Published in 2015

Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis

Singh, J. A., Cameron, C., Noorbaloochi, S., Cullis, T., Tucker, M., Christensen, R., Ghogomu, E. T., Coyle, D., Clifford, T., Tugwell, P. & Wells, G. A. 18 jul. 2015 I : Lancet (London, England). 386, 9990, s. 258-65 8 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: Serious infections are a major concern for patients considering treatments for rheumatoid arthritis. Evidence is inconsistent as to whether biological drugs are associated with an increased risk of serious infection compared with traditional disease-modifying antirheumatic drugs (DMARDs). We did a systematic review and meta-analysis of serious infections in patients treated with biological drugs compared with those treated with traditional DMARDs.

METHODS: We did a systematic literature search with Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to Feb 11, 2014. Search terms included "biologics", "rheumatoid arthritis" and their synonyms. Trials were eligible for inclusion if they included any of the approved biological drugs and reported serious infections. We assessed the risk of bias with the Cochrane Risk of Bias Tool. We did a Bayesian network meta-analysis of published trials using a binomial likelihood model to assess the risk of serious infections in patients with rheumatoid arthritis who were treated with biological drugs, compared with those treated with traditional DMARDs. The odds ratio (OR) of serious infection was the primary measure of treatment effect and calculated 95% credible intervals using Markov Chain Monte Carlo methods.

FINDINGS: The systematic review identified 106 trials that reported serious infections and included patients with rheumatoid arthritis who received biological drugs. Compared with traditional DMARDs, standard-dose biological drugs (OR 1.31, 95% credible interval [CrI] 1.09-1.58) and high-dose biological drugs (1.90, 1.50-2.39) were associated with an increased risk of serious infections, although low-dose biological drugs (0.93, 0.65-1.33) were not. The risk was lower in patients who were methotrexate naive compared with traditional DMARD-experienced or anti-tumour necrosis factor biological drug-experienced patients. The absolute increase in the number of serious infections per 1000 patients treated each year ranged from six for standard-dose biological drugs to 55 for combination biological therapy, compared with traditional DMARDs.

INTERPRETATION: Standard-dose and high-dose biological drugs (with or without traditional DMARDs) are associated with an increase in serious infections in rheumatoid arthritis compared with traditional DMARDs, although low-dose biological drugs are not. Clinicians should discuss the balance between benefit and harm with the individual patient before starting biological treatment for rheumatoid arthritis.

FUNDING: Rheumatology Division at the University of Alabama at Birmingham.

Originalsprog Engelsk
Tidsskrift Lancet (London, England)
Vol/bind 386
Tidsskriftsnummer 9990
Sider (fra-til) 258-65
Antal sider 8
DOI
Status Udgivet - 18 jul. 2015

Safety of Etoricoxib, Celecoxib, and Nonselective Nonsteroidal Antiinflammatory Drugs in Ankylosing Spondylitis and Other Spondyloarthritis Patients: A Swedish National Population-Based Cohort Study

Kristensen, L. E., Jakobsen, A. K., Askling, J., Nilsson, F. & Jacobsson, L. T. H. aug. 2015 I : Arthritis Care & Research. 67, 8, s. 1137-49 13 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: Safety data regarding the use of etoricoxib and other nonsteroidal antiinflammatory drugs (NSAIDs) in ankylosing spondylitis (AS) and other spondyloarthritis (SpA) patients are rather limited. Our objective was to estimate and compare rates of gastrointestinal, renovascular, and cardiovascular adverse events in patients exposed to etoricoxib, celecoxib, or nonselective NSAIDs or totally unexposed to NSAIDs.

METHODS: We performed a national register-based cohort study on patients with AS or SpA (n = 21,872) identified in the Swedish national patient register from 1987-2009. Treatment exposure was assessed time dependently based on the prescription drug register from 2006-2009, adjusting for sociodemographics and comorbidities derived from national population-based registers.

RESULTS: Exposure to etoricoxib, celecoxib, and nonselective NSAIDs was 7.6%, 3.9%, and 71.2%, respectively. No major risk differences for serious cardiovascular, gastrointestinal, or renal adverse events were seen among the 3 exposure groups. Patients unexposed to NSAIDs had more baseline comorbidities and an increased relative risk for congestive heart failure events during the study period (2.0, 95% confidence interval [95% CI] 1.3-3.2). The relative risk for atherosclerotic events was nonsignificant when compared to the nonselective NSAID group (1.0, 95% CI 0.7-1.5), while the relative risk for gastrointestinal events was lower for unexposed patients (0.5, 95% CI 0.4-0.7).

