Published in 2015

OBJECTIVE: To investigate the association between muscle perfusion in the peri-articular knee muscles assessed by dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and symptoms in patients with knee osteoarthritis (KOA).

DESIGN: In a cross-sectional setting, muscle perfusion was quantified by DCE-MRI in KOA. Regions of interest (ROI) were drawn around the peri-articular muscles, summed and averaged into one single "Total Muscle Volume" volume of interest (VOI). Symptoms were assessed via the Knee injury and Osteoarthritis Outcome Score (KOOS) (0: worst; 100: best).

RESULTS: DCE-MRI and clinical data were analyzed in 94 patients. The typical participant was a woman with a mean age of 65 years, and a body mass index (BMI) of 32 kg/m(2). Reduced multiple regression models analyzing the association between KOOS and DCE-MRI perfusion variables of Total Muscle Volume showed a statistically significant association between Nvoxel% and KOOS pain (0.41 (SE 0.14); P = 0.0048). Nvoxel% was defined as the proportion of highly perfused voxels; i.e., the voxels that show an early and rapid increase on the signal intensity vs time curves, reach a plateau state (plateau pattern) and then showing a relatively rapid decline (washout pattern) relative to the total number of voxels within the muscle VOI.

CONCLUSIONS: More widespread perfusion in the peri-articular knee muscles was associated with less pain in patients with KOA. These results give rise to investigations of the effects of exercise on muscle perfusion and its possible mediating role in the causal pathway between exercise and pain improvements in the conservative management of KOA.

Originalsprog Engelsk
Tidsskrift Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society
Vol/bind 23
Tidsskriftsnummer 10
Sider (fra-til) 1721-7
Antal sider 7
ISSN 1063-4584
DOI
Status Udgivet - okt. 2015

Back on track-Smoking cessation and weight changes over 9years in a community-based cohort study

Køster-Rasmussen, R., Permin, C. A., Siersma, V., Henriksen, J. E., Heitmann, B. L., Heldgaard, P. E. & de Fine Olivarius, N. 9 okt. 2015 I : Preventive Medicine. 81, s. 320-325 6 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: To examine the impact of smoking cessation on body weight compared with normal long-term weight development.

METHODS: Of 1970 adults (20-69years) in a rural town in Denmark invited to take part in the study in 1998-2000, 1374 (70%) participated. After 9years, 1121 participated in the follow-up study. Weight changes were compared using multivariable regression models.

RESULTS: The mean baseline weight of never-smokers was 76.4kg (SD 16.0). The adjusted weight of smokers and ex-smokers differed by -4.2kg (95% CI: -5.9, -2.6), and -0.7kg (95% CI: -2.5, 1.1), respectively. The adjusted weight gain rate (kg/year) of never-smokers, smokers, and ex-smokers was 0.213, 0.127, and 0.105, respectively. The absolute post cessation weight gain (PCWG) was 5.0kg (SD 7.0), and the adjusted PCWG was 2.8kg (95% CI: 1.7, 3.9) compared with never-smokers, and 3.5kg (95% CI: 2.3, 4.8) compared with smokers. The follow-up weight did not differ between quitters and never-smokers (0.1kg; 95% CI: -2.4, 2.6).

CONCLUSION: Smokers weigh less than never-smokers. By quitting, they gain weight and end up weighing the same as comparable never-smokers. Weight gain rates differ by smoking status. Consequently, PCWG depends on the length of follow-up. Our graphical model indicates that smoking cessation results in a return to normal weight development.

Originalsprog Engelsk
Tidsskrift Preventive Medicine
Vol/bind 81
Sider (fra-til) 320-325
Antal sider 6
ISSN 0091-7435
DOI
Status Udgivet - 9 okt. 2015
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Back on track—Smoking cessation and weight changes over 9 years in a community-based cohort study RSS Download PDF

Rasmus Køster-Rasmussen, Caroline Amalie Permin, Volkert Siersma, Jan Erik Henriksen, Berit Lilienthal Heitmann, Poul Erik Heldgaard and Niels de Fine Olivarius
Preventive Medicine, 2015-12-01, Volume 81, Pages 320-325, Copyright © 2015 Elsevier Inc.
Abstract

Objective

To examine the impact of smoking cessation on body weight compared with normal long-term weight development.

