Published in 2010

The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points

Ge, H., Wang, Y., Danneskiold-Samsøe, B., Nielsen, T. G. & Arendt-Nielsen, L., 1 jul. 2010, I : Journal of Pain. 11, 7, s. 644-51 8 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

The aim of this present study is to test the hypotheses that the 18 predetermined sites of examination for tender points (TP sites) in fibromyalgia syndrome (FMS) are myofascial trigger points (MTrPs), and that the induced pain from active MTrPs at TP sites may mimic fibromyalgia pain. Each TP site was evaluated with manual palpation followed by intramuscular electromyographic (EMG) registration of spontaneous electrical activity to confirm or refute the existence of an MTrP in 30 FMS patients. Overall spontaneous pain intensity and pain pattern were recorded before manual identification of MTrPs. Local and referred pain pattern from active MTrPs were drawn following manual palpation at TP sites. RESULTS: Showed that most of the TP sites are MTrPs. Local and referred pain from active MTrPs reproduced partly the overall spontaneous pain pattern. The total number of active MTrPs (r = .78, P <.0001), but not latent MTrPs (r = -.001, P = .99), was positively correlated with spontaneous pain intensity in FMS. The current study provides first evidence that pain from active MTrPs at TP sites mimics fibromyalgia pain. MTrPs may relate to generalized increased sensitivity in FMS due to central sensitization. PERSPECTIVE: This article underlies the importance of active MTrPs in FMS patients. Most of the TP sites in FMS are MTrPs. Active MTrPs may serve as a peripheral generator of fibromyalgia pain and inactivation of active MTrPs may thus be an alternative for the treatment of FMS.
Originalsprog Engelsk
Tidsskrift Journal of Pain
Vol/bind 11
Udgave nummer 7
Sider (fra-til) 644-51
Antal sider 8
ISSN 1526-5900
DOI
Status Udgivet - 1 jul. 2010

Validity, reliability and responsiveness of patient-reported outcome questionnaires when assessing hip and groin disability: a systematic review

Thorborg, K., Roos, E. M., Bartels, E. M., Petersen, J. & Hölmich, P., 1 dec. 2010, I : British Journal of Sports Medicine. 44, 16, s. 1186-96 11 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Novel treatment interventions are advancing rapidly in the management of hip and groin disability in the physically active young to middle-aged population.
Originalsprog Engelsk
Tidsskrift British Journal of Sports Medicine
Vol/bind 44
Udgave nummer 16
Sider (fra-til) 1186-96
Antal sider 11
ISSN 0306-3674
DOI
Status Udgivet - 1 dec. 2010

Published in 2009

A computer-aided detection system for rheumatoid arthritis MRI data interpretation and quantification of synovial activity

Kubassove, O., Boesen, M., Cimmino, M. A. & Bliddal, H., 2009, I : European Journal of Radiology. 74, 3, s. e67-72

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

RATIONAL AND OBJECTIVE: Disease assessment and follow-up of rheumatoid arthritis (RA) patients require objective evaluation and quantification. Magnetic resonance imaging (MRI) has a large potential to supplement such information for the clinician, however, time spent on data reading and interpretation slow down development in this area. Existing scoring systems of especially synovitis are too rigid and insensitive to measure early treatment response and quantify inflammation. This study tested a novel automated, computer system for analysis of dynamic MRI data acquired from patients with RA, Dynamika-RA, which incorporates efficient data processing and analysis techniques.
Originalsprog Engelsk
Tidsskrift European Journal of Radiology
Vol/bind 74
Udgave nummer 3
Sider (fra-til) e67-72
ISSN 0720-048X
DOI
Status Udgivet - 2009

Behandlingseffekten på reumatoid artritis for de tre eksisterende tumornekrosefaktor-alpha-haemmende behandlinger. Metaanalytisk litteraturstudie--sekundaerpublikation

Christensen, R., Kristensen, L. E., Geborek, P., Danneskiold-Samsøe, B., Saxne, T. & Bliddal, H., 2009, I : Ugeskrift for Laeger. 171, 26, s. 2192-4 3 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Absolute treatment efficacy (via number needed to treat) of rheumatoid arthritis for each of the three available anti tumour necrosis factor alpha inhibiting therapies. Our aim was to indirectly compare the long-term efficacy of the available anti-tumour necrosis factor (TNF) therapies in patients with established rheumatoid arthritis. The results indicate that the absolute efficacy associated with use of these anti-TNF therapies is equivalent if applied in equivalent dosages. In standard dosages, infliximab (3 mg/kg/eight weeks) is only half as effective as adalimumab (40 mg/two weeks) and etanercept (25 mg twice weekly).
Bidragets oversatte titel The efficacy of the three available anti-tumour necrosis factor therapies in patients with rheumatoid arthritis. A meta-analytic literature review--secondary publication
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 171
Udgave nummer 26
Sider (fra-til) 2192-4
Antal sider 3
ISSN 0041-5782
Status Udgivet - 2009