CONCLUSION: Overall, serious adverse events related to nonselective NSAIDs, etoricoxib, and celecoxib were similar and in the range of what would be expected in a group of SpA patients. Patients unexposed to NSAIDs had considerably more baseline comorbidities and increased risk for congestive heart failure, reflecting a selection of patients being prescribed NSAIDs in clinical practice.

Originalsprog Engelsk
Tidsskrift Arthritis Care & Research
Vol/bind 67
Tidsskriftsnummer 8
Sider (fra-til) 1137-49
Antal sider 13
ISSN 2151-464X
DOI
Status Udgivet - aug. 2015

Satisfaction with daily occupations amongst asylum seekers in Denmark

Morville, A-L., Erlandsson, L-K., Danneskiold-Samsøe, B., Amris, K. & Eklund, M. maj 2015 I : Scandinavian Journal of Occupational Therapy. 22, 3, s. 207-15 9 s.

Publikation: Forskning - peer reviewTidsskriftartikel

AIM: The aim of this study was to describe asylum seekers' satisfaction with daily occupations and activity level while in a Danish asylum centre, and whether this changed over time. Another aim was to describe whether exposure to torture, self-rated health measures, and ADL ability were related to their satisfaction with daily occupations and activity level.

METHODS: A total of 43 asylum seekers at baseline and 17 at follow-up were included. The questionnaires Satisfaction with Daily Occupations, Major Depression Inventory, WHO-5 Wellbeing, Pain Detect, a questionnaire covering torture, and basic social information were used as well as Assessment of Motor and Process Skills.

RESULTS: The results showed a low level of satisfaction with daily occupations at both baseline and follow-up. There was no statistically significant change in satisfaction or activity level between baseline and the follow-up. Associations between AMPS process skills--education, worst pain and activity level--were present at baseline, as was a relationship between AMPS process skills and satisfaction. At follow-up, associations between WHO-5 and satisfaction and activity level and between MDI scores and activity level were found.

CONCLUSION: Asylum seekers experience a low level of satisfaction with daily occupations, both at arrival and after 10 months in an asylum centre. There is a need for further research and development of occupation-focused rehabilitation methods for the asylum seeker population.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Occupational Therapy
Vol/bind 22
Tidsskriftsnummer 3
Sider (fra-til) 207-15
Antal sider 9
ISSN 1103-8128
DOI
Status Udgivet - maj 2015

Sugar-Sweetened Beverages and Obesity among Children and Adolescents: A Review of Systematic Literature Reviews

Keller, A. & Bucher Della Torre, S. aug. 2015 I : Childhood obesity (Print). 11, 4, s. 338-46 9 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: The prevalence of overweight and obesity among children and adolescents has increased worldwide and has reached alarming proportions. Currently, sugar-sweetened beverages (SSBs) are the primary source of added sugar in the diet of children and adolescents. Contradictive findings from studies and reviews have fueled an endless debate on the role of SSBs in the development of childhood obesity.

OBJECTIVES: The primary aim of the present review of reviews was to assess how review- and study-level methodological factors explain conflicting results across reviews and meta-analyses by providing an up-to-date synthesis of recent evidence regarding the association between SSB consumption and weight gain, overweight, and obesity in a population of 6-month-old to 19-year-old children and adolescents. The secondary aim was to assess the quality of included reviews using the Assessment of Multiple SysTemAtic Reviews (AMSTAR) measurement tool.

METHODS: Systematic literature reviews and meta-analyses were included. The literature search was performed through the platforms Pubmed/Medline, Cinahl, and Web of Knowledge.

RESULTS: Thirteen reviews and meta-analyses were included. Nine reviews concluded that there was a direct association between SSBs and obesity in children and adolescents and four others did not. The quality of the included reviews was low to moderate, and the two reviews with the highest quality scores showed discrepant results.

CONCLUSIONS: The majority of reviews concluded that there was a direct association between SSB consumption and weight gain, overweight, and obesity in children and adolescents. However, recent evidence from well-conducted meta-analyses shows discrepant results regarding the association between SSB and weight gain, overweight, and obesity among children and adolescents. Improving methodological quality of studies and reviews as well as ensuring responsible conduct of research and scientific integrity is essential for the provision of objective results.

