Published in 2016

BACKGROUND: The painDETECT questionnaire (PDQ) is a mechanism-based pain classification tool assigning patients to one of three categories depending on the quality of the experienced pain. Patients with non-nociceptive pain score high on the PDQ. The objective was to assess the proportions of the three PDQ classification groups in patients with rheumatoid arthritis (RA) and to explore differences in clinical characteristics.

METHOD: RA patients initiating or escalating their RA therapy were included prospectively and underwent a thorough examination programme. Low (PDQ score < 13), medium (PDQ score 13-18), and high (PDQ score > 18) scores indicate nociceptive, unclear/possible neuropathic, or neuropathic pain mechanisms, respectively.

RESULTS: The 102 included patients were classified into the following PDQ classification groups: low = 65%, medium = 23%, and high = 12%. Patients in the medium and high PDQ groups scored worse on indicators of anxiety, depression, disability, mental health-related quality of life, pain, and fatigue. They also had more tender points and an RA disease activity score based on 28 joints (DAS28) where a higher fraction of the composite score pertained to non-inflammatory factors compared to patients in the low PDQ classification group. There were no differences in objective inflammatory indices across groups. Multiple regression analysis demonstrated that the tender joint count (TJC) and the 36-item Short Form Health Survey (SF36) mental component summary (MCS) score were independently associated with the PDQ score.

CONCLUSIONS: In patients initiating or intensifying medical treatment for their RA, non-nociceptive pain (PDQ score ≥ 13) is common. In these patients, the pain mechanisms result in increased disease activity scores on a non-inflammatory basis.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Rheumatology
Vol/bind 45
Tidsskriftsnummer 6
Sider (fra-til) 461-469
Antal sider 9
ISSN 0300-9742
DOI
Status Udgivet - nov. 2016

INTRODUCTION: Persistent pain is a major concern for patients with psoriatic arthritis (PsA). Pain may be due to inflammatory activity or augmented central pain processing. Unawareness of the origin and mechanisms of pain can lead to misinterpretation of disease activity (by composite scores) and erroneous treatments. Ultrasonography (US) is a highly sensitive method to detect tissue inflammation. Evaluating pain mechanisms in relation to US measures may prove valuable in predicting response to treatment in PsA.

AIMS: To study the association and prognostic value of pain mechanisms, ultrasonic activity and clinical outcomes in patients with PsA who intensify antirheumatic treatment.

METHODS AND ANALYSES: 100 participants >18 years of age with PsA who initiate or switch antirheumatic treatment (biologicals and/or conventional synthetic disease-modifying antirheumatic drugs (DMARDs)) will be prospectively recruited from outpatient clinics in Copenhagen. All data (demographics, clinical, imaging, blood samples and patient-reported outcomes) will be collected at baseline and after 4 months. Pain is assessed by the PainDETECT Questionnaire, Visual Analogue Scale for pain, Swollen to Tender Joint Count Ratio, Widespread Pain Index and tender point examination. The association between pain variables and clinical/US characteristics will be described by correlation analyses. The predictive value of pain measures and baseline US scores on treatment response will be analysed with regression models. Outcomes are composite and clinical, as well as patient reported.

ETHICS AND DISSEMINATION: The study is approved by the ethics committee of the Capital Region of Denmark (H-15009080) and has been designed in cooperation with patient research partners. The study is registered at clinicaltrials.gov (number NCT02572700). Results will be disseminated through publication in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER: NCT02572700, Pre-results.

Originalsprog Engelsk
Tidsskrift B M J Open
Vol/bind 6
Tidsskriftsnummer 4
Sider (fra-til) e010650
ISSN 2044-6055
DOI
Status Udgivet - 2016

Perinatal characteristics, older siblings, and risk of ankylosing spondylitis: a case-control study based on national registers

Lindström, U., Forsblad-d'Elia, H., Askling, J., Kristensen, L. E., Lie, E., Exarchou, S. & Jacobsson, L. 2016 I : Arthritis Research & Therapy. 18, 1, s. 16

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: The effect of circumstances and exposures early in life on the risk of developing ankylosing spondylitis (AS) is largely unknown. The purpose of this study was to determine whether perinatal characteristics predict development of AS.

