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Landgren AJ, Jonsson CA, Bilberg A, Eliasson B, Torres L, Dehlin M, Jacobsson LTH, Gjertsson I, Larsson I, Klingberg E. Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention. Arthritis Res Ther 2023; 25:131. [PMID: 37501212 PMCID: PMC10373368 DOI: 10.1186/s13075-023-03105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Patients with psoriatic arthritis (PsA) are frequently obese. We have previously shown decreased disease activity in patients with PsA with a body mass index (BMI) ≥ 33 kg/m2 following weight loss treatment with Very Low Energy Diet (VLED), resulting in a median weight loss of 18.6% at six months (M6) after baseline (BL). In this study we assessed the effects of VLED on cytokines and adipokines at M6 in the same patients with PsA and controls (matched on sex, age and weight). METHODS VLED (640 kcal/day) during 12 or 16 weeks, depending on BL BMI < 40 or ≥ 40 kg/m2, was taken and followed by an energy-restricted diet. Cytokines and adipokines were measured with Magnetic Luminex Assays at BL and M6. RESULTS Serum interleukin (IL)-23, (median (interquartile range) 0.40 (0.17-0.54) ng/mL vs. 0.18 (0.10-0.30) ng/mL, p < 0.001) and leptin (26.28 (14.35-48.73) ng/mL vs. 9.25 (4.40-16.24) ng/mL, p < 0.001) was significantly decreased in patients with PsA. Serum total (tot)-adiponectin and high molecular weight (HMW) adiponectin increased significantly. Similar findings were found in controls. Also, in patients with PsA, ∆BMI was positively correlated with ∆IL-23 (rS = 0.671, p < 0.001). In addition, significant positive correlations were found between ΔBMI and ΔDisease Activity Score (DAS28CRP), ΔCRP, Δtumor necrosis factor (TNF)-α, ΔIL-13, ∆IL-17 and Δleptin, and negative correlations between ΔBMI and Δtot-adiponectin. CONCLUSIONS Weight loss was associated with decreased levels of leptin and cytokines, in particular IL-23. These findings may partly explain the anti-inflammatory effect of weight reduction in PsA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered.
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Affiliation(s)
- A J Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Södra Bohuslän, Sweden.
| | - C A Jonsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - B Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Torres
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Deminger A, Klingberg E, Lorentzon M, Hedberg M, Carlsten H, Jacobsson LTH, Forsblad-d'Elia H. Factors associated with changes in volumetric bone mineral density and cortical area in men with ankylosing spondylitis: a 5-year prospective study using HRpQCT. Osteoporos Int 2022; 33:205-216. [PMID: 34263348 PMCID: PMC8758642 DOI: 10.1007/s00198-021-06049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/24/2021] [Indexed: 12/02/2022]
Abstract
Patients with ankylosing spondylitis (AS) have impaired volumetric bone mineral density (vBMD) assessed with high-resolution peripheral computed tomography (HRpQCT). This first longitudinal HRpQCT study in AS shows that cortical and trabecular vBMD decreased at tibia and that signs of inflammation were associated with cortical bone loss at tibia and radius. INTRODUCTION Patients with ankylosing spondylitis (AS) have reduced volumetric bone mineral density (vBMD) in the peripheral skeleton assessed with high-resolution peripheral quantitative computed tomography (HRpQCT). The aims were to investigate longitudinal changes in vBMD, cortical area, and microarchitecture and to assess factors associated with changes in vBMD and cortical area in men with AS. METHODS HRpQCT of radius and tibia was performed in 54 men with AS at baseline and after 5 years. Univariate and multivariable linear regression analyses were used. RESULTS At tibia, there were significant decreases exceeding least significant changes (LSC) in cortical and trabecular vBMD, mean (SD) percent change -1.0 (1.9) and -2.7 (5.0) respectively (p<0.001). In multivariable regression analyses, increase in disease activity measured by ASDAS_CRP from baseline to follow-up was associated with decreases in cortical vBMD (β -0.86, 95% CI -1.31 to -0.41) and cortical area (β -1.66, 95% CI -3.21 to -0.10) at tibia. At radius, no changes exceeded LSC. Nonetheless, increase in ASDAS_CRP was associated with decreases in cortical vBMD, and high time-averaged ESR was associated with decreases in cortical area. Treatment with TNF inhibitor ≥ 4 years during follow-up was associated with increases in cortical vBMD and cortical area at tibia, whereas exposure to bisphosphonates was associated with increases in cortical measurements at radius. No disease-related variables or treatments were associated with changes in trabecular vBMD. CONCLUSION The findings in this first longitudinal HRpQCT study in patients with AS strengthen the importance of controlling disease activity to maintain bone density in the peripheral skeleton.