Originalsprog Engelsk
Tidsskrift Childhood obesity (Print)
Vol/bind 11
Tidsskriftsnummer 4
Sider (fra-til) 338-46
Antal sider 9
ISSN 2153-2168
DOI
Status Udgivet - aug. 2015

Introduction: Periodontitis and obesity are among the most common chronic disorders affecting the world's populations, and recent reviews suggest a potential link between overweight/obesity and periodontitis. However, due to the scarcity of prospective evidence, previous reviews were primarily based on cross-sectional studies, with only few longitudinal or intervention studies included. The objective was to examine the time-dependent association between obesity and periodontitis and how weight-changes may affect the development of periodontitis in the general population. Therefore, longitudinal and experimental studies that assessed the association between overweight, obesity, weight gain, waist circumference and periodontitis were reviewed Method: Intervention and longitudinal studies with overweight or obesity as their exposure and periodontitis as their outcome were searched through the platforms Pubmed/Medline and Web of Knowledge. Results: Eight longitudinal and five intervention studies were included. Two of the longitudinal studies found a direct association between degree of overweight at baseline and subsequent risk of developing periodontitis, and further three studies found a direct association between obesity and development of periodontitis among adults. Two intervention studies on the influence of obesity on periodontal treatment effects found that the response to non-surgical periodontal treatment was better among lean than obese patients, the remaining three studies did not report treatment differences between obese and lean. Among the eight longitudinal studies, one study adjusted for CRP and biological markers of inflammation such as CRP, IL-6 and TNFα and inflammation markers were analyzed separately in three of the five intervention studies. Conclusion: This systematic review suggests that overweight, obesity, weight gain and increased waist circumference may be risk factors for development or worsening with regard to periodontal measures.

Originalsprog Engelsk
Tidsskrift Journal of Periodontology
Sider (fra-til) 1-15
Antal sider 15
ISSN 0022-3492
DOI
Status Udgivet - 12 feb. 2015
We here describe a multimodality neuroimaging containing data from healthy volunteers and patients, acquired within the Lundbeck Foundation Center for Integrated Molecular Brain Imaging (Cimbi) in Copenhagen, Denmark. The data is of particular relevance for neurobiological research questions related to the serotonergic transmitter system with its normative data on the serotonergic subtype receptors 5-HT1A, 5-HT1B, 5-HT2A, and 5-HT4 and the 5-HT transporter (5-HTT), but can easily serve other purposes.

The Cimbi database and Cimbi biobank were formally established in 2008 with the purpose to store the wealth of Cimbi-acquired data in a highly structured and standardized manner in accordance with the regulations issued by the Danish Data Protection Agency as well as to provide a quality-controlled resource for future hypothesis-generating and hypothesis-driven studies.

The Cimbi database currently comprises a total of 1100 PET and 1000 structural and functional MRI scans and it holds a multitude of additional data, such as genetic and biochemical data, and scores from 17 self-reported questionnaires and from 11 neuropsychological paper/computer tests. The database associated Cimbi biobank currently contains blood and in some instances saliva samples from about 500 healthy volunteers and 300 patients with e.g., major depression, dementia, substance abuse, obesity, and impulsive aggression. Data continue to be added to the Cimbi database and biobank.

Originalsprog Engelsk
Tidsskrift NeuroImage
Udgivelsesdato 17 apr 2015
ISSN 1053-8119
DOI
Status In press

OBJECTIVE: To comprehensively identify components of the physical limitation concept in knee osteoarthritis (OA) and to rate the clinical importance of these using perspectives of both patients and health professionals.

DESIGN: Concept mapping, a structured group process, was used to identify and organize data in focus groups (patients) and via a global web-based survey (professionals). Ideas were elicited through a nominal group technique and then organized using multidimensional scaling, cluster analysis, participant validation, rating of clinical importance, and thematic analyses to generate a conceptual model of physical limitations in knee OA.

RESULTS: Fifteen Danish patients and 200 international professionals contributed to generating the conceptual model. Five clusters emerged: 'Limitations/physical deficits'; 'Everyday hurdles'; 'You're not the person you used to be'; 'Need to adjust way of living'; and 'External limitations,' each with sub-clusters. Patients generally found their limitations more important than the professionals did.

CONCLUSION: Patients and professionals agreed largely on the physical limitation concept in knee OA. Some limitations of high importance to patients were lower rated by the professionals, highlighting the importance of including patients when conceptualizing patient outcomes. These data offer new knowledge to guide selection of clinically relevant outcomes and development of outcome measures in knee OA.