METHODS: AS cases (n = 1960; 59 % men) were defined as listed with a diagnosis of AS at least once in the Swedish National Patient Register and registered in the Swedish Medical Birth Register (born ≥1973). Population controls were retrieved from the Swedish Population Register (n = 8378; mean 4.3 controls/case), matched on birth year, sex and county. Odds ratios (OR) for developing AS were determined through conditional logistic regression, with regard to: birth weight, birth order, season of birth, maternal age, gestational length, size for gestational age, type of birth, mode of delivery, congenital malformations, mothers' country of birth, mothers' civil status and size of delivery unit.

RESULTS: In the univariate analyses statistically significant increases in risk for developing AS were observed for having older siblings (OR 1.18; 95 % Cl 1.06-1.30). No association was observed for the remainder of analysed exposures, although there was a weak association with birth weight below 3000 g (OR 1.19; 95 % CI 1.04-1.37), though not for "low birth weight" <2500 g (OR 0.90; 95 % CI 0.70-1.16). The increase in risk associated with having older siblings was consistent in a multivariate analysis adjusting for possible confounders (OR 1.23; 95 % Cl 1.09-1.39). The direction and magnitude of the point estimates were also consistent in several sensitivity analyses and when stratifying by sex.

CONCLUSIONS: Having older siblings was associated with an increased risk for developing AS. These results need to be repeated and confirmed in other cohorts.

Originalsprog Engelsk
Tidsskrift Arthritis Research & Therapy
Vol/bind 18
Tidsskriftsnummer 1
Sider (fra-til) 16
ISSN 1478-6354
DOI
Status Udgivet - 2016

OBJECTIVES: To empirically assess the clinical effects of physiotherapy on pain in adults.

DESIGN: Using meta-epidemiology, we report on the effects of a 'physiotherapy' intervention on self-reported pain in adults. For each trial, the group difference in the outcome 'pain intensity' was assessed as standardised mean differences (SMD) with 95% CIs. Stratified analyses were conducted according to patient population (International Classification of Diseases-10 classes), type of physiotherapy intervention, their interaction, as well as type of comparator group and risks of bias. The quality of the body of evidence was assessed based on GRADE methodology.

DATA SOURCES: Systematic searches were carried out in MEDLINE and PEDro from 1 January 2004-31 December 2013. 174 trials (224 comparisons) met the inclusion criteria for the meta-analysis.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised trials using 'no intervention' or of a sham-controlled design were selected. Only articles written in English were eligible.

RESULTS: An overall moderate effect of physiotherapy on pain corresponding to 0.65 SD-units (95% CI 0.57 to 0.73) was found based on a moderate inconsistency (I(2)=51%). Stratified exploration showed that therapeutic exercise for musculoskeletal diseases tended to be more beneficial than multimodal interventions (difference 0.30 95% CI 0.03 to 0.57; p=0.03). Trials with a 'no intervention' comparator tended to have a higher overall effect size than trials with a sham comparator (difference 0.25; 95% CI 0.09 to 0.41; p=0.004). In general, our confidence in the estimates was low, mainly due to high risk of performance biases and between-study heterogeneity.

CONCLUSIONS: Physiotherapy reduces pain in adults, but standardisation of interventions and focus on trial research with low risks of bias and reproducible treatment modalities are needed.

TRIAL REGISTRATION NUMBER: CRD42014008754.

Originalsprog Engelsk
Tidsskrift British Journal of Sports Medicine
ISSN 0306-3674
DOI
Status Udgivet - 25 mar. 2016

OBJECTIVE: To investigate predictors of improvement in observed ability to manage activities of daily living as an outcome of rehabilitation in fibromyalgia.

METHODS: Exploratory analyses used data from the Interdisciplinary Rehabilitation and Evaluation Programme for Patients with Chronic Widespread Pain (the IMPROvE study); a randomized controlled trial including 191 females with fibromyalgia randomized (1:1) to rehabilitation or a waiting list. The primary outcome was observed activities of daily living ability evaluated with the Assessment of Motor and Process Skills (AMPS) 6 months post-intervention.

RESULTS: Overall, 38.7% of subjects were AMPS responders, i.e. having a clinically meaningful improvement in AMPS activities of daily living ability measures at 6 months post-intervention. In the exploratory analysis, only 4 baseline variables out of the 52 analysed showed a statistically significant interaction with treatment allocation (at the 0.05 level) indicating possible predictive value. Statistical analyses that used continuous variables dichotomized at the median suggested a predictive value of a low intake of weak and strong analgesics, and a high score of current pain and total score on the Pain Detect Questionnaire.