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Affiliation(s)
- A Deminger
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - M Lorentzon
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - M Hedberg
- Section of Rheumatology, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - H Carlsten
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
| | - H Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
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Deminger A, Klingberg E, Lorentzon M, Hedberg M, Carlsten H, Jacobsson LTH, Forsbladd'Elia H. Correction to: Factors associated with changes in volumetric bone mineral density and cortical area in men with ankylosing spondylitis: a 5-year prospective study using HRpQCT. Osteoporos Int 2021; 32:2601. [PMID: 34725720 PMCID: PMC8608770 DOI: 10.1007/s00198-021-06156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Deminger
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - M Lorentzon
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - M Hedberg
- Section of Rheumatology, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - H Carlsten
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
| | - H Forsbladd'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
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Landgren AJ, Bilberg A, Eliasson B, Larsson I, Dehlin M, Jacobsson LTH, Klingberg E. Cardiovascular risk factors are highly overrepresented in Swedish patients with psoriatic arthritis compared with the general population. Scand J Rheumatol 2019; 49:195-199. [DOI: 10.1080/03009742.2019.1672783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- AJ Landgren
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - B Eliasson
- Department of Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - I Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mellblom Bengtsson M, Hagel S, Jacobsson LTH, Turesson C. Lower extremity function in patients with early rheumatoid arthritis during the first five years, and relation to other disease parameters. Scand J Rheumatol 2019; 48:367-374. [DOI: 10.1080/03009742.2019.1579859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- M Mellblom Bengtsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - S Hagel
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - LTH Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - C Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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Pettersson H, Boström C, Bringby F, Walle-Hansen R, Jacobsson LTH, Svenungsson E, Nordin A, Alexanderson H. Muscle endurance, strength, and active range of motion in patients with different subphenotypes in systemic sclerosis: a cross-sectional cohort study. Scand J Rheumatol 2018; 48:141-148. [DOI: 10.1080/03009742.2018.1477990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- H Pettersson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - C Boström
- Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - F Bringby
- Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - R Walle-Hansen
- Department of Clinical Service, Orthopaedic Clinic, Oslo University Hospital, Oslo, Norway
| | - LTH Jacobsson
- Unit of Internal Medicine, Lund University Hospital, Lund, Sweden
| | - E Svenungsson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - A Nordin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - H Alexanderson
- Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Glintborg B, Lindström U, Aaltonen K, Kristianslund EK, Gudbjornsson B, Chatzidionysiou K, Askling J, Nordström D, Hetland ML, Di Giuseppe D, Dreyer L, Kristensen LE, Jørgensen TS, Eklund K, Grondal G, Ernestam S, Joensuu J, Törmänen MRK, Skydsgaard H, Hagfors J, Kvien TK, Lie E, Fagerli K, Geirsson AJ, Jonsson H, Provan SA, Krogh NS, Jacobsson LTH. Biological treatment in ankylosing spondylitis in the Nordic countries during 2010–2016: a collaboration between five biological registries. Scand J Rheumatol 2018; 47:465-474. [DOI: 10.1080/03009742.2018.1444199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B Glintborg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - EK Kristianslund
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - B Gudbjornsson
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - K Chatzidionysiou
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - D Nordström
- Department of Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - ML Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - D Di Giuseppe
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - L Dreyer
- Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - LE Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - TS Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - K Eklund
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - G Grondal
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - S Ernestam
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J Joensuu
- Faculty of Pharmacy, University of Helsinki, Helsinki,Finland
| | - MRK Törmänen
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - H Skydsgaard
- The Danish Rheumatism Association, Copenhagen, Denmark
| | - J Hagfors
- Norwegian Rheumatism Association, Oslo, Norway
