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  • 1.
    Andersson, Maria
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden.
    Reasons to stop drinking alcohol among patients with rheumatoid arthritis – a mixed method study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no Suppl 2, 1295Article in journal (Refereed)
    Abstract [en]

    Background: Studies of alcohol use in patients with rheumatoid arthritis are sparse and studies of why patients choose to stop drinking alcohol in particular.

    Objectives: The aim of the current study was twofold: first to identify patients with RA who stopped drinking alcohol and compare those to patients drinking alcohol, and second, to explore reasons to stop drinking alcohol.

    Methods: In 2010 a self-completion postal questionnaire was sent to all 2,102 prevalent patients in the Better anti-rheumatic farmacotherapy (BARFOT) study enquiring about disease severity, physical function (HAQ) and health related quality of life (EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors e.g. alcohol. The questions assessing alcohol included the question “Have you stopped drinking alcohol?” and an open question “Why have you stopped drinking alcohol?” A mixed method design was used and 1512 patients had answered the alcohol questions and was included in the study of those 86 had stopped drinking alcohol. Seventy-one patients answered the open question and their answers were analyzed with qualitative content analysis (1).

    Results: Comparing patient with RA using alcohol or not, the patients who stopped drinking alcohol was older median age (min-max) 69 (36–90) vs. 66 (23–95), p=0.011, more men 42% vs. 29%, p=0.015, had worse physical function, median HAQ (min-max) 0.50 (0–3.00) vs. 1.00 (0–2.75), p<0.001, worse health related quality of life, median EQ5D (min-max), 0.69 (-0.59–1.00) vs. 0.76 (-0.02–1.00), p<0.001, worse self-perceived health, median PatGA (min-max) 5 (0–10) vs. 3 (0–10), <0.001, more pain, median (min-max) 5 (0–10) vs. 3 (0–10), p<0.001, and more fatigue median (min-max) 6 (0–10) vs 4 (0–10), p<0.001. There were no differences between the groups regarding disease duration, swollen and tender joints. The qualitative content analysis resulted in five categories describing the reasons for patient with RA to stop drinking alcohol: disease and treatment, health and wellbeing, work and family, faith and belief and dependences and abuse.

    Conclusions: Patients with RA who stopped drinking alcohol have a lower physical function, health related quality of life, self-perceived health and more pain and fatigue comparing to patients with RA drinking alcohol. The reasons to stop drinking alcohol were of different nature such as medical, physical, mental, social and spiritual

  • 2.
    Arvidsson, Susann
    et al.
    Department of Research and Development, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Bergman, Stefan
    Department of Research and Development, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Chronic musculoskeletal pain and sleep disturbances as predictors for lower vitality measured by the short form 36 (SF-36) - A eight-year follow up study2006In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 65, no Suppl. 2, 656-656 p.Article in journal (Other academic)
    Abstract [en]

    Background: Subjects with chronic musculoskeletal pain or sleep disturbances have been shown to have a poor healthstatus as measured by the SF-36 health survey. Fatigue is commonly reported by subjects with chronic musculoskeletal pain and sleep disturbances. There is little known about the temporal relationship between chronic pain, sleep disturbances and changes of vitality.

    Objectives: The aim of this study was to evaluate the predictive value of chronic musculoskeletal pain and sleep disturbances with regard to changes in vitality as measured by SF-36 over an eight year period.

    Method: An eight year follow up of 2 425 subjects aged 20-74 from the general population that in 1995 answered the same postal questionnaire. The questionnaire assessed chronic musculoskeletal pain, sleep disturbances, and included the SF-36 health survey. Pain was considered "chronic" if persistent for three months or more. Sleep disturbances assessed were difficulty in falling asleep, frequent awakenings, early awakenings and not feeling rested. Main outcome measure was change of vitality as measured by SF-36 in those that at baseline reported vitality over the median value. Statistical analyses were done with use of logistic regression. Besides the studied variables, the logistic regression analyses also controlled for gender, age, socio-economic group, and the use of analgesics and sleeping pills.