Originalsprog Engelsk
Tidsskrift Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Vol/bind 24
Tidsskriftsnummer 10
Sider (fra-til) 2423-32
Antal sider 10
ISSN 0962-9343
DOI
Status Udgivet - okt. 2015

BACKGROUND: There is currently no standardised MRI evaluation protocol for athletes who present with symptoms that may relate to the pubic symphysis, the pubic bones, and the adductor muscle insertions. We outline the protocol and reliability data.

MATERIAL AND METHODS: Three musculoskeletal radiologists developed an 11-element MRI evaluation protocol defined according to precise criteria and illustrated in a pictorial atlas. Eighty-six male athletes (soccer players and non-soccer players) underwent standardised 3 Tesla MRI of the pelvis. Two external musculoskeletal radiologists were trained to use the protocol and pictorial atlas during two sessions of 2-4 h each. Each radiologist rated all 86 MRI independently. One radiologist evaluated the scans once, the other twice 2 months apart. Cohen κ statistics were used to determine intraobserver and interobserver agreement.

RESULTS: The main findings were (1) substantial intraobserver (κ range 0.65-0.67) and moderate interobserver (κ range 0.45-0.52) agreement in rating pubic bone marrow oedema, (2) substantial to moderate intraobserver (κ range 0.49-0.72) and moderate-to-fair interobserver (κ range 0.21-0.52) agreement in rating most other MRI findings, (3) slight intraobserver and interobserver (κ range -0.06-0.05) agreement in rating adductor longus tendinopathy.

CONCLUSIONS: The Copenhagen Standardised MRI protocol demonstrated moderate-to-substantial reliability in rating bone marrow oedema, and varied from fair-to-substantial agreement for the majority of MRI features, but showed only slight agreement in rating adductor longus tendinopathy. This rigorous investigation also confirms that while MRI evaluation seems to provide reasonable reliability in rating pubic bone marrow oedema, the evaluation of adductor tendinopathy in a clinical and research setting needs further resolution by continued development and testing of MRI acquisition protocols.

Originalsprog Engelsk
Tidsskrift British Journal of Sports Medicine
Vol/bind 49
Tidsskriftsnummer 10
Sider (fra-til) 692-9
ISSN 0306-3674
DOI
Status Udgivet - 2015
Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Pain
Vol/bind 6
Sider (fra-til) 43
Antal sider 49
ISSN 1877-8860
Status Udgivet - 2015

The e-health literacy framework: A conceptual framework for characterizing e-health users and their interaction wiht e-health systems

Nørgaard, O., Furstrand, D., Klokker, L., Karnoe, A., Batterham, R., Kayser, L. & Osborne, R. H. 2015 I : Knowledge Management & E-Learning: An International Journal. 7, 4, s. 522 540 s.

Publikation: Forskning - peer reviewTidsskriftartikel

Originalsprog Dansk
Tidsskrift Knowledge Management & E-Learning: An International Journal
Vol/bind 7
Tidsskriftsnummer 4
Sider (fra-til) 522
Antal sider 540
ISSN 2073-7904
Status Udgivet - 2015

The effect of comedication with conventional synthetic disease modifying antirheumatic drugs on TNF inhibitor drug survival in patients with ankylosing spondylitis and undifferentiated spondyloarthritis: results from a nationwide prospective study

Lie, E., Kristensen, L. E., Forsblad-d'Elia, H., Zverkova-Sandström, T., Askling, J., Jacobsson, L. T. & ARTIS Study Group jun. 2015 I : Annals of the Rheumatic Diseases. 74, 6, s. 970-8 9 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: To assess the effect of comedication with conventional synthetic disease modifying antirheumatic drugs (csDMARDs) on retention to tumour necrosis factor inhibitor (TNFi) therapy in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA).

METHODS: Data on patients with a clinical diagnosis of AS or uSpA starting treatment with adalimumab, etanercept or infliximab as their first TNFi during 2003-2010 were retrieved from the Swedish national biologics register and linked to national population based registers. Five-year drug survival was analysed by Cox regression with age, sex, baseline csDMARD comedication, TNFi type, prescription year and covariates representing frailty and socioeconomic status. AS and uSpA were analysed separately. Sensitivity analyses included models with csDMARD as a time-dependent covariate and adjustments for additional potential confounders.