CONCLUSION: The results of this exploratory study suggest that several subgroups of patients, specifically those with a low baseline intake of weak and strong analgesics, and more pronounced clinical signs of central sensitization, may gain most clinical benefit from specialized rehabilitation when the outcome of interest is improvement in observed activity of daily living ability.

Originalsprog Engelsk
Tidsskrift Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine
Vol/bind 48
Tidsskriftsnummer 1
Sider (fra-til) 65-71
Antal sider 7
ISSN 1651-2081
DOI
Status Udgivet - jan. 2016

Prognostic factors for disability and sick leave in patients with subacute non-malignant pain: a systematic review of cohort studies

Valentin, G. H., Pilegaard, M. S., Vaegter, H. B., Rosendal, M., Ørtenblad, L., Væggemose, U. & Christensen, R. 2016 I : B M J Open. 6, 1, s. e007616

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients.

SETTING: General practice and other primary care facilities.

PARTICIPANTS: Adults (>18 years) with a subacute (≤3-month) non-malignant pain condition. Eligibility criteria were cohort studies investigating the prediction of disability or long-term sick leave in adults with a subacute pain condition in a primary care setting. 19 studies were included, referring to a total of 6266 patients suffering from pain in the head, neck, back and shoulders.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was long-term disability (>3 months) due to a pain condition. The secondary outcome was sick leave, defined as 'absence from work' or 'return-to-work'.

RESULTS: PubMed, EMBASE, CINAHL and PEDro databases were searched from 16 January 2003 to 16 January 2014. The quality of evidence was presented according to the GRADE WG recommendations. Several factors were found to be associated with disability at follow-up for at least two different pain symptoms. However, owing to insufficient studies, no generic risk factors for sick leave were identified.

CONCLUSIONS: Multiple site pain, high pain severity, older age, baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites. There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain, indicating that these factors may not play as large a role as expected in developing disability due to a pain condition. Quality of evidence was moderate, low or very low, implying that confidence in the results is limited. Large prospective prognostic factor studies are needed with sufficient study populations and transparent reporting of all factors examined.

TRIAL REGISTRATION NUMBER: CRD42014008914.

Originalsprog Engelsk
Tidsskrift B M J Open
Vol/bind 6
Tidsskriftsnummer 1
Sider (fra-til) e007616
ISSN 2044-6055
DOI
Status Udgivet - 2016
Originalsprog Engelsk
Tidsskrift European journal of clinical nutrition
Vol/bind 70
Tidsskriftsnummer 9
Sider (fra-til) 1092
ISSN 0954-3007
DOI
Status Udgivet - sep. 2016

Risk of Stroke in Migraineurs Using Triptans. Associations with Age, Sex, Stroke Severity and Subtype

Albieri, V., Olsen, T. S. & Andersen, K. K. apr. 2016 I : EBioMedicine. 6, s. 199-205 7 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: Identifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population.

METHODS: A cohort study including all citizens 25-80years of age in Denmark 2003-2011 was conducted. All persons prescribed triptans, and all those hospitalized for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients.

FINDINGS: Of the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income, and educational level, risk for stroke was higher among migraineurs in respect to all strokes (RR 1.07; CI 1.01-1.14) and ischemic strokes (RR 1.07; CI 1.00-1.14). Risk for hemorrhagic stroke was increased but only in women (RR 1.41; CI 1.11-1.79). Risk was for mild strokes (RR 1.31; CI 1.16-1.48) while risk for severe strokes was lower among migraineurs (RR 0.77; CI 0.65-0.91). Risk was age-related; highest among women 25-45years (RR≈1.7). Risk was unrelated to numbers of dispensations.

INTERPRETATION: Migraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor and cardiovascular risk factors were less prevalent pointing to a migraine-specific etiology of stroke different from that of thromboembolism.