    Results: At baseline 1212 subjects reported a vitality score on SF-36 above the median score of 75. There were 943 subjects (78%) responding at the eight-year follow up. Chronic pain at baseline predicted (OR=1,64, 95% CI 1,14-2,36%, p=0,01) worsening of vitality over time. Loss of vitality was also predicted by moderate problems with falling asleep (OR=2,17, 95% CI 1,31-3,60%, p<0,01), and problems with not feeling rested (moderate problems OR=2,08, 95% CI 1,23-3,50%, p=0,01, and major problems OR=4,76, 95% CI 1,53-14,78%, p=0,01).

    Conclusion: Loss of vitality in SF-36 over an eight-year period was predicted by chronic musculoskeletal pain, problems with falling asleep and problems with not feeling rested. Problems with frequent awakenings and early awakenings did not predict lower value of vitality over an eight-year period. It could thus be important to attend to sleeping problems and especially the feeling of not being rested in subjects with chronic musculoskeletal pain.

  • 3.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Feeling rested predicts good health in subjects with and without chronic musculoskeletal pain2008In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 67, no Suppl. II, 552-552 p.Article in journal (Refereed)
    Abstract [en]

    Background: Musculoskeletal pain is a public health problem and a common cause for people to seek health care. It has also been shown that people with musculoskeletal pain estimates their health-related quality of life very low compared to a pain free population. Earlier studies have primarily looked at risk factors and there are little known about health predicting factors in a general population.

    Objectives: To investigate the associations between suggested health factors and health-related quality of life at baseline and in an eight-year follow up in subjects with and without chronic musculoskeletal pain.

    Methods: A longitudinal study in a Swedish general population (N=1 849) with a postal questionnaire at baseline 1995 and at a follow up 2003. Subjects were divided into two groups, according to their response about chronic musculoskeletal pain at baseline. Health-related quality of life was assessed by the SF-36 together with suggested health factors. The associations between the dependent variables (SF-36 subscales) and the independent variables (i.e. the suggested health factors; socioeconomic status, immigrant status, emotional support, regularly exercise, sleep structure, feeling rested, smoking and alcohol habits) were estimated by OR and 95% CI calculated by multivariable logistic regressions, with adjustment for all health factors, age, sex and baseline SF-36 values.

    Results: The most consistent finding for subjects with and without chronic musculoskeletal pain at baseline and in the eight-year follow up was a statistical significant (p<0.05) better health outcome in SF-36 subscales for subjects that were feeling rested at baseline. At baseline feeling rested was associated with having a health status better than the mean score in seven SF-36 subscales for both subjects with chronic pain (OR 1.5 (95% CI 1.0-2.3) – OR 4.4 (95% CI 2.9-6.6)) and subjects without chronic pain (OR 2.6 (95% CI 1.6-4.1) – OR 4.4 (95% CI 3.0-6.5)). At the follow up feeling rested predicted a better outcome in five subscales for subjects with chronic pain (OR 1.6 (95% CI 1.0-2.4) – OR 2.2 (95% CI 1.4-3.6)) and in six subscales for subjects without chronic pain (OR 1.6 (95% CI 1.0-2.5) – OR 2.7 (95% CI 1.8-4.1)). Other factors that in some aspects predicted a better outcome were belonging to higher socioeconomic group, being an inborn Swede, having emotional support, having good sleep structure, never being or being a former smoker, and regularly drinking alcohol.

    Conclusion: ''Feeling rested'' was the most consistent factor predicting a good health outcome, both in subjects with and without chronic musculoskeletal pain, and should be attended to in health promotion work. Emotional support, sleep structure, smoking and alcoholic habits also appears to be important health factors to take into account.

  • 4.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bengtsson-Tops, Anita
    School of Health Sciences & Social Work, Växjö University, Växjö, Sweden.
    People with Rheumatic Diseases Experiences of Health-Promoting Self-Care2010In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 69, no Suppl. 3, 743-743 p.Article in journal (Refereed)
    Abstract [en]

    Background: People with rheumatic diseases estimate their health status low. The health status and health belief are influencing the choice of self-care behaviours. Self-care behaviours are common and could prevent loss of valued life activities and health. Little is known of how people with rheumatic diseases experience self-care.

    Objectives: To describe people with rheumatic diseases experiences of health-promoting self-care.

    Methods: The study had a phenomenological approach based on a reflective life-world perspective. Data were gathered by unstructured and open-ended interviews with 12 individuals with various diagnoses of rheumatic diseases.

