Scandinavian Journal of Rheumatology最新文献

Objectives: In axial spondyloarthritis (axSpA), patient-perceived quality of life/global functioning and health (GH) can be assessed using disease-specific [Assessment of SpondyloArthrit is international Society Health Index (ASAS-HI)] or generic [(3-level EuroQol 5 Dimensions (EQ-5D-3L)] scores. Our objectives were to explore the link between these scores and to define thresholds for good and poor GH.

Method: We conducted a post-hoc analysis of the cross-sectional ASAS-PerSpA study for patients fulfilling ASAS criteria for axSpA. The ASAS-HI and EQ-5D scores were analysed visually (distribution, scatterplot) and through Spearman correlation and agreement (deciles). To determine cut-offs for good and poor GH on EQ-5D based on the validated ≤5 and ≥12 cut-offs for ASAS-HI, respectively, receiver operating characteristics (ROC) curves and distribution-based methods were applied. Validity was assessed using crude concordance and prevalence-adjusted bias-adjusted kappa; discordance between groups was explored.

Results: In 2651 patients (median age 41.0 years, 66.5% men), the correlation between ASAS-HI and EQ-5D was high (r = -0.73) and agreement (between deciles) was moderate (weighted kappa = 0.51). Both ROC areas under the curve were 0.86; thresholds of 0.69 and 0.54 for EQ-5D were chosen for good and poor GH, respectively. Crude concordances and agreement were satisfactory (0.80-0.81 and 0.60-0.61, respectively). The EQ-5D cut-off for good GH performed better than that for poor GH.

Conclusion: ASAS-HI and EQ-5D were highly correlated but did not fully overlap. We propose EQ-5D thresholds corresponding to the ASAS-HI thresholds for good and poor GH; however, caution is needed when assessing poor GH with EQ-5D. These findings will be useful to compare GH when only one of the outcome measures is available.

Objective: Although the prevalence of psoriatic arthritis (PsA) is considered equal between the sexes, recent PsA studies have reported a female predominance, with female-to-male ratios between 1.2:1 and 2:1. It is not clear whether this is related to a change in the epidemiology of the disease or to different patterns of patients attending outpatient clinics. We aimed to assess the female-to-male ratios in recent PsA studies.

Method: A systematic review of the literature (January 2020 to September 2022) was performed using the PubMed database with keywords and MeSH terms referring to 'psoriatic arthritis'. Randomized controlled trials (RCTs), and cross-sectional, prospective, and retrospective cohort studies involving at least 20 patients and specifying the number of males and females were considered eligible.

Results: From 2800 initially identified articles, 481 eligible studies with 871 144 participants were analysed, revealing a female majority (54.1%). When we evaluated the studies based on their design, we found that female sex was more predominant in each type of design, with retrospective cohort studies having the highest prevalence. According to the number of centres involved, multi-centre studies demonstrated a greater representation of female participants than single-centre studies (54% vs 50%). Regarding the geographical locations, studies conducted in America, Europe, and multinational contexts displayed a female predominance.

Conclusion: In our assessment, RCTs had the closest sex equality, with a slight preponderance of females. The real-life and multi-centre studies had more pronounced female rates, with several differences observed in different geographical locations.

Objective: Patient education is a cornerstone of rheumatology care, enabling patients to effectively and safely manage their condition. Standardized patient knowledge assessments are essential for benchmarking care quality and tailoring education to individual needs. This study aimed to develop and validate Danish and German versions of a patient knowledge questionnaire (PKQ) for rheumatoid arthritis (RA).

Method: Danish and German adaptations from the English version involved a forward-and-backward translation process. Face validity was assessed with patients with RA in Denmark and Germany. Subsequently, the generated PKQ-RA-11 versions were tested in Danish and German RA patients.

Results: The face-validity assessment included 20 patients (10 Danish, 10 German). Adjustments in the Danish version included rephrasing options and aligning with digital patient education content. The German version followed the refined Danish version with necessary cultural adjustments. PKQ-RA-11 comprises 11 multiple-choice questions with a scoring system to minimize guessing. The final PKQ-RA-11 was completed by 175 Danish and 174 German patients; mean completion time was 7.5 and 7.4 minutes, respectively. Mean ± sd baseline PKQ-RA-11 scores were 7.9 ± 1.6 for Danish and 6.2 ± 2.5 for German participants. Longitudinal data from Denmark indicated an increase in knowledge scores following patient education, shown by a mean score of 8.6 ± 1.5, demonstrating the tool's responsiveness to changes in patient understanding of RA.

Conclusion: PKQ-RA-11 is a standardized tool for assessing disease-related knowledge in individuals with RA. It can be used to provide objective and transparent measures of patient understanding in educational programmes, clinical practice, or research.

Objective: The north-south gradient hypothesis proposes that individuals with rheumatoid arthritis (RA) residing in southern regions manifest a younger age of onset and milder disease compared to their northern counterparts. This study aimed to compare treatment-naïve, new-onset RA patients in Denmark and Turkey, examining demographic, clinical, laboratory, and genetic parameters.

Method: Prospective data collection was conducted, with all patients meeting the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Shared epitope (SE) allele carrier frequencies were examined for genetic comparisons between patients and normal controls.

Results: Out of 223 RA patients, 109 were Danish and 114 Turkish. Danish patients exhibited a median age at onset of 60 years, whereas Turkish patients were younger at 51 years (p = 0.0007). The Danish cohort displayed significantly more swollen and tender joints, resulting in higher Disease Activity Score based on 28-joint count-C-reactive protein (DAS28-CRP). Danish RA patients and controls possessed more RA risk-enhancing alleles (S2 + S3P) and fewer risk-protective (S1 + S3D) alleles than Turkish patients and controls.