Methods

Of 1970 adults (20–69 years) in a rural town in Denmark invited to take part in the study in 1998–2000, 1374 (70%) participated. After 9 years, 1121 participated in the follow-up study. Weight changes were compared using multivariable regression models.

Results

The mean baseline weight of never-smokers was 76.4 kg (SD 16.0). The adjusted weight of smokers and ex-smokers differed by − 4.2 kg (95% CI: − 5.9, − 2.6), and − 0.7 kg (95% CI: − 2.5, 1.1), respectively. The adjusted weight gain rate (kg/year) of never-smokers, smokers, and ex-smokers was 0.213, 0.127, and 0.105, respectively. The absolute post cessation weight gain (PCWG) was 5.0 kg (SD 7.0), and the adjusted PCWG was 2.8 kg (95% CI: 1.7, 3.9) compared with never-smokers, and 3.5 kg (95% CI: 2.3, 4.8) compared with smokers. The follow-up weight did not differ between quitters and never-smokers (0.1 kg; 95% CI: − 2.4, 2.6).

Conclusion

Smokers weigh less than never-smokers. By quitting, they gain weight and end up weighing the same as comparable never-smokers. Weight gain rates differ by smoking status. Consequently, PCWG depends on the length of follow-up. Our graphical model indicates that smoking cessation results in a return to normal weight development.

Originalsprog Engelsk
Tidsskrift Preventive Medicine
Vol/bind 81
Sider (fra-til) 320-325
ISSN 0091-7435
DOI
Status Udgivet - 1 dec. 2015

Circulating Micro-RNA Profiles in Responders to Adalimumab Plus Methotrexate Versus Methotrexate Alone: A Placebo-Controlled Clinical Trial

OPERA study group 2015 I : Arthritis & Rheumatology. 67, S10, s. 3832-5 4 s.

Publikation: Forskning - peer reviewKonferenceabstrakt i tidsskrift

Originalsprog Engelsk
Tidsskrift Arthritis & Rheumatology
Vol/bind 67
Tidsskriftsnummer S10
Sider (fra-til) 3832-5
Antal sider 4
ISSN 1537-2960
Status Udgivet - 2015

OBJECTIVE: To compare reported birth weight (BW) information in school health records with BW from medical birth records, and to investigate if maternal and offspring characteristics were associated with any discrepancies.

DESIGN: Register-based cohort study.

SETTING: Denmark, 1973-1991.

PARTICIPANTS: The study was based on BW recorded in the Copenhagen School Health Records Register (CSHRR) and in The Medical Birth Register (MBR). The registers were linked via the Danish personal identification number.

PRIMARY AND SECONDARY OUTCOME MEASURES: Statistical comparisons of BW in the registers were performed using t tests, Pearson's correlation coefficients, Bland-Altman plots and κ coefficients. Odds of BW discrepancies >100 g were examined by logistic regressions.

RESULTS: The study population included 47 534 children. From 1973 to 1979 when BW was grouped in 500 g intervals in the MBR, mean BW differed significantly between the registers. During 1979-1991 when BW was recorded in 10 and 1 g intervals, mean BW did not significantly differ between the two registers. BW from both registers was highly correlated (0.93-0.97). Odds of a BW discrepancy significantly increased with parity, the child's age at recall and by marital status (children of married women had the highest odds).

CONCLUSIONS: Overall, BW information in school health records agreed very well with BW from medical birth records, suggesting that reports of BWs in school health records in Copenhagen, Denmark generally are valid.

Originalsprog Engelsk
Tidsskrift B M J Open
Vol/bind 5
Tidsskriftsnummer 11
Sider (fra-til) e008628
ISSN 2044-6055
DOI
Status Udgivet - 2015

BACKGROUND: The relationship between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) is currently debated. Using observational data from the South Swedish Arthritis Treatment Group register, we thus aimed to compare clinical development and treatment adherence between nr-axSpA and AS patients during three years of anti-TNF (tumor necrosis factor) therapy in clinical practice, and to explore the impact of inflammatory activity measured by CRP (C-reactive protein) at treatment initiation.