| | - TK Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Lie
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - K Fagerli
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - AJ Geirsson
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - H Jonsson
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - SA Provan
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Meesters JJL, Bergman S, Haglund E, Jacobsson LTH, Petersson IF, Bremander A. Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden. Scand J Rheumatol 2017; 47:185-193. [DOI: 10.1080/03009742.2017.1350744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- JJL Meesters
- ERC Syd, Skåne University Hospital, Lund, Sweden
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Research and Development, Sophia Rehabilitation Center, The Hague, The Netherlands
| | - S Bergman
- Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
| | - E Haglund
- Spenshult Research and Development Center, Halmstad, Sweden
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
| | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - IF Petersson
- Section of Orthopedics, Department of Clinical Sciences, University of Lund, Lund, Sweden
| | - A Bremander
- Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
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Landgren AJ, Jacobsson LTH, Lindström U, Sandström TZS, Drivelegka P, Björkman L, Fjellstedt E, Dehlin M. Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study. Arthritis Res Ther 2017; 19:173. [PMID: 28738835 PMCID: PMC5525359 DOI: 10.1186/s13075-017-1376-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nephrolithiasis (NL) is known to be associated with gout, although there are few comparative studies on risk and risk factors for NL in gout compared to population cohorts. In this cohort study we investigated: (1) overall incidence of NL in gout (cases) and general population controls; (2) risk and risk factors (common comorbidities and medications) for first-time NL in cases and controls separately. METHODS Cases (n = 29,968) and age-matched and sex-matched controls (n = 138,678) were identified from the regional healthcare database in western Sweden (VEGA). The analyzed risk factors (comorbidities and current medication use) for first-time NL, and socioeconomic factors were retrieved from VEGA and other national Swedish registers. For cases, follow up began on 1 January 2006 or on the first diagnosis of gout if this occurred later, and for controls on their index patient's first diagnosis of gout. Follow up ended on death, emigration or 31 December 2012. Incidence rates (IR) per 1000 person-years and hazard ratios (HR) were calculated. The incidence calculations were performed for cases (regardless of prior NL) and their controls. HRs with first occurrence of NL as outcome were calculated only in those without previous NL. RESULTS In cases there were 678 NL events (IR: 6.16 events per 1000 person-years (95% CI: 5.70-6.64) and in controls 2125 NL events (IR 3.85 events per 1000 person-years (95% CI: 3.69-4.02), resulting in an age-sex-adjusted incidence rate ratio of 1.60 (95% CI:1.47-1.74). Point estimates for predictive factors were similar in cases and controls, except for a significant interaction for losartan which increased the risk of NL only in controls (HR = 1.49 (95% CI: 1.03-2.14). Loop diuretics significantly decreased the risk of NL by 30-34% in both cases and controls. Further significant predictors of NL in gout cases were male sex, diabetes and obesity and in controls male sex and kidney disease. CONCLUSIONS The risk (age and sex adjusted) of NL was increased by 60% in cases compared to controls. None of the commonly used medications increased the risk of NL in gout patients.
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Affiliation(s)
- A J Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden.
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - T Z S Sandström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - P Drivelegka
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - L Björkman
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - E Fjellstedt
- Department of Nephrology and Transplantation, SUS University Hospital, Malmö, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
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Olofsson T, Petersson IF, Eriksson JK, Englund M, Nilsson JA, Geborek P, Jacobsson LTH, Askling J, Neovius M. Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work? Ann Rheum Dis 2017; 76:1245-1252. [PMID: 28073801 DOI: 10.1136/annrheumdis-2016-210239] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration. METHODS Patients with RA, aged 19-62 years, starting their first TNF inhibitor 2006-2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain ≥50% for patients without work ability at bio-start and work ability loss ≥50% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression. RESULTS During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35% for those with disease duration <5 years and 14% for disease duration ≥5 years (adjusted HR 2.1 (95% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start. CONCLUSIONS A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.