Biomechanical characteristics of the eccentric Achilles tendon exercise

Henriksen, M., Aaboe, J., Bliddal, H. & Langberg, H., 11 dec. 2009, I : Journal of Biomechanics. 42, 16, s. 2702-7 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Eccentric exercise has been shown to provide good short-term clinical results in the treatment of painful mid-portion chronic Achilles tendinopathies. However, the mechanisms behind the positive effects of eccentric rehabilitation regimes are not known, and research into the biomechanics of the exercise may improve our understanding.

METHODS: Sixteen healthy subjects performed one-legged full weight bearing ankle plantar and dorsiflexion exercises during which three-dimensional ground reaction forces (GRF), ankle joint kinematics and surface electromyography (EMG) of the lower leg muscles were recorded. Joint kinematics, GRF frequency contents, average EMG amplitudes, and Achilles tendon loads were calculated.

FINDINGS: The eccentric movement phase was characterized by a higher GRF frequency content in the 8-12 Hz range, and reduced EMG activity in the lower leg muscles. No differences in Achilles tendon loads were found.

INTERPRETATION: This descriptive study demonstrates differences in the movement biomechanics between the eccentric and concentric phases of one-legged full weight bearing ankle dorsal and plantar flexion exercises. In particular, the findings imply that although the tendon loads are similar, the tendon is vibrated at higher frequencies during the eccentric phase than during the concentric phases. This study provides data that may explain the mechanisms behind the effectiveness of eccentric exercises used in the treatment of Achilles tendinopathies.

Originalsprog Engelsk
Tidsskrift Journal of Biomechanics
Vol/bind 42
Udgave nummer 16
Sider (fra-til) 2702-7
Antal sider 6
ISSN 0021-9290
DOI
Status Udgivet - 11 dec. 2009

Blood glucose in acute stroke

Olsen, T. S., 2009, I : Expert Review of Neurotherapeutics. 9, 3, s. 409-19 10 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Udgivelsesdato: 2009-Mar
Originalsprog Engelsk
Tidsskrift Expert Review of Neurotherapeutics
Vol/bind 9
Udgave nummer 3
Sider (fra-til) 409-19
Antal sider 10
DOI
Status Udgivet - 2009

Can stimulating massage improve joint repositioning error in patients with knee osteoarthritis?

Lund, H., Henriksen, M., Bartels, E. M., Danneskiold-Samsøe, B. & Bliddal, H., 2009, I : Journal of Geriatric Physical Therapy. 32, 3, s. 111-6 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

PURPOSE: The purpose of this study was to investigate the effect of massage applied to the thigh muscles on joint repositioning error (JRE) in patients suffering from osteoarthritis (OA).We hypothesized that stimulating massage of the muscles around an osteoarthritic knee joint, could improve the neuromuscular function and thereby optimize the positive and minimize the negative performance factors in relation to an exercise program.

METHODS: In a cross-over design, 19 patients with knee osteoarthritis, mean age of 73.1 years (SD: 9.4; range 56 to 88 years), recruited from the local department of rheumatology, were randomly allocated to either receive massage and a week later, act as controls or vice versa. The applied massage consisted of stimulating massage of the quadriceps femoris, sartorious, gracilus, and hamstrings muscles for 10 min on the affected leg. Participants had their JRE measured before and immediately after the 10 min massage and control sessions. Data were analyzed by using paired t-test.

RESULTS: No significant change in JRE was observed (95% CI: -0.62 degrees to 0.85 degrees, p = 0.738).

CONCLUSION: Massage has no effect on the immediate joint repositioning error in patients with knee osteoarthritis, ie, if an improved JRE is important for improving the performance factors when exercising, stimulating massage may not be recommendable to use.