Originalsprog Engelsk
Tidsskrift EBioMedicine
Vol/bind 6
Sider (fra-til) 199-205
Antal sider 7
DOI
Status Udgivet - apr. 2016

Sensitization and Serological Biomarkers in Knee Osteoarthritis Patients With Different Degrees of Synovitis

Petersen, K. K., Siebuhr, A. S., Graven-Nielsen, T., Simonsen, O., Boesen, M., Gudbergsen, H., Karsdal, M., Bay-Jensen, A. C. & Arendt-Nielsen, L. okt. 2016 I : The Clinical journal of pain. 32, 10, s. 841-8 8 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: Synovitis is a frequent condition in knee osteoarthritis (KOA) and has been associated with pain. This study investigated the links between the pressure hyperalgesia, the clinical pain, the degree of the synovitis, inflammatory biomarkers, and tissue-specific biomarkers in KOA patients.

MATERIALS AND METHODS: Fifty-eight KOA patients and 33 pain-free controls participated in this study. The patients were magnetic resonance imaging scanned, and the Boston-Leeds OA Knee Score (BLOKS, 0 to 3) was used to assess the degree of synovitis. The maximal knee pain intensity over the last 24 hours was scored on a visual analog scale (VAS). The pressure pain thresholds (PPTs) were assessed over the KOA-affected knee. Serological biomarkers were measured in fasting serum: high-sensitive C-reactive protein, matrix metalloproteinase-mediated degradation of CRP, and matrix metalloproteinase-mediated collagen type I, II, and III degradation (C1M [connective tissue], C2M [cartilage], C3M [synovial membrane]).

RESULTS: Compared with controls, the KOA patients showed increased levels of C1M (P<0.02), C2M (P<0.001), and high-sensitive C-reactive protein (P<0.02), decreased level of C3M (P<0.03), and reduced PPTs (P<0.03). Patients with no (BLOKS 0) and moderate to severe (BLOKS 2&3) synovitis had significantly lower PPTs compared with mild synovitis (BLOKS 1). Significantly negative correlations were found between VAS and PPTs. No correlations were found between BLOKS and the VAS, PPT, or biomarkers.

DISCUSSION: Patients without and with moderate to severe synovitis demonstrated local pressure hyperalgesia and increased degrees of: (1) systemic inflammation, (2) connective tissue degradation, (3) cartilage degradation, and (4) decreased synovial membrane degradation as compared with controls.

Originalsprog Engelsk
Tidsskrift The Clinical journal of pain
Vol/bind 32
Tidsskriftsnummer 10
Sider (fra-til) 841-8
Antal sider 8
ISSN 0749-8047
DOI
Status Udgivet - okt. 2016

Serum 25-Hydroxyvitamin D Status and Longitudinal Changes in Weight and Waist Circumference: Influence of Genetic Predisposition to Adiposity

Larsen, S. C., Ängquist, L., Moldovan, M., Huikari, V., Sebert, S., Cavadino, A., Singh Ahluwalia, T., Skaaby, T., Linneberg, A., Husemoen, L. L. N., Toft, U., Pedersen, O., Hansen, T., Herzig, K-H., Jarvelin, M-R., Power, C., Hyppönen, E., Heitmann, B. L. & Sørensen, T. I. A. 2016 I : P L o S One. 11, 4, s. e0153611

Publikation: Forskning - peer reviewTidsskriftartikel

Studies of the relationship between serum 25-hydroxyvitamin D (25(OH)D) and changes in measures of adiposity have shown inconsistent results, and interaction with genetic predisposition to obesity has rarely been examined. We examined whether 25(OH)D was associated with subsequent annual changes in body weight (ΔBW) or waist circumference (ΔWC), and whether the associations were modified by genetic predisposition to a high BMI, WC or waist-hip ratio adjusted for BMI (WHRBMI). The study was based on 10,898 individuals from the Danish Inter99, the 1958 British Birth Cohort and the Northern Finland Birth Cohort 1966. We combined 42 adiposity-associated Single Nucleotide Polymorphisms (SNPs) into four scores indicating genetic predisposition to BMI, WC and WHRBMI, or all three traits combined. Linear regression was used to examine the association between serum 25(OH)D and ΔBW or ΔWC, SNP-score × 25(OH)D interactions were examined, and results from the individual cohorts were meta-analyzed. In the meta-analyses, we found no evidence of an association between 25(OH)D and ΔBW (-9.4 gram/y per 10 nmol/L higher 25(OH)D [95% CI: -23.0, +4.3; P = 0.18]) or ΔWC (-0.06 mm/y per 10 nmol/L higher 25(OH)D [95% CI: -0.17, +0.06; P = 0.33]). Furthermore, we found no statistically significant interactions between the four SNP-scores and 25(OH)D in relation to ΔBW or ΔWC. Thus, in view of the narrow CIs, our results suggest that an association between 25(OH)D and changes in measures of adiposity is absent or marginal. Similarly, the study provided evidence that there is either no or very limited dependence on genetic predisposition to adiposity.

