Scandinavian Journal of Rheumatology最新文献

Objectives: Early diagnosis is essential to the prognosis of rheumatoid arthritis (RA), but little is known about patients' perceptions of the first symptoms. Illness representations shape patients' help-seeking behaviour. The Illness Perception Questionnaire - Revised (IPQ-R) can measure these, allowing us to understand the patients' role in diagnostic delays. The aim of this study was to explore the connection between RA patients' perceptions of initial symptoms and the time taken to seek help from a general practitioner (GP).

Method: 1163 recently diagnosed individuals with RA, identified from the Danish Rheumatology Database, DANBIO, filled out a questionnaire. We used adjusted multivariable linear regression to calculate the median ratio (MR) for those with the highest scores within each IPQ-R subscale compared to the lowest scores.

Results: Altogether, 404 patients answered the questionnaire. The overall median patient delay was 63 [interquartile range (IQR) 17-214] days. Younger patients experienced longer delays than older [84 (IQR 30-361) vs 54 (14-162) days]. High expectations of treatment control led to 54% lower median time to first GP contact compared to low expectations [adjusted median ratio (MR) 0.54, 95% confidence interval (CI) 0.29-0.99]. High perceptions of symptom variability at disease onset led to a higher median time to first GP contact (adjusted MR 1.61, 95% CI 0.93-2.78).

Conclusion: People with RA symptoms may delay seeing their GP due to low expectations of treatment effectiveness and significant symptom variability. Information campaigns could educate patients on recognizing warning signs and encourage them to seek medical attention.

Objective: Many people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) face limitations in societal participation, including work. Supervised exercise therapy improves symptoms and physical functioning, but its impact on work outcomes is unclear. This systematic review aims to examine the reporting of and effects on work outcomes in exercise therapy trials.

Method: Eight databases were searched up to February 2024 for randomized controlled trials (RCTs) evaluating the (cost-)effectiveness of supervised exercise therapy interventions in adults with RA/axSpA. The reporting of work and other social participation outcomes, the content of the exercise therapy intervention, and their effects on work outcomes were extracted. Within- and between-group results on work outcomes were summarized.

Results: In total, 41 (22 RA, 19 axSpA) RCTs on supervised exercise therapy were included, none of which was specifically targeted at work. Two RCTs in people with RA included work outcomes (absenteeism and employment hours). None of the RCTs in axSpA reported work outcomes. A work-related item or subscale was reported in 6/22 of the RA and 7/19 of the axSpA trials. Outcomes on societal participation (including work) were reported in 13/22 of the RA and 18/19 of the axSpA trials. Effects on work were reported on different outcomes and results were inconclusive.

Conclusion: Work outcomes are rarely reported in exercise therapy trials in people with RA/axSpA. To determine the effects of supervised exercise therapy on work, future studies should include work outcomes. International consensus on which outcome to use could increase the comparability of results.

Objective: People with hand osteoarthritis (OA) report decreased ability to perform activities of daily living (ADL). However, few are referred to occupational therapy by their general practitioner. This study aimed to identify clinical predictors of decreased ADL ability in people with hand OA as markers of the need for referral to occupational therapy.

Method: A cross-sectional study was conducted as an independent add-on to a randomized controlled trial of adults with hand OA (the COLOR trial). Measures of self-reported (ADL Interview) and observed (Assessment of Motor and Process Skills) ADL ability were collected. Data representing potential predictors identified by stakeholders were extracted from the COLOR trial: age, sex, symptom duration, hand OA type, grip strength, pain, stiffness, function, illness perception, and health-related quality of life. Correlational analyses and prediction models were used.

Results: Correlations between ADL ability and potential predictors in the 62 participants were low to negligible (r < 0.5). Based on root mean square error (RMSE) estimates, prediction models for observed ADL motor (RMSE = 0.3) and ADL process (RMSE = 0.2) ability were more accurate than for self-reported ADL ability (RMSE = 0.6). However, these variables only predicted observed ADL motor and ADL process ability with 16% (adjusted R_s = 0.163) and 12% (adjusted R_s = 0.120) accuracy, respectively.

Conclusion: The findings suggest that variables representing body functions, perceived health, and quality of life do not predict ADL ability among people living with hand OA. An adequately powered study is recommended to explore this topic further.

Objective: We aimed to investigate the cardiovascular profile, including risk factors and cardiovascular abnormalities, in patients with idiopathic inflammatory myopathies (IIMs).

Method: In this cross-sectional study, 109 IIM patients and 20 age- and gender-matched healthy controls were enrolled and underwent electrocardiographic and transthoracic echocardiographic examinations. We analysed blood levels of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP), assessed IIM disease-specific features, and evaluated the medical history of cardiovascular risk factors. IIM patients were stratified into two groups: those with previous cardiac involvement and those without.