Originalsprog Engelsk
Tidsskrift Journal of Geriatric Physical Therapy
Vol/bind 32
Udgave nummer 3
Sider (fra-til) 111-6
Antal sider 6
ISSN 1539-8412
Status Udgivet - 2009

Disease-modifying anti-rheumatic drugs til behandling af ankyloserende spondylitis

Madsen, O. R. & Egsmose, C., 2009, I : Ugeskrift for Laeger. 171, 33, s. 2268-72 5 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Ankylosing spondylitis (AS) is an inflammatory disorder affecting the axial skeleton, peripheral joints, entheses and extra-articular sites. Patients with early disease, a higher level of erythrocyte sedimentation rate and/or peripheral arthritis might benefit from sulfasalazine. Otherwise, there is no evidence that disease-modifying anti-rheumatic (DMARDs) have a therapeutic effect in AS. Clinical evidence that greater TNF-inhibitor effectiveness can be achieved by combining with a DMARD is lacking, but further studies should be performed. More research is needed to clarify the role of DMARDs in the treatment of AS.
Bidragets oversatte titel [Disease-modifying anti-rheumatic drugs for treatment of ankylosing spondylitis]
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 171
Udgave nummer 33
Sider (fra-til) 2268-72
Antal sider 5
ISSN 0041-5782
Status Udgivet - 2009

Effect of whole body vibration exercise on muscle strength and proprioception in females with knee osteoarthritis

Trans, T., Aaboe, J., Henriksen, M., Christensen, R., Bliddal, H. & Lund, H., aug. 2009, I : The Knee. 16, 4, s. 256-61 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

The purpose of this study was to assess the effect of whole body vibration (WBV) exercise on muscle strength and proprioception in female patients with osteoarthritis in the knee (knee-OA). A single blinded, randomised, controlled trial was performed in an outpatient clinic on 52 female patients diagnosed with knee-OA (mean age 60.4 years+/-9.6). They were randomly assigned to one of 3 groups: 1. WBV-exercise on a stable platform (VibM; n=17 (mean age, 61.5+/-9.2)), WBV-exercise on a balance board (VibF; n=18 (mean age, 58.7+/-11.0)), or control group (Con; n=18 (mean age, 61.1+/-8.5)). The WBV groups trained twice a week for 8 weeks, with a progressively increasing intensity. The WBV groups performed unloaded static WBV exercise. The following were measured: knee muscle strength (extension/flexion) and proprioception (threshold for detection of passive movement (TDPM)). Self-reported disease status was measured using WOMAC. It was found that muscle strength increased significantly (p<0.001) in VibM compared to Con. Isometric knee-extension significantly increased (p=0.021) in VibM compared to Con. TDPM was significantly improved (p=0.033) in VibF compared to Con, while there was a tendency (p=0.051) for VibM to perform better compared to Con. There were no effects in the self-reported disease status measures. This study showed that the WBV-exercise regime on a stable platform (VibM) yielded increased muscle strength, while the WBV-exercise on a balance board (VibF) showed improved TDPM. The WBV-exercise is a time-saving and safe method for rehabilitation of women with knee-OA.

Originalsprog Engelsk
Tidsskrift The Knee
Vol/bind 16
Udgave nummer 4
Sider (fra-til) 256-61
Antal sider 6
ISSN 0968-0160
DOI
Status Udgivet - aug. 2009

Experimental muscle pain during a forward lunge--the effects on knee joint dynamics and electromyographic activity

Henriksen, M., Alkjaer, T., Simonsen, E. B. & Bliddal, H., jul. 2009, I : British Journal of Sports Medicine. 43, 7, s. 503-7 5 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: The purpose of this study was to investigate whether the knee joint dynamics during a forward lunge could be modulated by experimentally induced vastus medialis pain in healthy subjects.

DESIGN: Randomised cross-over study.

SETTING: Biomechanical movement laboratory.

PARTICIPANTS: 20 healthy subjects were included. One subject was excluded during data collection.

INTERVENTION: The subjects performed forward lunges before, during and 20 minutes after induction of experimental quadriceps muscle pain. Muscle pain was induced using hypertonic saline (5.8%) injected intramuscularly. Isotonic saline (0.9%) was used as control.

MAIN OUTCOME MEASUREMENTS: Three-dimensional movement analyses were performed and inverse dynamics were used to calculate joint kinematics and kinetics for ankle, knee and hip joints. Electromyographic (EMG) signals of the hamstrings and quadriceps muscles were recorded.

RESULTS: During and after pain, significant decreases in knee joint dynamics and EMG recordings were observed.

CONCLUSION: The study shows that local pain in the quadriceps is capable of modulating movements with high knee joint dynamics. The results may have implications in the management of muscle pain and prevention of injuries during activities involving the knee joint.