METHODS: Nr-axSpA and AS patients (n = 86/238) in southern Sweden, commencing anti-TNF therapy 1999-2011, were followed during three years. Anti-TNF cessation was defined as stopping therapy, without restarting another anti-TNF agent within three months. Differences in the three year developments of patient's visual analogue scale (VAS) scores for global health and pain, EuroQol 5-Dimensions utility, evaluator's global disease activity assessment, CRP, and ESR (erythrocyte sedimentation rate) were assessed by repeated ANOVA. Anti-TNF adherence was compared by Log rank test and Cox regression. In a subanalysis, the same outcomes were studied after splitting both groups into patients with/without baseline CRP elevation.

RESULTS: Nr-axSpA patients were more often female and had lower acute phase reactants at baseline. Apart from CRP, which remained lower in the nr-axSpA group throughout follow-up (p = 0.004), no between-group differences were detected regarding clinical developments (p >0.1 for all comparisons) or anti-TNF adherence (hazard ratio: 1.1 (95 % CI 0.7 to 1.8) for the nr-axSpA vs. AS group) during three years. Elevated baseline CRP was similarly associated with superior clinical outcomes and treatment adherence in both groups.

CONCLUSIONS: With the exception of constantly lower CRP levels in the nr-axSpA group, three years anti-TNF therapy resulted in similar clinical outcomes and treatment adherence in nr-axSpA and AS patients, thus strengthening the hypothesis that these diagnoses represent different aspects/phases of the same disease.

Originalsprog Engelsk
Tidsskrift Arthritis Research & Therapy
Vol/bind 17
Tidsskriftsnummer 1
Sider (fra-til) 378
ISSN 1478-6354
DOI
Status Udgivet - 2015

Concomitant fibromyalgia in rheumatoid arthritis is associated with the more frequent use of biological therapy: a cross-sectional study

Lage-Hansen, P. R., Chrysidis, S., Lage-Hansen, M., Hougaard, A., Ejstrup, L. & Amris, K. 16 jul. 2015 I : Scandinavian Journal of Rheumatology. s. 1-4 4 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVES: To compare the 28-joint Disease Activity Score (DAS28) and its components in patients with rheumatoid arthritis (RA) with and without concomitant fibromyalgia (FM), and to investigate the use of biological treatment in the two groups.

METHOD: Questionnaires developed to diagnose FM were handed out among RA patients during their planned visits. Values for DAS28 were obtained from the DANBIO registry. Demographic data and data on patients' medical treatment, disease duration, serological and radiological status were retrieved from patients' files. The χ(2) test and an unpaired t-test were applied to investigate group differences in the use of biological therapy, baseline characteristics, patient-reported outcomes, and DAS28 between groups when appropriate.

RESULTS: Questionnaires were completed by 162 out of 264 (61%) patients. Twenty-five patients (15.4%) with concomitant FM were identified. No group differences were found regarding disease duration, age, gender, and serological status. Of the RA patients with concomitant FM, 64% were treated with biological therapy vs. 32% of RA patients without concomitant FM (p = 0.002). The mean DAS28 in the FM group was 4.4 compared to 2.9 in the non-FM group (p < 0.001). Elevated DAS28 in the FM group resulted from a high tender joint count (p = 0.003) and a high visual analogue scale (VAS)-global score (p < 0.001). Erosions were more frequent in the non-FM group (p = 0.04).

CONCLUSIONS: Concomitant FM in patients with RA is associated with a higher DAS28 due to subjective parameters and with the more frequent use of biological treatments. This raises the question of whether the more frequent use of biologics in these patients is justified by inflammation, or is instead due to persistent pain and other centrally mediated symptoms.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Rheumatology
Sider (fra-til) 1-4
Antal sider 4
ISSN 0300-9742
DOI
Status Udgivet - 16 jul. 2015

Contributions to the understanding of osteoarthitis pain

Jørgensen, T. S. 2015 1 udg. Aalborg: Aalborg Universitetsforlag. 98 s.

Publikation: ForskningPh.d.-afhandling

Originalsprog Engelsk
Udgivelses sted Aalborg
Udgiver Aalborg Universitetsforlag
Vol/bind 1
Udgave 1
Antal sider 98
Status Udgivet - 2015
Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 74
Tidsskriftsnummer Suppl. 2
Sider (fra-til) 1263
Antal sider 1
ISSN 0003-4967
Status Udgivet - 2015

Development of a Draft Core Set of Domains for Measuring Shared Decision Making in Osteoarthritis: An OMERACT Working Group on Shared Decision Making