    Results: For people with rheumatic diseases, self-care was a way of life and implied being ready at all times to understand and respond to signals from the lived body. Self-care was experienced as an internal dialogue within the lived body but also as an external dialogue with the immediate environment. Self-care could also be described as a power struggle where the individuals strived and forced themselves to fight the diseases and its concrete consequences. The self-care also required that choices were made. Crucial for the choices were trust in oneself and belief in one's own ability to chosen health-promoting self-care. The individual prioritised self-care that was experienced as a beneficial and/or a reward for the lived body.

    Conclusion: People with rheumatic diseases experienced self-care as a way of life and that it meant to be ready at all times to understand and respond to signals that the lived body sends out. Self-care required dialogue, power struggle and choice. This knowledge ads to a fuller understanding of factors that from a patient perspective are important for health when living with a chronic rheumatic disease.

    Disclosure of Interest: None declared

  • 5.
    Arvidsson, Susann
    et al.
    Rheumatology, Spenshult Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Rheumatology, Spenshult Hospital, Oskarström, Sweden.
    Petersson, Ingemar
    Rheumatology, Spenshult Hospital, Oskarström, Sweden.
    In Patient Team Care Improved Health-Related Quality of Life for Patients with Rheumatic Diseases over Three and Six Months2006In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 65, no Suppl. 2, 274-275 p.Article in journal (Refereed)
    Abstract [en]

    Background: For measuring outcomes in team care, different aspects in the ICF (International Classification of Functioning) are relevant. Health-related quality of life as measured by SF-36 includes aspects of body function as well as activity and participation. HADS (Hospital Anxiety and Depression Scale) reflects more personal factors. Individuals with rheumatic diseases experience lower degree of health-related quality of life, compared with the general population.

    Objectives: To examine health-related quality of life as well as anxiety and depression in patients with rheumatic diseases directly after and three and six months after a period of three weeks in patient team based multiprofessional rehabilitation at a unit specialised for patients with different rheumatic diseases.

    Method: Quasi-experimental design with pre- and post-test in consecutive adult patients (Rheumatoid arthritis n=23, Spondylarthritides n=14, Osteoarthritis n=6, Other inflammatory rheumatic diseases n=10), one week before(n=55), one week after(n=53), three (n=40) and six months (n=36) after a period of three weeks of in patient team based multiprofessional care at a unit for rheumatic diseases. The instruments used for outcome measurements were the Short Form 36 Health questionnaire (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was done with the SPSS package 13.0. Differences between groups were evaluated with Wilcoxon signed rank test.

    Results: The patients reported worse outcome on the eight health scales in SF-36, at baseline and one week, three and six months after the rehabilitation, when comparing with the norm for the Swedish population. The mean values for SF-36 improved in all eight subscales one week after the rehabilitation period and six of the health scales obtained statistically significant improvement (p<0.05). Three and six months later there was still a statistically (p<0.05 for 3/8 subscales; Role Physical (RP), Vitality(VT) and Mental Health(MH)) and/or clinically significant (5/8 subscales; Physical function(PF), Bodily Pain(BP), General Health(GH), Social Fundtioning(SF) and Role Emotional(RE)) improvement as compared to the levels before the rehabilitation period. The levels for anxiety and depression as measured by HADS improved significantly (p<0.05) one week after the rehabilitation period as compared to baseline. Three and six months after the rehabilitation period, the levels were the same as at baseline.

    Conclusion: Earlier studies and this study have shown that people with rheumatic diseases experience reduced health-related quality of life and increased anxiety and depression. The result from this study showed that after a period of three weeks in patient team based multiprofessional rehabilitation, the experience of health-related quality of life was improved also after three and six months whereas the improvement in anxiety and depression returned to baseline after three and six months. Thus, improvements in health-related quality of life seem to reflect other aspects of the disease consquences than anxiety and depression.

  • 6.
    Arvidsson, Susann
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Nylander, Maria
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    People's perceptions of their phone call with rheuma directly, a rheumatic diseases helpline2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 1544-1545 p., AB1238-HPRArticle in journal (Refereed)
    Abstract [en]

    Background Information on rheumatic diseases is often complex to understand or scary, and additional support is often necessary. Rheuma Directly (RD) is a helpline with specially trained nurses on rheumatic diseases, funded by the Swedish Rheumatism Association and Spenshult Research and Development Centre. Little is known of how people calling a helpline perceive the contact.