Conclusion: This study substantiates the north-south gradient hypothesis, highlighting that new-onset RA patients in Denmark tend to experience an older age of onset and more severe disease activity than their Turkish counterparts. Variations in risk-enhancing alleles and fewer risk-protective alleles in Danish patients and controls are associated with these distinctions. Future research should investigate the genetic and environmental factors underlying these regional disparities, exploring their persistence in the long-term course of the disease through follow-up studies.

Objective: Inverse associations between systemic inflammation and cholesterol ('the lipid paradox') have been reported in rheumatoid arthritis (RA) and, in established axial spondyloarthritis (axSpA), but little is known about this relationship in early axSpA, which is the focus of the present study.

Method: In the Swedish part of the SPondyloArthritis Caught Early (SPACE) cohort (patients with chronic back pain for ≥3 months, ≤2 years; age at onset <45 years), serum levels of total cholesterol (TC) and apolipoproteins ApoA1 and ApoB were measured at inclusion, together with parameters reflecting inflammatory disease activity [C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and sacroiliitis by magnetic resonance imaging (MRI) following Assessment of SpondyloArthritis international Society (ASAS) criteria]. All patients included in the analysis either had axSpA based on a high physician's level of confidence or fulfilled the ASAS criteria for axSpA. Associations between lipids/lipoproteins and inflammation were assessed using multivariable linear regression models.

Results: In the 64 patients included, there were inverse associations for CRP with TC, ApoA1, and ApoB in age-sex-adjusted models. The negative associations with CRP remained significant for TC and ApoB in multivariable models adjusted for age, sex, BASDAI, and current smoking (p = 0.048). There were no significant associations for the lipid parameters with BASDAI or inflammation on MRI of the sacroiliac joints.

Conclusion: Inverse associations between systemic inflammation and lipids, particularly TC and ApoB, are present in early axSpA, similar to those shown for other inflammatory joint diseases. These patterns must be considered when including lipids in the evaluation of cardiovascular disease risk.

Objective: To investigate a potentially primary involvement of the facet joints (FJs) in axial spondyloarthritis (axSpA) development, by studying inflammatory and structural magnetic resonance imaging (MRI) and radiographic changes in the sacroiliac joints (SIJs) and lumbar spine, focusing on FJs, in newly diagnosed radiographic axSpA over a 3 year period.

Method: Twenty-four patients (14 male, 10 female; mean ± sd age 33.75 ± 8.6 years) with radiologically and MRI-confirmed axSpA according to modified New York and Assessment of SpondyloArthritis international Society criteria, with a symptom duration < 5.5 years at baseline (t0), were followed up after 3 years (t1) by rheumatologists and radiologists with axSpA MRI experience > 15 years. The Berlin MRI score was extended by an inflammation score of the lumbar FJs. Clinical assessments were performed.

Results: Radiographic SIJs and syndesmophyte progression increased significantly between t0 and t1. MRI progression of the SIJs between t0 and t1 showed increasing bone marrow oedema (BME), significant fat lesion progression, and significant increases in sclerosis and erosion. In the lumbar spine, BME and fat lesions decreased while erosions in the vertebral units (VUs) significantly increased. Facet joint inflammation (FJI) in t0 significantly influenced MRI changes in VU bone proliferation at t1. Biologicals had no effect on MRI changes from t0 to t1.

Conclusions: Structural MRI changes in the SIJs and lumbar VUs, and radiographic axSpA progression, developed significantly within 3 years. MRI-detected lumbar FJI in early disease is associated with MRI signs of VU bone proliferation, indicating a risk of potential ossification.

Objective: To evaluate the cost-effectiveness of longstanding personalized exercise therapy compared with usual care in people with rheumatoid arthritis (RA) and severe functional disability.

Method: In this cost-utility analysis of a randomized controlled trial (n = 215), with 1 year follow-up, the study population comprised individuals with RA and reported severe difficulties in performing basic daily activities. Assessments were at baseline, 12, 26, and 52 weeks, with measurements of costs including medical and non-medical costs as recorded by patients and healthcare providers. Quality-adjusted life-years (QALYs) were estimated using the EuroQol 5 dimensions 5 levels (EQ-5D-5L) and EuroQol Visual Analogue Scale (EQ-VAS). Costs and QALY differences were analysed according to the intention-to-treat principle using cost-effectiveness acceptability curves.

Results: The 1 year societal costs were non-significantly in favour of the usual care group, with a small difference of €180 [95% confidence interval (CI) €-4493 to €4852]. The QALYs were non-significantly in favour of the intervention group, by 0.02 according to the EQ-5D-5L (95% CI -0.05 to 0.09) and by 0.04 according to the EQ-VAS (95% CI 0.00 to 0.08). For a willingness-to-pay threshold of €50 000 per QALY, the intervention was the cost-effective strategy with 60% certainty.

Conclusion: This economic evaluation showed no clear economic preference for either group, as the intervention costs were higher in the intervention group, but partly compensated by other cost savings and improved QALYs. Despite severe RA, patients had better clinical outcomes compared with usual care, suggesting no economic reasons to refrain from exercise therapy.

Trial registration number: Netherlands Trial Register NL8235, included in the International Clinical Trial Registry Platform (ICTRP) (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235).