Toupin-April, K., Barton, J., Fraenkel, L., Li, L., Grandpierre, V., Guillemin, F., Rader, T., Stacey, D., Légaré, F., Jull, J., Petkovic, J., Scholte-Voshaar, M., Welch, V., Lyddiatt, A., Hofstetter, C., De Wit, M., March, L., Meade, T., Christensen, R., Gaujoux-Viala, C., Suarez-Almazor, M. E., Boonen, A., Pohl, C., Martin, R. & Tugwell, P. S. dec. 2015 I : Journal of Rheumatology. 42, 12, s. 2442-7 6 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: Despite the importance of shared decision making for delivering patient-centered care in rheumatology, there is no consensus on how to measure its process and outcomes. The aim of this Outcome Measures in Rheumatology (OMERACT) working group is to determine the core set of domains for measuring shared decision making in intervention studies in adults with osteoarthritis (OA), from the perspectives of patients, health professionals, and researchers.

METHODS: We followed the OMERACT Filter 2.0 method to develop a draft core domain set by (1) forming an OMERACT working group; (2) conducting a review of domains of shared decision making; and (3) obtaining opinions of all those involved using a modified nominal group process held at a session activity at the OMERACT 12 meeting.

RESULTS: In all, 26 people from Europe, North America, and Australia, including 5 patient research partners, participated in the session activity. Participants identified the following domains for measuring shared decision making to be included as part of the draft core set: (1) identifying the decision, (2) exchanging information, (3) clarifying views, (4) deliberating, (5) making the decision, (6) putting the decision into practice, and (7) assessing the effect of the decision. Contextual factors were also suggested.

CONCLUSION: We proposed a draft core set of shared decision-making domains for OA intervention research studies. Next steps include a workshop at OMERACT 13 to reach consensus on these proposed domains in the wider OMERACT group, as well as to detail subdomains and assess instruments to develop a core outcome measurement set.

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 42
Tidsskriftsnummer 12
Sider (fra-til) 2442-7
Antal sider 6
ISSN 0315-162X
DOI
Status Udgivet - dec. 2015

Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology

Buch, M. H., Silva-Fernandez, L., Carmona, L., Aletaha, D., Christensen, R., Combe, B., Emery, P., Ferraccioli, G., Guillemin, F., Kvien, T. K., Landewe, R., Pavelka, K., Saag, K., Smolen, J. S., Symmons, D., van der Heijde, D., Welling, J., Wells, G., Westhovens, R., Zink, A. & Boers, M. jun. 2015 I : Annals of the Rheumatic Diseases. 74, 6, s. 963-9 7 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVES: Our initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports.

METHODS: We formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A '0-10' agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance.

RESULTS: Seven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations.

CONCLUSIONS: This EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes.

Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 74
Tidsskriftsnummer 6
Sider (fra-til) 963-9
Antal sider 7
ISSN 0003-4967
DOI
Status Udgivet - jun. 2015

OBJECTIVE: To investigate whether the Assessment of Motor and Process Skills (AMPS), the physical function subscales of the Fibromyalgia Impact Questionnaire (FIQ PF) and the 36-item Short Form (SF-36 PF) can identify subgroups of women with fibromyalgia with clinically relevant differences in ability to perform activities of daily living.

DESIGN: Cross-sectional study.

SUBJECTS: A total of 257 women with fibromyalgia.

METHODS: Participants were evaluated with the AMPS (measuring activities of daily living motor and activities of daily living process ability), FIQ and SF-36. AMPS independence cut-offs were used to divide the participants into 4 subgroups. Clinically relevant differences between subgroups were investigated based on the AMPS, FIQ PF and SF-36 PF.

RESULT: Participants in the 4 AMPS-derived subgroups demon-strated clinically relevant differences in observed activities of daily living motor and process ability. Neither the FIQ PF nor the SF-36 PF could differentiate between subgroups with clinically relevant differences in AMPS activities of daily living process ability.

CONCLUSION: Activities of daily living process skills reflect underlying organizational and adaptive capacities of the individual and are relevant targets for interventions aiming at improving activities of daily living ability. Since self-report instruments do not capture differences in activities of daily living process ability, clinicians should include observations-based assessment of activities of daily living ability in order to individualize interventions offered.