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Affiliation(s)
- T Olofsson
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - I F Petersson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - J K Eriksson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - J A Nilsson
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - P Geborek
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation, Research Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Södergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DPM, Nurmohamed MT. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2016; 76:17-28. [DOI: 10.1136/annrheumdis-2016-209775] [Citation(s) in RCA: 683] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/24/2016] [Accepted: 09/08/2016] [Indexed: 12/28/2022]
Abstract
Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.
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Abstract
In twenty-six patients injected with metrizoate during urography, plasma was analyzed for iodine concentration using x-ray fluorescence analysis, and total plasma clearance of contrast medium was calculated. Total plasma clearance of 51Cr-EDTA was also determined, but not simultaneously, in order to find out if the urographic procedure would influence the kidneys to such an extent that the contrast medium clearance value would differ much from the 51Cr-EDTA clearance value. The errors in the method were assessed and the total error of the contrast medium clearance determination was calculated. When comparing 51Cr-EDTA and metrizoate clearance a correlation of 0.94 and a mean ratio of 1.046 (SD 0.138) was found. The assessable errors cannot fully explain the standard deviation, which might indicate a transient change in kidney function related to elements of the urographic procedure such as laxation with possible dehydration and/or the contrast medium dose.
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Boijsen M, Granerus G, Jacobsson L, Björneld L, Aurell M, Tylén U. Glomerular Filtration Rate Estimated after Multiple Injections of Contrast Medium during Angiography. Acta Radiol 2016. [DOI: 10.1177/028418518802900612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In twenty-six patients referred for angiography, clearance of contrast medium was determined with x-ray fluorescence analysis after multiple injections of contrast medium. A formula for correction of the injected amount, which takes into consideration the different times of contrast medium injections, approximating the total injected amount into one injection, was used. A single injection clearance of 51Cr-EDTA was determined at the same time. The results showed a good correlation between the clearance of contrast medium after multiple injections and the 51Cr-EDTA clearance after a single injection (r=0.945). The correlation between contrast medium clearance calculated without correction for the different injection times, and “Cr-EDTA clearance was the same (r=0.946), due to short angiography time and rather low clearance values in our patients. It is concluded that total plasma clearance of contrast medium can easily be estimated after multiple injections. In this way patients with a risk of developing post-angiographic renal failure can be found.
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Boijsen M, Goss F, Jacobsson L, Lamm C, Schlossman D, Björneld L, Tylén U. Cardiac Output Determination during Intravenous Cardioangiography Using X-ray Fluorescence Analysis. Acta Radiol 2016. [DOI: 10.1177/028418518802900407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac output was determined with an indicator dilution technique during digital venous angiography of the left ventricle in 11 patients. The contrast medium injected into the right atrium was used as indicator. During and after the injection of contrast medium one blood sample per second was obtained through a catheter placed in the descending aorta. The samples were analyzed for iodine content with x-ray fluorescence analysis and cardiac output determined ad modum Stewart-Hamilton. Thermodilution was used as a reference method. The results indicate that the indicator dilution method with the use of contrast medium might be used for calibration of videodensitometric methods for blood flow measurements.