Originalsprog Engelsk
Tidsskrift P L o S One
Vol/bind 11
Tidsskriftsnummer 4
Sider (fra-til) e0153611
ISSN 1932-6203
DOI
Status Udgivet - 2016

BACKGROUND: Women show increased risk of depressive symptoms in life phases where ovarian steroid hormone levels fluctuate or decline rapidly. The risk mechanisms may include changes in mental state and affective cognition possibly mediated by serotonergic neurotransmission.

METHODS: In a randomized controlled double-blinded trial, 61 healthy women (mean age 24.3±4.9 years) were tested with measures of affective verbal memory, reaction time, mental distress, and serotonin transporter binding at baseline and at follow-up after receiving gonadotropin-releasing hormone agonist (GnRHa) or placebo intervention. Women also reported daily mood profiles during intervention. We tested direct effects of intervention and indirect effects through changes in serotonin transporter binding on verbal affective memory, simple reaction time and self-reported measures of mental distress, and further effects of GnRHa on daily mood.

RESULTS: GnRHa induced an increase in simple reaction time (p=0.03) and more pronounced fluctuations in daily self-reported mood in a manner dependent on baseline mood (p=0.003). Verbal affective memory recall, overall self-perceived mental distress, and serotonin transporter binding were not affected.

CONCLUSIONS: In healthy women transient sex-steroid hormone fluctuations decrease speed of information processing and further produce more labile mood only in women with elevated levels of mood disturbances at baseline.

Originalsprog Engelsk
Tidsskrift Psychoneuroendocrinology
Vol/bind 68
Sider (fra-til) 39-46
Antal sider 8
ISSN 0306-4530
DOI
Status Udgivet - jun. 2016

Socioeconomic Variations in Use of Prescription Medicines for COPD: A Register-Based Study

Jacobsen, R., Ekholm, O., Rasmussen, N. K., Hansen, E. H. & Frølich, A. jul. 2016 I : Respiratory Care. 61, 7, s. 943-9 7 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: The purpose of this study was to examine socioeconomic variations in the use of prescription medicines among elderly subjects with COPD.

METHODS: Data from the Danish national administrative registers were used. The study population included 1,365 individuals >60 y old residing in the Municipality of Copenhagen and diagnosed with COPD in a hospital setting in 2007. Logistic regression analysis was applied to examine the associations between the use of all prescription medicines for obstructive pulmonary diseases and the use of long-acting bronchodilators, in subject groups of different socioeconomic position.

RESULTS: The study demonstrated that approximately 90% of subjects with COPD purchased at least one prescription medicine for obstructive pulmonary diseases, whereas approximately 50% purchased a long-acting bronchodilator. Medicine use did not vary according to educational status or personal wealth.

CONCLUSIONS: There were no systematic socioeconomic differences in the use of relevant prescription medicines in elderly subjects diagnosed with COPD in hospital settings in Copenhagen. However, our findings indicate a gap between guideline recommendations and observed use of long-acting bronchodilators and hence suboptimal quality of treatment in the elderly COPD population.

Originalsprog Engelsk
Tidsskrift Respiratory Care
Vol/bind 61
Tidsskriftsnummer 7
Sider (fra-til) 943-9
Antal sider 7
ISSN 0020-1324
DOI
Status Udgivet - jul. 2016

Stillingsbetinget rodtryk hos en rygpatient med bensmerter i stående stilling

Hansen, B. B., Dons, K., Hansen, P., Bliddal, H. & Boesen, M. 8 feb. 2016 I : Ugeskrift for laeger. 178, 6, s. V09150721

Publikation: Forskning - peer reviewTidsskriftartikel

Six months after L5 hemilaminectomy and discectomy a patient experienced diffuse radiating symptoms to the right leg, especially in the standing position. Conventional supine magnetic resonance imaging (MRI) showed some scar tissue in the L5 spinal recess but no signs of nerve root compression to neurogenic claudication. Subsequently, an MRI with the patient in standing position displayed lateral recess stenosis and nerve root compression. This supports the notion that spinal stenosis should be regarded as a dynamic phenomenon also in the diagnostic workup setting.