Originalsprog Engelsk
Tidsskrift Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine
ISSN 1651-2081
DOI
Status Udgivet - 19 okt. 2015

Do "Evidence-Based Recommendations" Need to Reveal the Evidence?: Minimal Criteria Supporting an "Evidence Claim"

Christensen, R., Singh, J. A., Wells, G. A. & Tugwell, P. S. okt. 2015 I : Journal of Rheumatology. 42, 10, s. 1737-9 3 s.

Publikation: Forskning - peer reviewTidsskriftartikel

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 42
Tidsskriftsnummer 10
Sider (fra-til) 1737-9
Antal sider 3
ISSN 0315-162X
DOI
Status Udgivet - okt. 2015

INTRODUCTION: Recent studies have shown that vitamin-D intake can improve skeletal muscle function and strength in frail vitamin-D insufficient individuals. We investigated whether vitamin-D intake can improve the muscular response to resistance training in healthy young and elderly individuals, respectively.

METHODS: Healthy untrained young (n = 20, age 20-30) and elderly (n = 20, age 60-75) men were randomized to 16 weeks of daily supplementary intake of either 48 μg of vitamin-D + 800 mg calcium (Vitamin-D-group) or 800 mg calcium (Placebo-group) during a period and at a latitude of low sunlight (December-April, 56°N). During the last 12 weeks of the supplementation the subjects underwent progressive resistance training of the quadriceps muscle. Muscle hypertrophy, measured as changes in cross sectional area (CSA), and isometric strength of the quadriceps were determined. Muscle biopsies were analyzed for fiber type morphology changes and mRNA expression of vitamin-D receptor (VDR), cytochrome p450 27B1 (CYP27B1) and Myostatin.

RESULTS: In the vitamin-D groups, serum 25(OH)D concentration increased significantly and at week 12 was significantly different from placebo in both young men (71.6 vs. 50.4 nmol/L, respectively) and elderly men (111.2 vs. 66.7 nmol/L, respectively). After 12 weeks of resistance training, quadriceps CSA and isometric strength increased compared to baseline in young (CSA p < 0.0001, strength p = 0.005) and elderly (CSA p = 0.001, strength p < 0.0001) with no difference between vitamin-D and placebo groups. Vitamin-D intake and resistance training increased strength/CSA in elderly compared to young (p = 0.008). In the young vitamin-D group, the change in fiber type IIa percentage was greater after 12 weeks training (p = 0.030) and Myostatin mRNA expression lower compared to the placebo group (p = 0.006). Neither resistance training nor vitamin-D intake changed VDR mRNA expression.

CONCLUSION: No additive effect of vitamin-D intake during 12 weeks of resistance training could be detected on either whole muscle hypertrophy or muscle strength, but improved muscle quality in elderly and fiber type morphology in young were observed, indicating an effect of vitamin-D on skeletal muscle remodeling.

TRIAL REGISTRATION: ClinicalTrials with nr. NCT01252381.

Originalsprog Engelsk
Artikel nummer 32
Tidsskrift Nutrition & Metabolism
Udgivelsesdato 2015
Vol/bind 12
Antal sider 14
ISSN 1743-7075
DOI
Status Udgivet

PURPOSE: To evaluate the reliability, agreement and smallest detectable change in a measurement instrument for pain and function in knee osteoarthritis; the Dynamic weight-bearing Assessment of Pain (DAP).

METHODS: The sample size was set to 20 persons, recruited from the outpatient osteoarthritis clinic at Frederiksberg Hospital, Copenhagen. Two physiotherapists tested all participants during two visits; at the first visit, one single DAP (including four scores) was conducted by rater one; at the second visit, DAP was conducted by both raters one and two in randomized order with concealed allocation. The time interval was approximately 1.5 h. Measurement error was estimated by standard error of measurement (SEM). The intra- and inter-rater reliability was estimated by Intra-class Correlation Coefficients for agreement based on a two-way ANOVA with random effects (single measures ICC 2.1). Smallest detectable change (SDC) and limits of agreement were calculated.

RESULTS: The pain score showed excellent reliability in terms of ICC (intra-rater 0.93, CI 0.83-0.97, inter-rater 0.91, CI 0.78-0.96), low SEM (intra-rater 0.70, inter-rater 0.86, on a scale from 0 to 10), and acceptable SDC for intra-rater test (1.95). The three knee bend scores all had ICC above 0.50, showing fair-to-good reliability. None of the knee bend scores showed acceptable SEM and SDC.