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Arvidsson L, Bergström U, Pikwer M, Nilsson JÅ, Jacobsson L, Turesson C. AB0098 Shift Work May Be Associated with An Increased Risk of Rheumatoid Arthritis in Women, but Not in Men. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Frisell T, Di Giuseppe D, Ernestam S, Forsblad-d'Elia H, Jacobsson L, Turesson C, van Vollenhoven R, Askling J. THU0158 Which Patient Characteristics Influence The Choice of Biological Therapy after First TNF Inhibitor Therapy in RA? A Nationwide Study of Channeling in Sweden 2010-2012:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Drivelegka P, Jacobsson L, Sigurdardottir V, Svärd A, Dehlin M. THU0523 Comorbidity Pattern at The Time of Gout Diagnosis: A Population- and Register-Based Case-Control Study from Western Sweden. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dehlin M, Hoxha Ekström E, Petzold M, Strömberg U, Telg G, Jacobsson L. THU0520 Treatment of Gout – Factors Affecting Initiation and Persistence of Urate Lowering Therapy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Dehlin M, Drivelegka P, Sigurdardottir V, Svärd A, Jacobsson L. THU0522 Increasing Incidence of Gout in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Rydell E, Book C, Forslind K, Nilsson JÅ, Jacobsson L, Turesson C. AB0180 Smoking and Persistent Disease Activity Are Associated with An Increased Risk of Rapid Joint Destruction in Patients with Early Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Dehlin M, Drivelegka P, Sigurdardottir V, Svärd A, Jacobsson L. THU0521 Prevalence of Gout and ULT Treatment in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Thorarinsdottir K, Camponeschi A, Cavallini N, Grimsholm O, Jacobsson L, Gjertsson I, Mårtensson IL. CD21(-/low) B cells in human blood are memory cells. Clin Exp Immunol 2016; 185:252-62. [PMID: 27010233 DOI: 10.1111/cei.12795] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 01/01/2023] Open
Abstract
The complement receptor 2 (CR2, CD21) is part of a complex (CD21/CD19/CD81) acting as a co-receptor to the B cell receptor (BCR). Simultaneous triggering of the BCR and CD21 lowers the threshold for B cell activation. Although CD21 is important, B cells that express low amounts or lack surface CD21 (CD21(-/low) ) are increased in conditions with chronic inflammation, e.g. autoimmune diseases. However, little is known about the CD21(-/low) B cell subset in peripheral blood from healthy donors. Here, we show that CD21(-/low) cells represent approximately 5% of B cells in peripheral blood from adults but are barely detectable in cord blood, after excluding transitional B cells. The CD21(-/low) subset can be divided into CD38(-) 24(+) and CD38(-) 24(low) cells, where most of the CD38(-) 24(+) are CD27(+) immunoglobulin (Ig)M(+) IgD(+) and the CD38(-) 24(low) are switched CD27(-) . Expression levels of additional markers, e.g. CD95 and CD62L, are similar to those on classical memory B cells. In contrast to naive cells, the majority of CD21(-/low) cells lack expression of the ABCB1 transporter. Stimulation with a combination of BCR, Toll-like receptor (TLR)-7/8 and interleukin (IL)-2 induces proliferation and differentiation of the CD21(-/low) B cells comparable to CD21(+) CD27(+) memory B cells. The response excluding BCR agonist is not on par with that of classical memory B cells, although clearly above that of naive B cells. This is ascribed to a weaker response by the CD38(-) 24(low) subset, implying that some memory B cells require not only TLR but also BCR triggering. We conclude that the CD21(-/low) cells in healthy donors are memory B cells.
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Affiliation(s)
- K Thorarinsdottir
- Department of Rheumatology and Inflammation Research, University of Gothenburg.,Rheumatology Clinic, the Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Camponeschi
- Department of Rheumatology and Inflammation Research, University of Gothenburg.,Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - N Cavallini
- Department of Rheumatology and Inflammation Research, University of Gothenburg
| | - O Grimsholm
- Department of Rheumatology and Inflammation Research, University of Gothenburg
| | - L Jacobsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg.,Rheumatology Clinic, the Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Gjertsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg.,Rheumatology Clinic, the Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I-L Mårtensson