    Objectives To describe the variation in how people perceive the contact with the helpline RD.

    Methods The study had a descriptive, qualitative design with a phenomenographic approach and was carried out by means of 27 semi-structured telephone interviews. The informants were 22 female and 5 men, and their ages ranged from 22 to 89 years (mean 54 years).

    Results The informants called RD when they had problems getting answers to their questions through the Internet or from healthcare professionals. Three different description categories emerged: Specific competence, Constructive dialogue, and Applicability. The informants' perceived Specific competence when the nurses were knowledgeable, the call was complementary to previously received information and when the informants had greater knowledge after the contact with RD. They perceived that it was a Constructive dialogue when they got someone to discuss with, a “sounding board”, and perceived emotional support, felt reassured and were satisfied with the answer. The informants perceived Applicability because RD was available and they could make different choices according to their own desire; before (how and when they would contact RD), during (what to tell and what question they would ask) and after (how and what they would do after the contact with RD).

    Conclusions People calling RD perceived that the telephone call with the nurses meant meeting specific competence, gaining constructive dialogue and that the helpline was applicable. This knowledge ad to a fuller understanding of factors that from a caller's perspective, are important when calling a helpline with specially trained nurses on rheumatic diseases. © 2017, Published by the BMJ Publishing Group Limited.

  • 7.
    Bergman, Stefan
    Research & development centre Spenshult, Oskarström, Sweden.
    Co-Ordinating Care: The Role of the General Practitioner2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A20-A20 p.Article in journal (Other academic)
    Abstract [en]

    The general practitioner (GP) has a unique role in the care of people with rheumatic disorders. The main possibilities lie within early detection of the rheumatic disease and knowledge in how to diagnose and treat common co-morbidities. The GP could also be a link between specialised rheumatology care and paramedical resources in primary care. There are however great differences in how care is organised in different countries and thus how the possibilities within primary care are utilised. Lessons could be learned from how GPs work in collaboration with rheumatologists and other caregivers in different settings, with the patients' best in focus.

  • 8.
    Bergman, Stefan
    Research and development centre Spenshult, Oskarström, Sweden & Dept. of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Number of Painful Regions and their Distribution Predicts Outcome of Pain in the General Population2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, Suppl. 3, A98-A98 p.Article in journal (Refereed)
    Abstract [en]

    Background: Pain reported by a mannequin or predefined figure with body regions is important in evaluation of pain impact and development in general practice. Such reports are also of importance in classification of pain as being regional or widespread, as part of for example the 1990 ACR criteria for fibromyalgia. New proposed criteria for fibromyalgia have however omitted the evaluation of how painful regions are distributed and only focus on the number of regions.

    Objectives: The aim was to study if the number of painful regions and their distribution (regional or widespread) independently predicted chronic widespread pain in a 12 year follow up of a cohort from the general population.

    Methods: Within the Epipain-project a cohort of 2425 subjects from the general population in south Sweden answered a postal survey on pain and health. The questionnaire included a pain mannequin with 18 predefined regions. The number of regions was calculated and their distribution was analyzed with regard to ACR 1990 criteria for chronic widespread pain (CWP). Subjects were classified as having no chronic pain, chronic regional pain (CRP) or CWP. The survey was repeated after 3, 8 and 12 years. Odds ratios (Ors) for the independent variables pain distribution (NCP, CRP or CWP) and number of painful regions (0-18) with regard to report of CWP at follow up were analyzed with multiple logistic regression.

    Results: Report of CWP vs. NCP at 3, 8 and 12 year follow was independently predicted by both pain distribution and the number of painful regions. ORs for subjects with CWP at baseline were 6.3 (95% CI 2.3-17.2), 5.0 (95% CI 1.9-13.3), and 4.0 (95% CI 1.6-9.7) at respectively follow up. Corresponding ORs for number of painful regions at baseline were 1.4 (1.3-1.6), 1.4 (1.2-1.5), and 1.3 (1.2-1.4).

    Conclusions: Both the number of painful regions and their distribution (widespread or not) independently contributed to the prognosis for reporting chronic widespread pain in a 12 year follow up of pain development in the general population. This added prognostic value of pain distribution should be considered in evaluation of pain mannequins in general practice.