RESULTS: 1365 patients with AS and 1155 patients with uSpA were included, of whom 40.8% versus 50.3% used csDMARD comedication at baseline. In the unadjusted analyses superior drug survival was observed for patients using versus not using csDMARD comedication among patients with AS (p<0.001) but not among patients with uSpA (p=0.175). In the multivariable Cox regression analyses comedication with csDMARD was associated with better retention to TNFi therapy both in AS (HR 0.71, p<0.001) and uSpA (HR 0.82, p=0.020). The results were similar with csDMARD comedication as a time-dependent covariate, and the associations were retained when adjusting for erythrocyte sedimentation rate, C-reactive protein, patient global, swollen joints, uveitis, psoriasis and inflammatory bowel disease.

CONCLUSIONS: In this large register study of patients with AS and uSpA, use of csDMARD comedication was associated with better 5-year retention to the first TNFi.

Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 74
Tidsskriftsnummer 6
Sider (fra-til) 970-8
Antal sider 9
ISSN 0003-4967
DOI
Status Udgivet - jun. 2015

BackgroundSedentary behavior has been recognized as a distinct and independent risk factor for cardiovascular morbidity and mortality, independent of moderate and vigorous physical activity during leisure time. Sedentary behavior has become increasingly prevalent in modern society. Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease and premature death, partly caused by the chronic inflammatory rheumatic disease itself, but also due to physical inactivity. Recent research has shown that sedentary behavior can be reduced through behavioral intervention in elderly and in overweight study populations.BackgroundPatients with RA (Rheumatoid Arthritis) are more sedentary than the general population. Reduction of Sedentary Behaviour (SB) has been suggested as a mean for improvement of health in patients with chronic diseases and mobility problems. Short-term intervention studies have demonstrated that SB can be reduced by behavioural interventions in healthy populations. However, it remains unexplored whether it is valid for patients with RA also.Therefore, the aim of this trial is to investigate the efficacy of an individually tailored, theory-based motivational counseling intervention on reducing daily sitting time in sedentary patients with RA. Additionally, to explore whether a reduction in daily sitting time is associated with reduced pain and fatigue, self-reported physical function, self-efficacy, improved health-related quality of life (HRQoL) and cardiovascular biomarker levels, and finally to assess the cost-effectiveness of the intervention.Methods/DesignFor this parallel group randomized trial, 150 patients with RA and at least 5 hours of sitting time per day, will be recruited from a rheumatology outpatient clinic, and block-randomized to the intervention group or the control group receiving usual care. The intervention includes: 1) individual motivational counseling (in total 3 sessions) on reduction of daily sitting time in combination with 2) individual Short Text Message Service (SMS) reminders over a 16-week intervention period. Primary outcome is change in daily sitting time (minutes) from baseline to 16 weeks measured objectively using an ActivPAL® Activity Monitor. Secondary outcomes include fatigue, pain, physical function, HRQoL, self-efficacy, costs and cost-effectiveness. Furthermore, anthropometric measures will be included as well as measurement of blood pressure and serum lipids. All outcomes are assessed at baseline and repeated after 16 weeks. Follow-up assessments are made at 6 and 18 months post-intervention.DiscussionThe intervention is simple, non-invasive and may be implemented at low costs. If the study confirms the positive results expected, the intervention might be implemented in clinical practice and potentially transferred to other clinical populations.Trial registrationClinicalTrial.gov registration number: NCT01969604.Date of registration: 17 October 2013.

Originalsprog Engelsk
Tidsskrift Trials
Vol/bind 16
Tidsskriftsnummer 1
Sider (fra-til) 23
ISSN 1745-6215
DOI
Status Udgivet - 27 jan. 2015

The International Dermatology Outcome Measures Group: formation of patient-centered outcome measures in dermatology

Gottlieb, A. B., Levin, A. A., Armstrong, A. W., Abernethy, A., Duffin, K. C., Bhushan, R., Garg, A., Merola, J. F., Maccarone, M. & Christensen, R. feb. 2015 I : Journal of the American Academy of Dermatology. 72, 2, s. 345-8 4 s.

Publikation: Forskning - peer reviewTidsskriftartikel

As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project.

Originalsprog Engelsk
Tidsskrift Journal of the American Academy of Dermatology
Vol/bind 72
Tidsskriftsnummer 2
Sider (fra-til) 345-8
Antal sider 4
ISSN 0190-9622
DOI
Status Udgivet - feb. 2015

BACKGROUND: Although associated with excess mortality and morbidity, obesity is associated with lower mortality after stroke. The association between obesity and risk of recurrent stroke is unclear.