- Department of Rheumatology and Inflammation Research, University of Gothenburg
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Olsson P, Theander E, Bergström U, Jovinge S, Jacobsson LTH, Turesson C. Multiplex cytokine analyses in patients with rheumatoid arthritis require use of agents blocking heterophilic antibody activity. Scand J Rheumatol 2016; 46:1-10. [DOI: 10.3109/03009742.2016.1161070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- P Olsson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden
| | - E Theander
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden
| | - U Bergström
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden
| | - S Jovinge
- Fred and Lena Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
- Van Andel Institute, Grand Rapids, MI, USA
- Lund Stem Cell Centre, Lund University BMC, Lund, Sweden
| | - LTH Jacobsson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - C Turesson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden
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Feldthusen C, Grimby-Ekman A, Forsblad-d'Elia H, Jacobsson L, Mannerkorpi K. Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: A longitudinal study. J Rehabil Med 2016; 48:469-76. [DOI: 10.2340/16501977-2090] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kristensen LE, Jakobsen AK, Askling J, Nilsson F, Jacobsson LTH. Safety of Etoricoxib, Celecoxib, and Nonselective Nonsteroidal Antiinflammatory Drugs in Ankylosing Spondylitis and Other Spondyloarthritis Patients: A Swedish National Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2015; 67:1137-49. [PMID: 25623277 DOI: 10.1002/acr.22555] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- L E Kristensen
- Copenhagen University Hospital, Frederiksberg, Denmark and Skåne University Hospital, Lund University, Lund, Sweden
| | - A K Jakobsen
- Malmö University Hospital of Skåne, Malmö, Sweden
| | - J Askling
- Karolinska Institutet, Stockholm, Sweden
| | - F Nilsson
- Copenhagen University Hospital, Frederiksberg, Denmark
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Jakobsen AK, Jacobsson LTH, Patschan O, Hopfgarten T, Askling J, Kristensen LE. Surgical interventions for nephrolithiasis in ankylosing spondylitis and the general population. Scand J Urol 2015; 49:486-491. [PMID: 26389795 DOI: 10.3109/21681805.2015.1089523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to estimate rates and type of definitive surgical interventions for nephrolithiasis in Swedish patients with ankylosing spondylitis (AS) compared to the general population. MATERIALS AND METHODS This national prospective cohort study linked data from Swedish population and healthcare registries. Incidence rates and interventions for nephrolithiasis during follow-up in patients with AS were compared to general population comparator (GPC) subjects. RESULTS In total, 8572 AS patients were followed for 49,959 person-years and 39,639 matched GPCs were followed for 225,221 person-years. Mean age at study entry was 46 years [interquartile range (IQR) 36-56 years] and 65% were male. In AS patients with a diagnosis of nephrolithiasis during the study period, 29% (72/250) underwent similar intervention for nephrolithiasis compared to 24% (114/466) GPCs (p = 0.21). The incidence rate ratio (RR) in overall AS patients was 2.9 [95% confidence interval (CI) 2.1-3.8] during a median follow-up of 6.2 years (IQR 3.2-8.6 years). With prior diagnosis of nephrolithiasis, the RR for AS patients compared to GPCs was 3.7 (95% CI 1.8-7.7); without prior nephrolithiasis the RR was 2.1 (95% CI 1.5-3.0). Increasing age [odds ratio (OR) 1.02, 95% CI 1.01-1.03], prior nephrolithiasis diagnosis (OR 3.3, 95% CI 1.97-5.62) and atherosclerotic cardiac disease (OR 2.0, 95% CI 1.03-3.91) were identified as predictors of intervention for nephrolithiasis. CONCLUSIONS Patients with AS have an almost three-fold increased risk of surgical intervention for kidney stones, with similar management, compared to the general population.
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Affiliation(s)
- Ane Krag Jakobsen
- a Department of Urology, Skåne University Hospital, Lund University , Malmö, Sweden
| | - L T H Jacobsson
- b Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg , Gothenburg, Sweden.,c Department of Clinical Sciences, Section of Rheumatology, Lund University , Malmö, Sweden
| | - O Patschan
- a Department of Urology, Skåne University Hospital, Lund University , Malmö, Sweden
| | - T Hopfgarten