  • 9.
    Bergsten, Ulrika
    et al.
    Rheumatology unit, Sahlgrenska University Hospital, Göteborg, Sweden & R&D-Centre, Spenshult, Oskarström, Sweden.
    Bagge, Jan
    The Sweden Rheumatism Association, Stockholm, Sweden.
    Åkerhielm, Caroline
    The Sweden Rheumatism Association, Stockholm, Sweden.
    Bergman, Stefan
    R&D-Centre, Spenshult, Oskarström, Sweden.
    Dignity, Identity and Quality of Life – In Focus when Patients Set the Research Agenda2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A776-A776 p.Article in journal (Refereed)
    Abstract [en]

    Background: The rheumatic diseases are usually long lasting and affect the daily life in form of pain, stiffness and fatigue. Patients' perceptions of their illness and its consequences differ to some extent from the established medical view. This also means that there could be unidentified areas of research that could be of great value for the patients. The Swedish Rheumatism Association (the national patient organization) and Research- and Development-center Spenshult decided to carry out a joint project to develop patient initiated research in order to increase knowledge and to improve the care of the rheumatic diseases.

    Objectives: The aim of the project was to develop and describe new research areas from a patient perspective that not had been adequately covered previously and to initiate projects that patients consider to be of importance for development of rheumatology care.

    Methods: A project team was formed consisting of five research partners (specially educated people with personal experience of a rheumatic disease) and a project manager. The project team used a structured method throughout the project in order to maintain focus at the patient perspective. The structured method that was used – The dialogue model – is developed with the purpose to promote the dialogue between different stakeholders such as patients and researchers. During the project there were other members of the local rheumatic association engaged in the form of focus groups. Experiences were communicated in four focus group interviews and by individuals that had experience of rheumatic disease. The material was analyzed by content analysis research method.

    Results: The analysis resulted in several research ideas and research areas that were important from the patient perspective. Most of them focused on the patient's dignity, identity and quality of life. The repeated theme was: How can a person maintain or improve their quality of life despite chronic illness? Persons who participated in the focus groups communicated their experiences of having a rheumatic disease and the central point was how life changes when you suffer from a chronic disease and that the “whole life” was affected to different degrees. It was also clear that there are shortcomings in health care and society in terms of providing support and assistance to the person with a rheumatic disease.

    Conclusions: A structured approach involving research partners and members of patient associations generated several new research ideas that now are planned to be developed further. The patient initiated research agenda complements the established medical view and could improve the knowledge and understanding of having a rheumatic disease and an opportunity to develop rheumatology care to be more person-centered.

  • 10.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Forslind, K.
    Lund University, Lund and Helsingborg, Sweden & Helsingborg's hospital, Helsingborg, Sweden.
    Eberhardt, K.
    Lund University, Lund, Sweden.
    Andersson, M.
    Lund University, Lund, Sweden & Spenshult Research and Devlopment Centre, Halmstad, Sweden.
    Functional Impairment in Patients with RA in an Eight Year Perspective2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 1513-1514 p.Article in journal (Refereed)
    Abstract [en]

    Background: In people with Rheumatoid arthritis (RA) impaired physical functioning is an acute as well as long term effect of the disease. Observational performance tests reflecting range of motion in upper as well as in lower extremities should be easy to perform in the clinic as well as in research as a complement to self-reported measures of physical functioning. The Signal Of Functional Impairment (SOFI)1 is a performance test which so far has been applied only in Sweden but commonly used in the clinic and in long term follow-up clinical studies.

    Objectives: The aim was to study performance-based function assessed with SOFI over 8 years and, secondly, to study which items included in SOFI that were associated with change in functioning over time.

    Methods: An inception cohort of 1 052 patients with early RA, from the BARFOT-study, recruited 1992–2006 was investigated, mean (SD) age was 54 years (14), 70% were women. The patients were followed by a structured protocol at baseline, 3 and 6 months and at 1, 2, 5, and 8 years. SOFI consists of 3 parts measuring hand, arm (upper), and leg (lower) function (1). Hand function is tested by 4 movements; cylinder grip (H1), pen grip (H2), pincer grip (H3) and opposition of the thumb (H4). Arm function is assessed by 3 movements; hand behind the head and the ability to touch the cervical spine processes with fingers (A1), elbow supination (A2) and elbow extension (A3). Leg function is tested by 4 movements; the ability to touch the opposite knee with the heel while sitting (L1), knee extension in supine position (L2), dorsiflexion of the foot standing on a balance board (L3), and the ability to stand on tip toes without shoes (L4). An assessor scores the patient's ability to perform the different tests on an ordinal scale (0=normal, 1= partly impaired and 2= unable to perform). The range of SOFI scores is 0–44 (best to worst).