Originalsprog Dansk
Tidsskrift Ugeskrift for laeger
Vol/bind 178
Tidsskriftsnummer 6
Sider (fra-til) V09150721
ISSN 0041-5782
Status Udgivet - 8 feb. 2016

Sugar-Sweetened Beverages and Obesity Risk in Children and Adolescents: A Systematic Analysis on How Methodological Quality May Influence Conclusions

Bucher Della Torre, S., Keller, A., Laure Depeyre, J. & Kruseman, M. apr. 2016 I : Journal of the Academy of Nutrition and Dietetics. 116, 4, s. 638-59 22 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: In the context of a worldwide high prevalence of childhood obesity, the role of sugar-sweetened beverage (SSB) consumption as a cause of excess weight gain remains controversial. Conflicting results may be due to methodological issues in original studies and in reviews.

OBJECTIVE: The aim of this review was to systematically analyze the methodology of studies investigating the influence of SSB consumption on risk of obesity and obesity among children and adolescents, and the studies' ability to answer this research question.

METHODS: A systematic review of cohort and experimental studies published until December 2013 in peer-reviewed journals was performed on Medline, CINAHL, Web of Knowledge, and ClinicalTrials.gov. Studies investigating the influence of SSB consumption on risk of obesity and obesity among children and adolescents were included, and methodological quality to answer this question was assessed independently by two investigators using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS: Among the 32 identified studies, nine had positive quality ratings and 23 studies had at least one major methodological issue. Main methodological issues included SSB definition and inadequate measurement of exposure. Studies with positive quality ratings found an association between SSB consumption and risk of obesity or obesity (n=5) (ie, when SSB consumption increased so did obesity) or mixed results (n=4). Studies with a neutral quality rating found a positive association (n=7), mixed results (n=9), or no association (n=7).

CONCLUSIONS: The present review shows that the majority of studies with strong methodology indicated a positive association between SSB consumption and risk of obesity or obesity, especially among overweight children. In addition, study findings highlight the need for the careful and precise measurement of the consumption of SSBs and of important confounders.

Originalsprog Engelsk
Tidsskrift Journal of the Academy of Nutrition and Dietetics
Vol/bind 116
Tidsskriftsnummer 4
Sider (fra-til) 638-59
Antal sider 22
ISSN 2212-2672
DOI
Status Udgivet - apr. 2016

Sustained Remission Improves Physical Function in Patients with Established Rheumatoid Arthritis, and Should Be a Treatment Goal: A Prospective Observational Cohort Study from Southern Sweden

Einarsson, J. T., Geborek, P., Saxne, T., Kristensen, L. E. & Kapetanovic, M. C. jun. 2016 I : Journal of Rheumatology. 43, 6, s. 1017-23 7 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: It has been proposed that remission should be maintained throughout the course of rheumatoid arthritis (RA); however, the evidence supporting this is limited. Physical function measured by the Health Assessment Questionnaire (HAQ) is a major outcome in RA, and HAQ is shown to be one of the strongest predictors of longterm outcomes. The purpose of this study was to investigate the physical function over a long time in patients with RA who achieved sustained remission (SR) compared with that of patients occasionally achieving remission [non-sustained remission (NSR)].

METHODS: Patients with RA treated with antitumor necrosis factor and included in the South Swedish Arthritis Treatment Group register were eligible for this study. We identified patients with a Disease Activity Score at 28 joints (DAS28) < 2.6 or Simplified Disease Activity Index (SDAI) ≤ 3.3 at some point and those who achieved SR, i.e., remission during consecutive visits for at least 6 months. The course of functional status was assessed using the HAQ at each visit.

RESULTS: Of the 2416 patients, 1177 (48.7%) reached DAS28 remission at some point. SR was achieved by 382 (15.8%) for the DAS28 and 186 (7.7%) for the SDAI criteria. Comparing the SR and NSR groups, HAQ improved during the first 12 months in the DAS28 remission. HAQ continued to improve relatively as long as SR was maintained. A higher proportion of patients in SR reached full physical function.