Results: IIM patients had a higher body mass index (BMI) and a greater prevalence of diabetes mellitus and dyslipidaemia than healthy controls (p = 0.023, p = 0.024, and p = 0.042, respectively). They also showed significantly higher rates of arrhythmia, cardiac axis deviation, negative T-waves, and suspected pulmonary hypertension, along with elevated NT-proBNP levels (p = 0.041, p = 0.004, p = 0.041, p = 0.012, and p = 0.034, respectively). A significantly higher proportion (p = 0.037) of immune-mediated necrotizing myopathy (IMNM) subtype (50%) was found among IIM with previous cardiac involvement compared to those without (20%). cTnI levels were significantly higher in IIM with cardiac involvement than in IIM without cardiac involvement (p = 0.009).

Conclusions: Cardiovascular complications in patients with IIM may result from an increased prevalence of traditional cardiovascular risk factors, such as higher BMI, diabetes mellitus, and dyslipidaemia, and/or from direct cardiac involvement, such as previous myocarditis. Cardiac involvement in IIM is notably associated with the IMNM subtype.

Objective: The aim of this study was to investigate associations between sex and treatment response and persistence in patients with rheumatoid arthritis (RA) initiating their first tumour necrosis factor inhibitor (TNFi).

Method: This Danish nationwide cohort study included RA-patients starting their first TNFi treatment between 2006 and 2022. Overall and age-specific treatment response was compared across sexes at 4 and 12 months. Treatment persistence was investigated using survival analysis.

Results: In total, 7789 RA-patients were identified; 75% were females. Females had slightly smaller ∆DAS28-CRP compared to males after 12 months, mainly due to less reduction of swollen joint count (SJC) and CRP. At 12 months the crude proportion of males with good response was higher (62%) than in females (55%), adjusted RR 1.14 (95% confidence interval (CI) 1.06; 1.23). The adjusted hazard ratio for treatment termination within first year was 0.82 (95% CI 0.73; 0.92) in males versus females. The median treatment persistence for individuals aged <50 years was 1.6 years (95% CI 1.4; 1.8) in females and 3.2 years (95% CI 2.6; 4.0) in males. The same difference was not seen in patients aged > 50 years.

Conclusion: Despite similar baseline disease activity, females had a lower chance than males of achieving good response 4 and 12 months after starting treatment with first TNFi. The sex difference in DAS28-CRP improvement is caused by a greater decrease in CRP and SJC among males. Further, females had an increased risk of discontinuation, especially among patients aged < 50 years.

Objective: To evaluate the prognostic significance and safety of therapeutic plasma exchange (TPE) in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) with severe organ or system involvement.

Method: Data of patients diagnosed with AAV between 2011 and 2021 were evaluated retrospectively. Patients with baseline estimated glomerular filtration rate (eGFR) ≤ 50 mL/min/1.73m² or diffuse alveolar haemorrhage (DAH) were included in the analysis (n = 71). Patients who underwent TPE were compared with others in the groups formed after two models of propensity score matching (PSM). Initial PSM was performed according to the presence of DAH, age, gender, eGFR, and BVAS. A data-driven approach was conducted for the second model.

Results: In the initial PSM cohort (n = 48), the remission rate at 6 months was lower in the TPE group (p = 0.04). There were no significant differences in mortality and improvement of eGFR at 6 and 12 months. No severe complications due to TPE were observed. Rates of serious infections (SIs) and end-stage renal disease (ESRD) at 12 months were higher in the TPE group (p = 0.016 and 0.02, respectively). Data-driven PSM analysis (n = 44) revealed no significant differences between groups.

Conclusion: We did not demonstrate a positive effect of TPE on remission, ESRD, and mortality in AAV in this study. Despite low short-term complication rates, the increased risk of SIs possibly associated with ESRD was remarkable. The limited long-term benefits of TPE should be carefully weighed against its associated risks when selecting patients for treatment.

Objective: Recent studies suggest that dyslipidaemia may play a critical role in the progression of cardiovascular disease in Takayasu arteritis (TA), although the exact relationship between dyslipidaemia and TA disease activity remains unclear, which is the focus of this study.

Method: We evaluated dyslipidaemia and atherosclerosis in a cohort of untreated female patients. Fifty untreated female patients with TA (median age 30 years) and 98 healthy controls matched for age and body mass index (median age 30 years) were assessed for lipid profiles [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), ApoB, ApoE, lipoprotein(a)], inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)], and atherosclerotic plaque frequency.

Results: TA patients exhibited significantly higher levels of TG and the non-HDL-C/HDL-C ratio than the control group, whereas TC, HDL-C, LDL-C, and ApoA1 levels were significantly lower. Pearson's correlation analysis indicated a positive correlation between CRP and ApoB, as well as the non-HDL-C/HDL-C ratio, and negative correlations with TG, HDL-C, and ApoA1. Atherosclerotic plaques were detected in 14.3% of the TA patients. Multivariate regression analysis revealed that the presence of atherosclerotic plaques was associated only with age, independent of inflammatory markers and lipoprotein levels.

Conclusion: The results of this study indicate that untreated female TA patients exhibit a markedly dysregulated serum lipid profile. Atherosclerosis in early TA was not related to lipids or markers of inflammation.