    Results: At baseline the mean (SD) SOFI was 7.2 (5.8), and at 1 year follow-up the improvement was 2.75 (5.65), p<0.001. From 1 year to 8 year follow-up the deterioration was 1.5 (4.6), p<0.001. When studying hand, upper and lower function separately, the pen grip and the ability to stand on tip toes improves most during the first year. From 1 to 8 year the pincer grip and the ability to stand on tip toes are the items that deteriorate most (Figure). Assessment of the pen grip, the pincer grip and the ability to stand on tip toes explain 58% to 70% of the SOFI score over time, with the highest rate at 5 (65%) and 8 years follow-up (70%).

    Conclusions: Functioning as assessed by SOFI improved during the first year in patients with early RA and then deteriorated slowly. Over a longer period, pincer grip and the ability to stand on tip toes seemed to be the two most important items to measure when assessing functional impairment over time. © 2017, BMJ Publishing Group Limited

  • 11.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ndosi, M.
    University of the West of England, Bristol, United Kingdom.
    The Educational Needs of Patients with Undifferentiated Spondyloarthritis2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 1495-1496 p.Article in journal (Refereed)
  • 12.
    Brorsson, S.
    et al.
    Health and Welfare, Dala Sports Academy, Dalarna University, Falun, Sweden.
    Thorstensson, C.
    Department of Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Nilsdotter, A.
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Two different sets of handexercises improved grip strength after after eight weeks in patients with arthritis2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, 1210-1210 p.Article in journal (Refereed)
    Abstract [en]

    Background Hand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand exercises are recommended. A number of hand exercises are often used in the clinic but there is little information about “the effects of a minimal set of hand exercises” and if the choice of exercises is important to improve strength and function in the hand.

    Objectives To study the effect on grip- and finger extension strength and patient reported hand function from two different sets of handexercises performed over 8 weeks using a randomized study design.

    Methods Female patients with arthritis (RA and HOA, n=121) were randomly assigned to two different sets of handexercises (HE) for 8 weeks. The four hand exercises applied in the program were exercises commonly used in traditional hand training programs. The exercises were split into two groups depending on if the muscle activation (measured with EMG) were greater in forearm flexor (HE I, n=62) or in extensor muscles (HE II, n=59) (REF). HE I: isolated finger opposition (digits II-V) and rolling the putty with a flat hand, HE II: squeezing the putty and finger extension with putty resistance. The two HE were performed daily and each set was repeated 15 times, training time per day was maximum 5 minutes 7 days/week.

    Grip strength was measured with Grippit and finger extension strength with EX-it both validated instruments (unit: N). Pain was measured with a Visual Analogue Scale (VAS), 0-10 (best to worst). Hand functions were evaluated with the patient reported questionnaire Quick Disability Arm Shoulder and Hand (QuickDASH), 0-100 (best to worst).

    Results Mean grip strength (p=0.01) and mean finger extension force (p=0.004) increased after the training period in the group using HE I. In HE II the mean finger extension force increased (p=0.044), table 1. Hand function was stable over the training period.

    Table 1.

    Descriptive data of finger extension (EXIT) force and grip strength in the right hand, hand function (QuickDASH) and VAS pain presented as mean ± SD (min–max)

    Conclusions Five daily minutes with two hand exercises resulted increased grip strength and finger extension force after eight weeks. We suggest that hand exercises should be combined and selected to improve both flexor and extensor muscle strength of the forearm.

  • 13.
    Brorsson, Sofia
    et al.
    Dalarna University, Falun, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Spenshult Hospital, Oskarström, Sweden.
    Qualitative differences in the muscle activities in the forearm flexor and extensor muscles in healthy men and women in different ages2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no Suppl. 3, 755-755 p.Article in journal (Refereed)
    Abstract [en]

    Background:

    Balance between flexor and extensor muscle activity is essential for optimal function. This has been demonstrated previously for the lower extremity, trunk and shoulder function, but information on the relationship in hand function is lacking.