CONCLUSION: In patients with established RA, physical function measured by the HAQ improves in patients reaching SR compared with patients who only occasionally reach remission. The improvement continues while in remission, which supports that maintaining remission should be a treatment goal.

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 43
Tidsskriftsnummer 6
Sider (fra-til) 1017-23
Antal sider 7
ISSN 0315-162X
DOI
Status Udgivet - jun. 2016

OBJECTIVES: To investigate the association between pain and peripatellar-synovitis on static and dynamic contrast-enhanced MRI in knee osteoarthritis.

METHODS: In a cross-sectional setting, knee synovitis was assessed using 3-Tesla MRI and correlated with pain using the knee injury and osteoarthritis outcome score (KOOS). Synovitis was assessed in the peripatellar recesses with: (i) dynamic contrast-enhanced (DCE)-MRI, using both pharmacokinetic and heuristic models, (ii) contrast-enhanced (CE)-MRI, and (iii) non-CE-MRI. The DCE-MRI variable IRExNvoxel was chosen as the primary variable in the analyses.

RESULTS: Valid data were available in 94 persons with a mean age of 65 years, a BMI of 32.3kg/m(2) and a mean Kellgren-Lawrence grade of 2.5. IRExNvoxel showed a statically significant correlation with KOOS-Pain (r=-0.34; p=0.001), as was the case with all DCE-variables but one. Correlations between static MRI-variables and KOOS-Pain ranged between -0.21<r<-0.29 (p<0.040). Intraclass correlation coefficients ranged between 0.90-0.99 for the heuristic and 0.66-0.93 for the pharmacokinetic DCE-MRI variables.

CONCLUSIONS: The results confirm an association between peripatellar-synovitis and pain in KOA. Overall, DCE-MRI showed stronger correlations with KOOS-Pain compared to static MRI. DCE-MRI analyses were highly reproducible and have the potential to be used to further investigate the role of inflammation and perfusion in KOA.

Originalsprog Engelsk
Tidsskrift European journal of radiology
Vol/bind 85
Tidsskriftsnummer 6
Sider (fra-til) 1099-108
Antal sider 10
ISSN 0720-048X
DOI
Status Udgivet - jun. 2016

Systematic reviews and research waste

Lund, H., Juhl, C. & Christensen, R. 9 jan. 2016 I : Lancet. 387, 10014, s. 123-4 2 s.

Publikation: Forskning - peer reviewTidsskriftartikel

Originalsprog Engelsk
Tidsskrift Lancet
Vol/bind 387
Tidsskriftsnummer 10014
Sider (fra-til) 123-4
Antal sider 2
ISSN 0140-6736
DOI
Status Udgivet - 9 jan. 2016
Originalsprog Engelsk
Tidsskrift Clinical and Experimental Rheumatology
Vol/bind 34
Tidsskriftsnummer 1
Sider (fra-til) 158
ISSN 0392-856X
Status Udgivet - 4 jan. 2016
The aim of this study was to translate, culturally adapt and evaluate the psychometric properties of the Pain Self-Efficacy Questionnaire (PSEQ) in a population of patients with fibromyalgia in Denmark. The study sample included 102 patients diagnosed with fibromyalgia referred to a specialist clinic. The PSEQ was translated and adapted to a Danish setting using a standard stepw-ise forward-backward translation procedure, followed by initial testing and focus group interview. Reliability was examined by analysing internal consistency and test-retest agreement. Construct validity was exami-ned by investigating dimensionality, targeting, local independence, category functioning and differential item functioning (DIF). Reliability was high: Cronbach's alpha 0.88, test-retest correlation 0.93, intraclass correlation coefficient (ICC) 0.89 and item-total correlations 0.44-0.70. Factor analyses and item response (IRT) models indicated unidimensionality, and the PSEQ-DK was well targeted to the sample. High interitem correlation was observed between two items, indicating local dependence, and item misfit and DIF were observed for a few items. However, the overall fit of the scale to a single-factor model and IRT models supported acceptable construct validity. The PSEQ-DK showed acceptable psychometric properties and can therefore represent a reliable and valid measure for evaluating self-efficacy in patients with fibromyalgia in Denmark.
Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Caring Sciences
Vol/bind 30
Tidsskriftsnummer 1
Sider (fra-til) 202-10
ISSN 0283-9318
DOI
Status Udgivet - apr. 2016

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