital renal cysts. With the aid of tritiated water it was possible to estimate the fluid turnover in the cysts and compare it with their volume, pressure and potassium and creatinine levels. Fluid turnover was rapid in all the renal cysts. Two to five hours after i.v. injection of tritium, the tritium concentration in cystic fluid averaged 88% of the concentration in plasma fluid in patients with polycystic kidneys and 73 percent in patients with solitary cysts. Fluid turnover was more rapid in small than in large cysts, but there was no such difference between cysts with high and low pressure. It is possible that the fluid turnover was slightly faster in cysts with high potassium and creatinine levels than in those with low levels. The results show that the fluid turnover in a renal cyst of 10 ml is considerable--probably more than 100 ml/24 hours. This indicates that fluid inflow to the cyst comes mainly from cells in the cyst wall and not from a single glomerule. Fluid probably leaves the cyst actively via cells in the cyst wall, since the fluid turnover does not increase with high cyst pressure. The fluid turnover is probably secondary to the active solute transportation, which is performed by the cyst cells. This means that these cells have a tubular cell-like function and should respond to pharmacotherapy.
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Improved outcome in Wegener's granulomatosis and microscopic polyangiitis? A retrospective analysis of 95 cases in two cohorts. J Intern Med 2009; 265:496-506. [PMID: 19141094 DOI: 10.1111/j.1365-2796.2008.02060.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Mortality rates for Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) have decreased after the introduction of cyclophosphamide. Standardized mortality ratio (SMR) expresses the overall mortality of patients compared with the general population. The aims of this study were to compare survival in an old and a recent cohort of patients with WG and MPA using SMR and to determine predictors for death in both groups combined. DESIGN Survival analyses were performed by Kaplan-Meier survival curves, SMR and proportional hazards regression models. SETTING The nephrology and rheumatology clinics at Linköping University Hospital, Sweden. SUBJECTS All patients diagnosed with WG or MPA in the catchment area during 1978-2005 were divided into two cohorts; patients diagnosed before (n=32, old cohort) and after (n=63, recent cohort) December 31, 1996. RESULTS The two cohorts differed regarding the proportion of WG (75% vs. 56%, P=0.03) and a tendency for more pronounced kidney involvement in the old cohort: 266 micromol L(-1) (16% dialysis-dependent) vs. 192 micromol L(-1) (5% dialysis-dependent), but were comparable regarding disease severity. SMR at 1 and 5 years were 2.1 (95% CI: 0.43-6.09) and 1.6 (95% CI: 0.6-3.2) in the recent cohort and 5.2 (95% CI: 1.07-15.14) and 2.5 (95% CI: 0.93-5.52) in the old cohort. Five-year survival was 87% and 81%. Serum creatinine, age, end-stage renal disease, diagnosis before 1997 and first relapse were independent predictors for death. CONCLUSION Patient survival in WG and MPA analysed with SMR may be better than previously believed. Severe renal disease and disease relapse were the major predictors of reduced survival.
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Musculoskeletal symptoms and perceived work strain among reindeer herders in Sweden. Occup Med (Lond) 2008; 58:572-9. [DOI: 10.1093/occmed/kqn153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perinatal characteristics, early life infections and later risk of rheumatoid arthritis and juvenile idiopathic arthritis. Ann Rheum Dis 2008; 68:1159-64. [PMID: 18957482 DOI: 10.1136/ard.2008.089342] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the importance of birth characteristics and early life infections on the risk of later rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). METHODS A nationwide register-based case-control study was performed based on prospectively recorded data on individuals born in 1973 or later. Using the Swedish inpatient register and the early arthritis register, cases with RA aged 16 years or above (n = 333) and JIA (n = 3334) were identified. From the Swedish medical birth register (MBR), four controls per case, matched by sex, year and delivery unit were randomly selected. Through linkage to the MBR and to the Swedish inpatient register information on maternal, pregnancy and birth characteristics and infections during the first year of life was identified. Univariate and multivariate odds ratios (OR) were calculated using conditional logistic regression. RESULTS Overall, infections during the first year of life were associated with increased risks for seronegative (OR 2.6, 95% CI 1.0 to 7.0) but not seropositive (OR 1.2) RA and for JIA (OR 1.9, 95% CI 1.7 to 2.1). Low birth weight (OR 0.7) and being small for gestational age (OR 0.5) were associated with reduced risks of RA of borderline statistical significance. Preterm birth (gestational age < or =258 days) was associated with a non-significantly decreased risk of RA (OR 0.6). Large for gestational age (OR 1.6) and having more than three older siblings (OR 1.4) were non-significantly associated with the risk of RA. CONCLUSION Infections during the first year of life, and possibly also factors related to fetal growth and timing of birth, may be important in the aetiologies of adult RA and JIA.