    Objectives:

    The purpose of this study was to evaluate whether there are qualitative differences in finger extension force, grip force, force duration, force balance and the muscle activities in the forearm flexor and extensor muscles in healthy men and women in different ages.

    Methods:

    Healthy controls (men, n=65, women, n=40) were included. Primary outcome was muscle activity measured with S-EMG and finger flexion- and finger extension force in Newton (N). The maximal force from the first trial was used as reference value (maximal voluntary isometric contraction, MVIC). The S-EMG activity of the m. extensor digitorum communis (EDC) and the m. flexor carpi radialis (FCR) were measured on the dominant hand when performing seven clinically often used hand exercises. Hand function was also evaluated with the self-reported questioner Quick DASH and VAS pain and VAS stiffness.

    Results:

    The force balance between finger extension and flexion force was statistically significant for both men (r=0.51, p=0.000) and women (r=0.78, p=0.000). The finger extension force was not influenced by age, but flexion force was significantly correlated to age. The coefficient of determination showed that age and gender can explain 45-55% of differences in the force measurements. Muscle activity from hand exercises was significant related to gender for EDC and muscle activity in FCR showed significantly relation to age. Only 3 of the 7 hand exercise were adjustable for both men and women unrelatedly to age. Concerning the muscle activation in EDC and FCR in daily activities, the age and gender explain 31% respectively 19% of the differences.

    Conclusions:

    This study shows that there are differences between men and women's hand force capacity and that gender and age can explain 45-55% of the differences. Furthermore this study shows that the EDC muscle is related to gender and FCR is related to age. In a longer perspective this information is useful for designing optimal training program for adjusted for gender and age.

    References:

    Greig M, Wells R. A systematic exploration of distal arm muscle activity and perceived exertion while applying external forces and moments. Ergonomics. [Research Support, Non-U.S. Gov't]. 2008 Aug;51(8):1238-57.

    Nordenskiold U, Grimby G. Assessments of disability in women with rheumatoid arthritis in relation to grip force and pain. Disabil Rehabil. 1997 Jan;19(1):13-9.

    Kapandji I. The physiology of the joints - annotated diagrams of the mechanics of the human joints. Edingburgh London, Melborne and New York: Churchill Livingstone; 1982.

    Brorsson S, Nilsdotter A, Sollerman C, Baerveldt AJ, Hilliges M. A new force measurement device for evaluating finger extension function in the healthy and rheumatoid arthritic hand. Technol Health Care. 2008;16(4):283-92.

    Disclosure of Interest: None Declared

  • 14.
    Brorsson, Sofia
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Lugnet Institute of Sport Science, Dalarna University, Falun, Sweden.
    Nilsdotter, Anna
    Department of Research and Education, Halmstad Central Hospital, Halmstad, Sweden.
    Thorstensson, Carina
    Research and Development Centre, Spenshult, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Research and Development Centre, Spenshult, Oskarström, Sweden.
    Hand flexor and extensor muscle activity in daily activities and hand exercises in women with rheumatoid arthritis or hand osteoarthritis2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, 754-754 p.Article in journal (Refereed)
    Abstract [en]

    Background: Impaired hand grip function is common and occurs early in the course of disease in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA), affecting daily life activities and quality of life.

    Objectives: To evaluate muscle force and muscle activity in forearm flexors and extensors during daily activities and clinically well-known hand exercises in women with RA and HOA compared with healthy controls

    Methods: The RA group was consecutively included from a specialist clinic and had a disease duration of at least one year.  Women with HOA were allocated from out-patients primary health care clinics in the same area and clinically diagnosed with symptomatic HOA. The age matched control group had no history of hand/arm injuries, inflammatory or muscle disease. Full active finger extension ability was required for all subjects. Hand force (Newton) was measured with EX-it (extension) and Grippit (flexion), both validated instruments. Muscle activity was measured in m. extensor digitorum communis (EDC) and m. flexor carpi radialis (FCR) with surface EMG (S-EMG) on the dominant hand while performing four daily activities (ADL) and four hand exercises and described as percent of maximal voluntary isometric contraction (% MVIC) based on data from EX-it and Grippit. Pain was measured with Visual Analogue Scale (VAS) 0-10 (best to worst). Differences between groups were analyzed and controlled for age.