- a Department of Urology, Skåne University Hospital, Lund University , Malmö, Sweden
| | - J Askling
- d Clinical Epidemiology Unit and Rheumatology Unit, Department of Medicine (Solna), Karolinska Institutet , Stockholm, Sweden
| | - L E Kristensen
- c Department of Clinical Sciences, Section of Rheumatology, Lund University , Malmö, Sweden.,e The Parker Institute, Department of Rheumatology, Copenhagen University Hospital , Frederiksberg, Denmark
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Jöud A, Olofsson T, Jacobsson L, Karlsson J, Bliddal H, Kristensen L. THU0597 Work Disability in Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis Before and After Start of Anti-Tnf Therapy: A Swedish Observational Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dackhammar C, Forsblad-d'Elia H, Kristensen LE, Lindström U, Ernestam S, Jacobsson L. THU0197 Survival on Drug in Patients with Spondyloarthritis Receiving Certolizumab Pegol. Results from the Nationwide Swedish Rheumatology Quality Register. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rydholm M, Book C, Wikström I, Jacobsson L, Turesson C. FRI0033 Despite Early Improvement, Patients with Rheumatoid Arthritis Still Have Impaired Grip Force 5 Years After Diagnosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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31
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Dehlin M, Stasinopoulou K, Jacobsson L. SAT0354 Validity of Gout Diagnosis in Swedish Primary and Secondary Care. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Lindström U, Forsblad-d'Elia H, Askling J, Kristensen L, Lie E, Exarchou S, Jacobsson L. OP0275 Birth Characteristics and Childhood Infections Predict Ankylosing Spondylitis. A National Register Based Nested Case-Control Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lindström U, Exarchou S, Sigurdardottir V, Sundström B, Askling J, Eriksson JK, Forsblad-d’Elia H, Turesson C, Kristensen LE, Jacobsson L. Validity of ankylosing spondylitis and undifferentiated spondyloarthritis diagnoses in the Swedish National Patient Register. Scand J Rheumatol 2015; 44:369-76. [DOI: 10.3109/03009742.2015.1010572] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Østergaard M, Jacobsson LTH, Schaufelberger C, Hansen MS, Bijlsma JWJ, Dudek A, Rell-Bakalarska M, Staelens F, Haake R, Sundman-Engberg B, Bliddal H. MRI assessment of early response to certolizumab pegol in rheumatoid arthritis: a randomised, double-blind, placebo-controlled phase IIIb study applying MRI at weeks 0, 1, 2, 4, 8 and 16. Ann Rheum Dis 2014; 74:1156-63. [PMID: 25512675 PMCID: PMC4431335 DOI: 10.1136/annrheumdis-2014-206359] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/15/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify the first time point of an MRI-verified response to certolizumab pegol (CZP) therapy in patients with rheumatoid arthritis (RA). METHODS Forty-one patients with active RA despite disease-modifying antirheumatic drug therapy were randomised 2:1 to CZP (CZP loading dose 400 mg every 2 weeks at weeks 0-4; CZP 200 mg every 2 weeks at weeks 6-16) or placebo→CZP (placebo at weeks 0-2; CZP loading dose at weeks 2-6; CZP 200 mg every 2 weeks at weeks 8-16). Contrast-enhanced MRI of one hand and wrist was acquired at baseline (week 0) and weeks 1, 2, 4, 8 and 16. All six time points were read simultaneously, blinded to time, using the Outcome Measures in Rheumatology Clinical Trials RA MRI scoring system. Primary outcome was change in synovitis score in the CZP group; secondary outcomes were change in bone oedema (osteitis) and erosion scores and clinical outcome measures. RESULTS Forty patients were treated (27 CZP, 13 placebo→CZP), and 36 (24 CZP, 12 placebo→CZP) completed week 16. In the CZP group, there were significant reductions from baseline synovitis (Hodges-Lehmann estimate of median change, -1.5, p=0.049) and osteitis scores (-2.5, p=0.031) at week 16. Numerical, but statistically insignificant, MRI inflammation reductions were observed at weeks 1-2 in the CZP group. No significant change was seen in bone erosion score. Improvements across all clinical outcomes were seen in the CZP group. CONCLUSIONS CZP reduced MRI synovitis and osteitis scores at week 16, despite small sample size and the technical challenge of reading six time points simultaneously. This study provides essential information on optimal MRI timing for subsequent trials. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT01235598.