CONCLUSIONS: The reproducibility of the DAP pain score meets the demands for use in clinical practice and research. The total knee bend could be useful for motivational purpose in clinical use. Testing of other psychometric properties of the DAP is pending.

Originalsprog Engelsk
Tidsskrift Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Vol/bind 24
Tidsskriftsnummer 12
Sider (fra-til) 2985-92
Antal sider 8
ISSN 0962-9343
DOI
Status Udgivet - dec. 2015

STUDY DESIGN: Cross-sectional study.

OBJECTIVE: To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI).

SUMMARY OF BACKGROUND DATA: The lumbar lordosis increases with a change of position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain.

METHODS: Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured.

RESULTS: Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75 (±5.0) mm during activities, and 38 healthy controls were included. MRI findings were common in both groups, whereas, the summation of the Pfirrmann's grades (LDD-score) was significantly higher in the patients [(MD 1.44; 95% confidence intervals (CI) 0.80 to 2.10; P < 0.001]. The patients were less lordotic than the controls in both the supine (MD -6.4°; 95% CI -11.4 to -1.3), and standing position (MD -5.6°; 95% CI -10.7 to -0.7); however, the changes between the positions (ΔLA) were the same (MD 0.8°; 95% CI -1.8 to 3.3). Using generalized linear model the LDD-score was associated with age (P < 0.001) for both groups. The LDD-score and ΔLA were negatively associated in the control group (P < 0.001), also after adjustments for gender and age (β-coefficient: -2.66; 95% CI -4.3 to -1.0; P = 0.002).

CONCLUSION: Patients may be less lordotic in both the supine and standing position, whereas, change in the lordosis between the positions may be independent of pain. Decreasing lordosis change seems to be associated with age-related increasing disc degeneration in healthy individuals.

LEVEL OF EVIDENCE: 2.

Originalsprog Engelsk
Tidsskrift Spine
Vol/bind 40
Tidsskriftsnummer 21
Sider (fra-til) 1690-6
Antal sider 7
ISSN 0362-2436
DOI
Status Udgivet - nov. 2015

OBJECTIVE: To compare results of obese patients with knee osteoarthritis (OA) who, after an intensive weight loss regimen, received 1 year of either dietary support (D), a knee-exercise program (E), or "no attention" (C; control group).

METHODS: We conducted a randomized, 2-phase, parallel-group trial. A total of 192 obese participants with knee OA were enrolled; the mean age was 62.5 years and 81% were women with a mean entry weight of 103.2 kg. In phase 1, all participants were randomly assigned to 1 of 3 groups and began a dietary regimen of 400-810 and 1,250 kcal/day for 16 weeks (2 8-week phases) to achieve a major weight loss. Phase 2 consisted of 52 weeks' maintenance in either group D, E, or C. Outcomes were changes from randomization in pain on a 100-mm visual analog scale, weight, and response according to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria.

RESULTS: Mean weight loss for phase 1 was 12.8 kg. After 1 year on maintenance therapy, the D group sustained a lower weight (11.0 kg, 95% confidence interval [95% CI] 9.0, 12.8 kg) than those in the E (6.2, 95% CI 4.4, 8.1 kg) and C (8.2, 95% CI 6.4, 10.1 kg) groups (P = 0.002 by analysis of covariance [ANCOVA]). Adherence was low in the E group. All groups had statistically significant pain reduction (D: 6.1; E: 5.6; and C: 5.5 mm) with no difference between groups (P = 0.98 by ANCOVA). In each group 32 (50%), 26 (41%), and 33 (52%) participants responded to treatment in the D, E, and C groups, respectively, with no statistically significant difference in the number of responders (P = 0.41).

CONCLUSION: A significant weight reduction with a 1-year maintenance program improves knee OA symptoms irrespective of maintenance program.