Originalsprog Engelsk
Tidsskrift British Journal of Sports Medicine
Vol/bind 43
Udgave nummer 7
Sider (fra-til) 503-7
Antal sider 5
ISSN 0306-3674
DOI
Status Udgivet - jul. 2009

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Henriksen, M., Aaboe, J., Simonsen, E. B., Alkjaer, T. & Bliddal, H., 19 jun. 2009, I : Journal of Biomechanics. 42, 9, s. 1236-40 5 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (-39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (-6.4% and -4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by 1 degrees . Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.

Originalsprog Engelsk
Tidsskrift Journal of Biomechanics
Vol/bind 42
Udgave nummer 9
Sider (fra-til) 1236-40
Antal sider 5
ISSN 0021-9290
DOI
Status Udgivet - 19 jun. 2009

Fibromyalgi, diagnostik og praevalens. Kan kønsforskellen forklares?

Bartels, E. M., Dreyer, L., Jacobsen, S., Jespersen, A., Bliddal, H. & Danneskiold-Samsøe, B., 30 nov. 2009, I : Ugeskrift for Laeger. 171, 49, s. 3588-92 5 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Most non-inflammatory musculoskeletal diseases are more common in women than in men. Fibromyalgia is characterised by chronic generalised muscle pain. The male:female ratio is 1:9. Interacting factors including genetic, hormonal, environmental and behavioural elements may cause this condition, and there are possibly subgroups of which one has shown to be treatable. A different pathogenetic appearance in the two sexes may also be present. The gender difference may partly be explained by the fact that pressure pain test in tender points forms part of the diagnosis. This may leave some male fibromyalgia patients unrecognized.
Bidragets oversatte titel [Fibromyalgia, diagnosis and prevalence. Are gender differences explainable?]
Originalsprog Dansk
Tidsskrift Ugeskrift for Laeger
Vol/bind 171
Udgave nummer 49
Sider (fra-til) 3588-92
Antal sider 5
Status Udgivet - 30 nov. 2009

Forward lunge as a functional performance test in ACL deficient subjects: test-retest reliability

Alkjaer, T., Henriksen, M., Dyhre-Poulsen, P. & Simonsen, E. B., jun. 2009, I : The Knee. 16, 3, s. 176-82 7 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

The forward lunge movement may be used as a functional performance test of anterior cruciate ligament (ACL) deficient and reconstructed subjects. The purposes were 1) to determine the test-retest reliability of a forward lunge in healthy subjects and 2) to determine the required numbers of repetitions necessary to yield satisfactory reliability. Nineteen healthy subjects performed four trials of a forward lunge on two different days. The movement time, impulses of the ground reaction forces (IFz, IFy), knee joint kinematics and dynamics during the forward lunge were calculated. The relative reliability was determined by calculation of Intraclass Correlation Coefficients (ICC). The IFz, IFy and the positive work of the knee extensors showed excellent reliability (ICC >0.75). All other variables demonstrated acceptable reliability (0.4>ICC<0.75). The relative reliability increased when more than a single forward lunge was used. In conclusion, the reliability was acceptable. It is recommended to represent the biomechanical variables as an average of at least three trials of the forward lunge.

Originalsprog Engelsk
Tidsskrift The Knee
Vol/bind 16
Udgave nummer 3
Sider (fra-til) 176-82
Antal sider 7
ISSN 0968-0160
DOI
Status Udgivet - jun. 2009

Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors

Andersen, K. K., Olsen, T. S., Dehlendorff, C. & Kammersgaard, L. P., 2009, I : Stroke. 40, 6, s. 2068-72 4 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Udgivelsesdato: 2009-Jun
Originalsprog Engelsk
Tidsskrift Stroke
Vol/bind 40
Udgave nummer 6
Sider (fra-til) 2068-72
Antal sider 4
ISSN 0039-2499
DOI
Status Udgivet - 2009

OBJECTIVE: Use of ultrasound Doppler (USD) in diagnosing and treatment monitoring of patients with RA has increased considerably. Hyperaemia is an integral part of the inflammatory response, and the amount of USD activity in an inflamed synovium may therefore be used to quantify the inflammatory activity. It is unclear, however, whether the hyperaemia alone reflects the disease activity or may be influenced by other factors.