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Disease activity and disability but probably not glucocorticoid treatment predicts loss in bone mineral density in women with early rheumatoid arthritis. Scand J Rheumatol 2008; 37:248-54. [PMID: 18612924 DOI: 10.1080/03009740801998747] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Osteoporosis is a known complication of rheumatoid arthritis (RA). This prospective study aimed to evaluate whether disease activity, disability, and glucocorticoid (GC) treatment in early RA were risk factors for loss of bone mineral density (BMD). METHODS We followed 97 women (mean age 58 years), for 24 months, with a history of RA of less than 12 months. At baseline, 77 women were receiving standard treatment with disease-modifying antirheumatic drugs (DMARDs) and 20 were receiving no treatment. Risk factors for osteoporosis were recorded. Disease activity score (DAS28), Health Assessment Questionnaire (HAQ) score, and medications were registered at baseline and every 6 months and calculated as areas under the curve (AUCs). Femoral neck and lumbar spine BMD were measured at baseline and after 2 years and compared to BMD in age- and gender-matched controls. Risk factors were analysed by linear regression models. RESULTS BMD loss was comparable to that of age-matched women in both the lumbar spine and the femoral neck, although neither was significantly different from baseline. In multivariate analyses the AUC for DAS28 was an independent predictor of changes in lumbar spine BMD (p = 0.003) and that for HAQ of changes in femoral neck BMD (p = 0.018). GC use was not an overall predictor of BMD loss. CONCLUSION BMD loss was predicted by high disease activity and disability but not by GC treatment. With the DMARD, GC, hormone replacement therapy (HRT), and bisphosphonate treatment strategies used during the study period, the general outcome seems favourable concerning loss of BMD in patients with early RA.
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General mental health, quality of life and suicide-related attitudes among Kurdish people in Iran. Int J Soc Psychiatry 2008; 54:457-68. [PMID: 18786907 DOI: 10.1177/0020764008091663] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate (1) general mental health, (2) quality of life and (3) suicide-related attitudes in Kurds living in Iranian Kurdistan. METHODS Cross-sectional investigation; cluster random sampling procedure; 1,000 Kurds were randomly selected from 1,000 of 68,000 households in Sannandaj City, Iran; General Health Questionnaire (GHQ-12); Questionnaire on Attitudes Towards Suicide (ATTS). RESULTS About 27% of the subjects had to be regarded as probably suffering from a psychological disturbance. There was no gender difference regarding the number of ;cases'. These possible ;cases' were younger than ;non-cases'. The most ;cases' occurred among the unemployed. An increasing number of experiences related to suicide and the increasing emotional closeness of those experiences was found to be related to an increased probability that the individual would be classified as a ;case' according to the GHQ-12 total score. Unmarried individuals more often evaluated their overall quality of life as ;moderate' or ;bad' compared to married individuals. Unemployed people, self-employed people and housewives formed the groups who most often reported a ;very bad' or ;bad' quality of life. CONCLUSIONS Kurdish people in Iran are in need of facilities and interventional programmes aiming to improve general mental health.
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Breast feeding, but not use of oral contraceptives, is associated with a reduced risk of rheumatoid arthritis. Ann Rheum Dis 2008; 68:526-30. [DOI: 10.1136/ard.2007.084707] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:To determine whether breast feeding or the use of oral contraceptives (OCs) affects the future risk of rheumatoid arthritis (RA) in a community-based prospective cohort.Methods:A community-based health survey (18 326 women) was linked to regional and national registers, and incident cases of RA were identified. All women with a diagnosis of RA after inclusion in the health survey (n = 136) and four female controls for every case, who were alive and free from RA when the index person was given a diagnosis of RA, were included in a case–control study. Data on lifestyle factors at baseline were derived from a self-administered questionnaire. Potential predictors were examined in logistic regression models.Results:136 women with incident RA were compared with 544 age-matched controls. A longer history of breast feeding was associated with a reduced risk of RA (OR 0.46 (95% CI 0.24 to 0.91) for women who had breast fed for ⩾13 months and OR 0.74 (95% CI 0.45 to 1.20) for those who had breast fed for 1–12 months, compared with those who had never breast fed). The protective effect of longer breast feeding remained significant after adjustment for smoking and level of education in multivariate models, and point estimates were protective also when the analyses were restricted to parous women. Neither parity nor OC use had any significant effect on the risk of RA.Conclusion:In this study, long-term breast feeding, but not OC use, was associated with a significant reduction in the risk of RA.
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Discharge procedures for mentally ill people: The perspective of former psychiatric patients on their primary social network, quality of life and future life expectations. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1468-2397.1993.tb00013.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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