Originalsprog Engelsk
Tidsskrift Arthritis Care & Research
Vol/bind 67
Tidsskriftsnummer 5
Sider (fra-til) 640-50
Antal sider 11
ISSN 2151-464X
DOI
Status Udgivet - maj 2015

Effectiveness and drug adherence of biologic monotherapy in routine care of patients with rheumatoid arthritis: a cohort study of patients registered in the Danish biologics registry

Jørgensen, T. S., Kristensen, L. E., Christensen, R., Bliddal, H., Lorenzen, T., Hansen, M. S., Østergaard, M., Jensen, J., Zanjani, L., Laursen, T., Butt, S., Dam, M. Y., Lindegaard, H. M., Espesen, J., Hendricks, O., Kumar, P., Kincses, A., Larsen, L. H., Andersen, M., Næser, E., Jensen, D. V., Grydehøj, J., Unger, B., Dufour, N., Sørensen, V., Vildhøj, S., Jensen Hansen, I. M., Raun, J., Krogh, N. S. & Lund Hetland, M. dec. 2015 I : Rheumatology (Oxford, England). 54, 12, s. 2156-65 10 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVES: To estimate the prevalence of Danish RA patients currently on biologic monotherapy and compare the effectiveness and drug adherence of biologic therapies applied as monotherapy.

METHODS: All RA patients registered in the Danish biologics database (DANBIO) as receiving biologic DMARD (bDMARD) treatment as monotherapy without concomitant conventional synthetic DMARDs (csDMARDs) during the study period 1 May, 2011 through 30 April 2013 were eligible for inclusion. All patient files were checked to ensure that they were in accordance with the treatment registration in DANBIO. Descriptive statistics for prevalence, effectiveness and drug adherence of bDMARD monotherapy were calculated.

RESULTS: Of the 775 patients on bDMARD monotherapy, adalimumab (21.3%), etanercept (36.6%) and tocilizumab (15.3%) were the most prevalent biologic agents administered. At the 6-month follow-up, the overall crude clinical disease activity index remission rate in patients still on a biologic drug was 22%, the 28-joint DAS remission rate was 41% and the response rate of those with a 50% improvement in ACR criteria was 28%. At the 6-month follow-up, the drug adherence rates were similar for the different bDMARDs, with the exception of infliximab, which had significantly poorer drug adherence (P < 0.001). The overall drug adherence (except for infliximab) was approximately 70% after 2 years.

CONCLUSION: Nearly one in five (19%) biologic treatments for RA was prescribed in Denmark as monotherapy, of which 70% were on monotherapy from bio-initiation and 30% were on monotherapy after cessation of a concomitant csDMARD. Acceptable drug adherence and remission rates were achieved with bDMARDs. With the exception of infliximab, no statistically significant differences were observed between anti-TNFs and biologics with other modes of action.

Originalsprog Engelsk
Tidsskrift Rheumatology (Oxford, England)
Vol/bind 54
Tidsskriftsnummer 12
Sider (fra-til) 2156-65
Antal sider 10
ISSN 1462-0324
DOI
Status Udgivet - dec. 2015

The aim of this study was to assess the clinical efficacy and safety of oral ginger for symptomatic treatment of osteoarthritis (OA) by carrying out a systematic literature search followed by meta-analyses on selected studies. Inclusion criteria were randomized controlled trials (RCTs) comparing oral ginger treatment with placebo in OA patients aged >18 years. Outcomes were reduction in pain and reduction in disability. Harm was assessed as withdrawals due to adverse events. The efficacy effect size was estimated using Hedges' standardized mean difference (SMD), and safety by risk ratio (RR). Standard random-effects meta-analysis was used, and inconsistency was evaluated by the I-squared index (I(2)). Out of 122 retrieved references, 117 were discarded, leaving five trials (593 patients) for meta-analyses. The majority reported relevant randomization procedures and blinding, but an inadequate intention-to-treat (ITT) analysis. Following ginger intake, a statistically significant pain reduction SMD = -0.30 ([95% CI: [(-0.50, -0.09)], P = 0.005]) with a low degree of inconsistency among trials (I(2) = 27%), and a statistically significant reduction in disability SMD = -0.22 ([95% CI: ([-0.39, -0.04)]; P = 0.01; I(2) = 0%]) were seen, both in favor of ginger. Patients given ginger were more than twice as likely to discontinue treatment compared to placebo ([RR = 2.33; 95% CI: (1.04, 5.22)]; P = 0.04; I(2) = 0%]). Ginger was modestly efficacious and reasonably safe for treatment of OA. We judged the evidence to be of moderate quality, based on the small number of participants and inadequate ITT populations. Prospero: CRD42011001777.

Originalsprog Engelsk
Tidsskrift Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society
Vol/bind 23
Tidsskriftsnummer 1
Sider (fra-til) 13-21
Antal sider 9
ISSN 1063-4584
DOI
Status Udgivet - jan. 2015

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