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Affiliation(s)
- M Østergaard
- Copenhagen Center for Arthritis Research, Copenhagen University Hospital at Glostrup, Glostrup, Denmark
| | - L T H Jacobsson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Schaufelberger
- Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Sejer Hansen
- Department of Rheumatology, Gentofte Hospital, Gentofte, Denmark
| | - J W J Bijlsma
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Dudek
- Medica Pro Familia, Warsaw, Poland
| | | | | | - R Haake
- UCB Pharma, Raleigh, North Carolina, USA
| | | | - H Bliddal
- Department of Rheumatology, The Parker Institute, Frederiksberg, Denmark
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Lindström U, Exarchou S, Sigurdardottir V, Sundström B, Askling J, Eriksson J, Forsblad d'Elia H, Turesson C, Kristensen L, Jacobsson L. SAT0098 Validity of Ankylosing Spondylitis and Spondyloarthritis Diagnoses in the Swedish National Patient Register. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thorarinsdottir K, Jirholt P, Jacobsson L, Mårtensson IL, Gjertsson I. THU0496 B-Cell Subpopulations Differ in Rheumatoid Arthritis Patients with and without Autoantibodies. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ljung L, Askling J, Rantapää-Dahlqvist S, Jacobsson L. THU0182 Tumour Necrosis Factor Inhibitors and the Risk of Acute Coronary Syndromes in Rheumatoid Arthritis Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Eriksson J, Jacobsson L, Kristensen LE, Askling J, Neovius M. OP0278 Sick Leave and Disability Pension in Relation to First Initiation of Biologic Therapy across Indications: A Nationwide Cohort Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Østergaard M, Jacobsson L, Schaufelberger C, Sejer-Hansen M, Bijlsma J, Dudek A, Rell-Bakalarska M, Staelens F, Haake R, Sundman-Engberg B, Bliddal H. FRI0246 Magnetic Resonance Imaging-Assessment of Early Response to Certolizumab Pegol in Rheumatoid Arthritis: A Randomized, Double-Blind, Placebo-Controlled Phase Iiib Study Applying Magnetic Resonance Imaging at Weeks 0, 1, 2, 4, 8 and 16. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Löfvendahl S, Petersson I, Haglund E, Bremander A, Jacobsson L, Jöud A. FRI0136 Duration between Symptom Onset and Spondyloarthritis Diagnosis – Changes over A Decade. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jakobsson K, Jacobsson L, Mohammad A, Nilsson JÅ, Warrington K, Matteson E, Turesson C. SAT0271 The Impact of Clinical Features and Corticosteroids on Biopsy Findings in GIANT Cell Arteritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ljung L, Jacobsson L, Rantapää-Dahlqvist S, Askling J. AB0399 Reduced Risk of Acute Coronary Syndromes among Rheumatoid Arthritis Patients with Good Response on Tumor Necrosis Factor Inhibition. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Feldthusen C, Grimby-Ekman A, Forsblad d'Elia H, Jacobsson L, Mannerkorpi K. FRI0568-HPR Variations of Fatigue in Persons with Rheumatoid Arthritis- A 1 Year Longitudinal Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lindegren S, Jensen H, Jacobsson L. A radio-high-performance liquid chromatography dual-flow cell gamma-detection system for on-line radiochemical purity and labeling efficiency determination. J Chromatogr A 2014; 1337:128-32. [PMID: 24630054 DOI: 10.1016/j.chroma.2014.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 11/26/2022]
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Askling J, Ernestam S, Forsblad-d’Elia H, von Vollenhoven R, Jacobsson L, Turesson C, Frisell T. FRI0241 Which ra patients end up starting which biologic? a nationwide assessment of differential channelling to biological treatments in sweden 2006-2011. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ljung L, Rantapää-Dahlqvist S, Askling J, Jacobsson L. SAT0140 The risk of acute coronary syndromes in RA in relation to TNF inhibitors and risks in the general population: A national cohort study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Theander L, Nyhäll Wåhlin BM, Nilsson JÅ, Jacobsson L, Geborek P, Petersson IF, Turesson C. FRI0159 Severe extra-articular manifestations in rheumatoid arthritis: risk factors and incidence in relation to treatment with tnf-inhibitors. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Holmqvist M, Wållberg-Jonsson S, Jacobsson L, Askling J. FRI0122 Thromboembolism in rheumatoid arthritis: Increased risks unrelated to hospitalization and disease duration. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pikwer M, Jacobsson L, Nilsson JÅ, Bergström U, Turesson C. FRI0087 Early menopause predicts a mild type of rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jakobsson K, Jacobsson L, Warrington K, Matteson EL, Turesson C. Biopsy findings in giant cell arteritis: relationship to baseline factors and corticosteroid treatment. Scand J Rheumatol 2013; 42:331-2. [DOI: 10.3109/03009742.2013.775330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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