METHODS: Twenty-nine patients with RA underwent USD examination of the wrist before and immediately after three interventions. The interventions were carried out on three separate days. The interventions were (i) isometric exercise of the muscles of the hand and forearm, (ii) heating and (iii) cooling of the hand. The amount of Doppler in the wrist joint was quantified by measuring the percentage of colour in the synovium-the colour fraction (CF). The CF values estimated before and after each intervention were compared to see if any intervention affected the amount of Doppler in the synovium.

RESULTS: The CF decreased significantly after cooling of the hand (P = 0.018 and <0.0001). Despite being highly significant, the numerical decrease in CF was only modest, 0.78-1.33 percentage points. The other interventions did not affect the CF significantly, with P-values of 0.65 and 0.59 in the heating intervention and 0.49 in the exercise intervention.

CONCLUSIONS: Cooling of the hand should, if possible, be avoided before a USD examination of the wrist in patients with RA, because the amount of Doppler activity might be affected by low skin temperatures.

Originalsprog Engelsk
Tidsskrift Rheumatology (Online)
Vol/bind 48
Udgave nummer 12
Sider (fra-til) 1520-3
Antal sider 4
ISSN 1462-0332
DOI
Status Udgivet - dec. 2009

Proposal for levels of evidence schema for validation of a soluble biomarker reflecting damage endpoints in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, and recommendations for study design

Maksymowych, W. P., Fitzgerald, O., Wells, G. A., Gladman, D. D., Landewé, R., Østergaard, M., Taylor, W. J., Christensen, R., Tak, P-P., Boers, M., Syversen, S. W., Bathon, J. M., Ritchlin, C. J., Mease, P. J., Bykerk, V. P., Garnero, P., Geusens, P., El-Gabalawy, H., Aletaha, D., Inman, R. D., Kraus, V. B., Kvien, T. K. & van der Heijde, D., aug. 2009, I : Journal of Rheumatology. 36, 8, s. 1792-9 8 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: At OMERACT 8 a framework for levels of evidence was proposed for the validation of biomarkers as surrogate outcome measures. We aimed to adapt this scheme in order to apply it in the setting of soluble biomarkers proposed to replace the measurement of damage endpoints in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). We also aimed to generate consensus on minimum standards for the design of longitudinal studies aimed at validating biomarkers.

METHODS: Before the meeting, the Soluble Biomarker Working Group prepared a preliminary framework and discussed various models for association and prediction related to the statistical strength domain. In addition, 3 Delphi exercises addressing longitudinal study design for RA, PsA, and AS were conducted within the working group and members of the Assessments in SpondyloArthritis International Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). This formed the basis for discussions among OMERACT 9 participants.

RESULTS: The proposed framework was accepted by consensus. In the study design domain a requirement for both prospective observational studies and randomized controlled trials (RCT) in different drug classes was noted. A template for determining the level of statistical strength was proposed. The addition of a new domain on biomarker assay performance was considered essential, and participants suggested that for any biomarker this domain should be addressed first, i.e., before starting clinical validation studies. Participants agreed on most elements of a longitudinal study design template. Where consensus was lacking the working group has drafted solutions that constitute a basis for prospective validation studies.

CONCLUSION: The OMERACT 9 Soluble Biomarker Group has successfully formulated a levels of evidence scheme and a study design template that will provide guidance to conduct validation studies in the setting of soluble biomarkers proposed to replace the measurement of damage endpoints in RA, PsA, and AS.

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 36
Udgave nummer 8
Sider (fra-til) 1792-9
Antal sider 8
ISSN 0315-162X
DOI
Status Udgivet - aug. 2009
To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength.
Originalsprog Engelsk
Tidsskrift Arthritis & Rheumatism
Vol/bind 61
Udgave nummer 6
Sider (fra-til) 732-9
Antal sider 8
ISSN 0004-3591
DOI
Status Udgivet - 2009

The Bath metrology index as assessed by a trained and an untrained rater in patients with spondylarthropathy: a study of intra- and inter-rater agreements

Madsen, O. R., Hansen, L. B., Rytter, A., Suetta, C. & Egsmose, C., jan. 2009, I : Clinical Rheumatology. 28, 1, s. 35-40 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