AIMS: The study aims to investigate the association in stroke patients between body mass index and risk of death and readmission for recurrent stroke.

METHODS: An administrative Danish quality-control registry designed to collect a predefined dataset on all hospitalized stroke patients in Denmark 2000–2010 includes 45 615 acute first-ever stroke patients with information on body mass index in 29 326. Data include age, gender, civil status, stroke severity, computed tomography, and cardiovascular risk factors. Patients were followed up to 9·8 years (median 2·6 years). We used Cox regression models to compare risk of death and readmission for recurrent stroke in the four body mass index groups: underweight (body mass index < 18·5), normal weight (body mass index 18·5–24·9), overweight (body mass index 25·0–29·9), obese (body mass index ≥ 30·0).

RESULTS: Mean age 72·3 years, 48% women. Mean body mass index 23·0. Within follow-up, 7902 (26·9%) patients had died; 2437 (8·3%) were readmitted because of recurrent stroke. Mortality was significantly lower in overweight (hazard ratio 0·72; confidence interval 0·68–0·78) and obese (hazard ratio 0·80; confidence interval 0·73–0·88) patients while significantly higher in underweight patients (hazard ratio 1·66; confidence interval 1·49–1·84) compared with normal weight patients. Risk of readmission for recurrent stroke was significantly lower in obese than in normal weight patients (hazard ratio 0·84; confidence interval 0·72–0·92).

CONCLUSIONS: Obesity was not only associated with reduced mortality relative to normal weight patients. Compared with normal weight, risk of readmission for recurrent stroke was also lower in obese stroke patients.

Originalsprog Engelsk
Tidsskrift International journal of stroke : official journal of the International Stroke Society
Vol/bind 10
Tidsskriftsnummer 1
Sider (fra-til) 99-104
Antal sider 6
ISSN 1747-4930
Status Udgivet - jan. 2015

The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations: a nationwide register study

Exarchou, S., Lindström, U., Askling, J., Eriksson, J. K., Forsblad-d'Elia, H., Neovius, M., Turesson, C., Kristensen, L. E. & Jacobsson, L. T. H. 2015 I : Arthritis Research & Therapy. 17, 1, s. 118

Publikation: Forskning - peer reviewTidsskriftartikel

INTRODUCTION: Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment.

METHODS: All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers.

RESULTS: A total of 11,030 cases with an ankylosing spondylitis diagnosis (alive, living in Sweden, and 16 to 64 years old in December 2009) were identified in the National Patient Register, giving a point prevalence of 0.18% in 2009. The prevalence was higher in northern Sweden, and lower in those with a higher level of education. Men had a higher prevalence of ankylosing spondylitis (0.23% versus 0.14%, P < 0.001), a higher frequency of anterior uveitis (25.5% versus 20.0%, P < 0.001) and were more likely to receive tumor necrosis factor inhibitors than women (15.6% versus 11.8% in 2009, P < 0.001). Women were more likely than men to have peripheral arthritis (21.7% versus 15.3%, P < 0.001), psoriasis (8.0% versus 6.9%, P = 0.03), and treatment with oral corticosteroids (14.0% versus 10.4% in 2009, P < 0.001).

CONCLUSION: This nationwide, register-based study demonstrated a prevalence of clinically diagnosed ankylosing spondylitis of 0.18%. It revealed phenotypical and treatment differences between the sexes, as well as geographical and socio-economic differences in disease prevalence.

Originalsprog Engelsk
Tidsskrift Arthritis Research & Therapy
Vol/bind 17
Tidsskriftsnummer 1
Sider (fra-til) 118
ISSN 1478-6354
DOI
Status Udgivet - 2015

The specificity of ultrasound-detected bone erosions for rheumatoid arthritis

Zayat, A. S., Ellegaard, K., Conaghan, P. G., Terslev, L., Hensor, E. M. A., Freeston, J. E., Emery, P. & Wakefield, R. J. 2015 I : Annals of the Rheumatic Diseases. 74, 5, s. 897-903