The Bath ankylosing spondylitis metrology index (BASMI; range 0-10) has gained widespread use in daily clinical practice as an objective measure of spinal stiffness not only in patients with ankylosing spondylitis (AS) but also in patients with other spondylarthropathies (SpA). We examined intra-rater and inter-rater reproducibility of BASMI scoring in 30 Danish patients with SpA (median age 40 years, range 22-56 years) fulfilling the European Spondylarthropathy Study Group criteria, 25 of them satisfying the modified New York Criteria for AS. Measurements were performed twice on two different days (median interval 7 days, range 4-11) by a trained physiotherapist (PT) and by an untrained nurse who had undergone a single 1-h training session with the PT. The median BASMI score obtained by the PT on the two test days was 3.5 (range 1-8) and 3.0 (range 1-8), respectively (NS). Test-retest BASMI scores from the PT were significantly correlated (r(s) = 0.95, p < 0.0001). The 95% likely range for the difference between a patient's BASMI scores from two tests was +/-1.4 corresponding to a minimal detectable difference of +/-2 in the individual patient as the scale consists of intervals of 1. Similar results were achieved by the nurse. BASMI scores obtained by the two raters were significantly inter-correlated (r(s) = 0.95, p < 0.0001). The mean difference between paired BASMI scores obtained by the nurse and the PT on test day 1 was -0.2 with a minimal detectable difference of +/-2. A similar result was found using data from test day 2. In conclusion, a change in BASMI less than 2 may be due solely to expected random measurement error. A single 1-h training session allowed an untrained nurse to obtain BASMI results almost identical to those of an experienced PT.

Originalsprog Engelsk
Tidsskrift Clinical Rheumatology
Vol/bind 28
Udgave nummer 1
Sider (fra-til) 35-40
Antal sider 6
ISSN 0770-3198
DOI
Status Udgivet - jan. 2009

Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept

Carlsen, K. M., Riis, L. & Madsen, O. R., 1 aug. 2009, I : Clinical Rheumatology. 28, 8, s. 1001-3 3 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

We present a case of toxic hepatitis related to infliximab treatment in a 38-year-old woman with rheumatoid arthritis (RA). The patient had previously been treated with different disease-modifying drugs (DMARDs) alone or in combination but had never revealed signs of liver dysfunction. Due to high disease activity, treatment with infliximab (3 mg/kg i.v.) was initiated in combination with methotrexate (MTX) (25 mg/week) and folic acid (5 mg/week). The patient stopped MTX and folic acid on her own initiative after 3 weeks due to improvement of joint symptoms. After seven infusions, progressive elevations of the transaminases up to five times the upper normal limit were noted and treatment with infliximab was terminated. Serological tests for viral and autoimmune hepatitis and for ANA and anti-dsDNA were all negative. Specific infliximab antibodies could not be detected. Ultrasound of the liver was normal. Liver biopsy showed late signs of acute toxic hepatitis without MTX-related fibrosis. This is one the first cases that convincingly demonstrates that infliximab treatment may cause toxic hepatitis. Moreover, the case suggests a lack of hepatic cross-toxicity between infliximab and etanercept as the patient continued with etanercept without new episodes of liver dysfunction.
Originalsprog Engelsk
Tidsskrift Clinical Rheumatology
Vol/bind 28
Udgave nummer 8
Sider (fra-til) 1001-3
Antal sider 3
ISSN 0770-3198
DOI
Status Udgivet - 1 aug. 2009

OBJECTIVE: Colour Doppler ultrasound (CDU) displays blood flow in the tissues and is able to detect hyperaemia. Because hyperaemia is part of the inflammatory response, the amount of CDU activity in the inflamed synovium may be used to quantify the inflammatory activity in RA. It has never been investigated if the amount of CDU activity in a single joint can be used to quantify disease activity in RA.

METHODS: A total of 109 patients with RA and affection of the wrist joint underwent a standardized CDU examination assessing three positions in their most affected wrist at start up in biological treatment. On the same day the following measures of disease activity were collected: assessment of the number of tender and swollen joints, CRP, ESR and 28-joint disease activity score (DAS28). The amount of CDU activity was quantified by measuring the percentage of colour in the synovium--the colour fraction (CF). Correlation between CF and other measures of disease activity was calculated.

RESULTS: There was a significant correlation between CF and DAS28 (r = 0.29; P < 0.001), swollen joint count (r = 0.35; P < 0.001), CRP (r = 0.5; P < 0.001) and ESR (r = 0.5; P < 0.001). No other significant correlations were found.

CONCLUSION: A standardized ultrasound examination of a single affected wrist joint in patients with RA may be used as a measure of disease activity. More studies are needed to identify the number of joints needed to examine by CDU to obtain the best validity of Doppler measurements.

Originalsprog Engelsk
Tidsskrift Rheumatology
Vol/bind 48
Udgave nummer 3
Sider (fra-til) 254-7
Antal sider 4
ISSN 1462-0324
DOI
Status Udgivet - 2009

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