Publikation: Forskning - peer reviewTidsskriftartikel

Bone erosion is one of the hallmarks of rheumatoid arthritis (RA), but also seen in other rheumatic diseases. The objective of this study was to determine the specificity of ultrasound (US)-detected bone erosions (including their size) in the classical 'target' joints for RA.
Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 74
Tidsskriftsnummer 5
Sider (fra-til) 897-903
ISSN 0003-4967
DOI
Status Udgivet - 2015
Originalsprog Dansk
Udgivelses sted København
Udgiver Faculty of Health Sciences, University of Copenhagen
Vol/bind 1
Udgave 1
Status Udgivet - 2015

Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures

Petkovic, J., Epstein, J., Buchbinder, R., Welch, V., Rader, T., Lyddiatt, A., Clerehan, R., Christensen, R., Boonen, A., Goel, N., Maxwell, L. J., Toupin-April, K., De Wit, M., Barton, J., Flurey, C., Jull, J., Barnabe, C., Sreih, A. G., Campbell, W., Pohl, C., Duruöz, M. T., Singh, J. A., Tugwell, P. S. & Guillemin, F. dec. 2015 I : Journal of Rheumatology. 42, 12, s. 2448-59 12 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures.

METHODS: The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM.

RESULTS: Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation.

CONCLUSION: Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 42
Tidsskriftsnummer 12
Sider (fra-til) 2448-59
Antal sider 12
ISSN 0315-162X
DOI
Status Udgivet - dec. 2015

Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

Terslev, L., Gutierrez, M., Schmidt, W. A., Keen, H. I., Filippucci, E., Kane, D., Thiele, R., Kaeley, G., Balint, P., Mandl, P., Delle Sedie, A., Hammer, H. B., Christensen, R., Möller, I., Pineda, C., Kissin, E., Bruyn, G. A., Iagnocco, A., Naredo, E., D'Agostino, M. A. & OMERACT Ultrasound Working Group nov. 2015 I : Journal of Rheumatology. 42, 11, s. 2177-81 5 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group on the validation of US as a potential outcome measure in gout.

METHODS: Based on the lack of definitions, highlighted in a recent literature review on US as an outcome tool in gout, a series of iterative exercises were carried out to obtain consensus-based definitions on US elementary components in gout using a Delphi exercise and subsequently testing these definitions in static images and in patients with proven gout. Cohen's κ was used to test agreement, and values of 0-0.20 were considered poor, 0.20-0.40 fair, 0.40-0.60 moderate, 0.60-0.80 good, and 0.80-1 excellent.

RESULTS: With an agreement of > 80%, consensus-based definitions were obtained for the 4 elementary lesions highlighted in the literature review: tophi, aggregates, erosions, and double contour (DC). In static images interobserver reliability ranged from moderate to almost perfect, and similar results were found for the intrareader reliability. In patients the intraobserver agreement was good for all lesions except DC (moderate). The interobserver agreement was poor for aggregates and DC but moderate for the other components.

CONCLUSION: These first steps in evaluating the validity of US as an outcome measure for gout show that the reliability of the definitions ranged from moderate to excellent in static images and somewhat lower in patients, indicating that a standardized scanning technique may be needed, before testing the responsiveness of those definitions in a composite US score.

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 42
Tidsskriftsnummer 11
Sider (fra-til) 2177-81
Antal sider 5
ISSN 0315-162X
DOI
Status Udgivet - nov. 2015

Objective. To validate the agreement between the 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) and the 28-joint disease activity score based on C-reactive protein (DAS28-CRP) in a group of Danish patients with rheumatoid arthritis (RA). Methods. Data from 109 Danish RA patients initiating biologic treatment were analysed at baseline and following one year of treatment. Participants were retrospectively enrolled from a previous cohort study and were considered eligible for this project if CRP and ESR were measured at baseline and at the follow-up visit. To assess the extent of agreement between the two DAS28 definitions, the "European League Against Rheumatism" (EULAR) response criteria based on each definition were calculated with cross-classification. Weighted Kappa (κ) coefficients were calculated, and Bland-Altman plots were used to illustrate degree of agreement between DAS28 definitions. Results. The 75 eligible patients were classified as EULAR good, moderate, and nonresponders with good agreement (61/75; 81%) between DAS28-CRP and DAS28-ESR (κ = 0.75 (95% CI: 0.63 to 0.88)). Conclusions. According to our findings, DAS28-CRP and DAS28-ESR are interchangeable when assessing RA patients and the two versions of DAS28 are comparable between studies.

Originalsprog Engelsk
Tidsskrift Arthritis
Vol/bind 2015
Sider (fra-til) 401690
ISSN 2090-1984
DOI
Status Udgivet - 2015

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