    Results: Fifty-six women were included; 20 with RA (age mean (SD) 59.2 (10.7) years, VAS pain 2.2 (1.6)), 16 with HOA (age 67.5 (9.3) years, VAS pain 4.1 (1.9)) and 20 healthy controls (age 56.0 (9.7) years). Women with RA and HOA showed decreased extension and flexion force compared with healthy women (p<0.03).There was a tendency towards higher % MVIC in all tests for women with RA or HOA compared with healthy women, with a statistically significant difference between HOA and healthy women for EDC (p<0.05).

    ADL activities “writing with a pen”, and “cutting with scissors” showed the highest % MVIC in both EDC and FCR in all groups. The exercises “isolated opposition”, and “rolling the dough with flat hands”, had high % MVIC in EDC, while “squeezing the dough” and “isolated opposition” had high % MVIC in FCR.

    Conclusions: Women with RA and HOA tend to use a higher % MVIC than healthy women in many daily activities and in hand exercises. Strengthening exercises should include both extensor and flexor specific training.

    Disclosure of Interest: None Declared

  • 15.
    Eberhardt, K.
    et al.
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Forslind, Kristina
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Spenshult, Research And Development Centre, Halmstad, Sweden.
    Svensson, Björn
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Andersson, Maria
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden & Spenshult, Research And Development Centre, Halmstad, Sweden.
    THU0104 Physical Function in Relation to Gender in Patients with Rheumatoid Arthritis – A 15 Year Follow up Study from the Barfot Cohort2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, 230-231 p.Article in journal (Refereed)
    Abstract [en]

    Objectives The aim was to study physical function in individuals with rheumatoid arthritis (RA) as measured by SOFI (observed physical function) and HAQ (self-rated physical function) over 15 years and describe associated variables, with focus on gender differences.

    Methods In all 2558 patients (847 men and 1711 women) age (SD) 58 (16) were recruited from the BARFOT inception cohort of patients with early RA. They had at inclusion a disease duration of one year or less and fulfilled the ACR 1987 criteria. At 15 years follow-up 663 out of 690 patients participated. Physical function was assessed by the SOFI (Signals of functional impairment) test, (scores 0-44, best to worst) which includes 12 performance tests measuring objective physical function, and the HAQ (Health Assessment Questionnaire) (scores 0-3, best to worst) measuring self-reported activity. A logistic regression model was performed to assess if being in the highest quartile of SOFI and HAQ, respectively, at the15 year follow up visit was associated to gender. Age, disease duration at inclusion, disease activity, smoking habits, RF positivity and pain were included in the model.

    Results Women had lower mean SOFI than men at inclusion and during the first study year, p<0.001. HAQ showed a conversed pattern, where women reported worse physical function than men on all occasions, p<0.001. During the first year SOFI and HAQ decreased in both genders, p<0.001. Thereafter throughout the study period mean SOFI and HAQ increased in men and women, p<0.001, figure 1A and B.

    At the 15 year follow up visit being in the highest quartile of SOFI (score ≥10) was not associated with gender while women had a higher risk to be in the highest quartile of HAQ (score ≥1.13) OR (95% CI) 2.86 (1.73-4.74), p<0.001. DAS 28 at inclusion showed a weak association with SOFI, OR (95% CI) 1.36 (1.11-1.68), p=0.003 while pain at inclusion was somewhat closer associated with HAQ, 1.02 (1.01-1.03), p<0.001. The correlation between the two functional test was r=0.54.

    Conclusions Women had an almost three times higher risk of worse outcome of HAQ after 15 years while the outcome of SOFI was not associated with gender. These two measures provide information of different aspects of physical function and should be used concomitantly.

    Disclosure of Interest None declared

  • 16.
    Gilljam, Britt-Mari
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Nygren, Jens
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Involving Children with Juvenile Idiopathic Arthritis in Health-Related Research – Why and How?2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, 1312-1312 p.Article in journal (Refereed)
    Abstract [en]

    Background: Children with severe Juvenile idiopathic arthritis (JIA) are exposed to care situations and harsh treatments such as intra-articular corticosteroid injections (1). In order for these children to feel confidence, it is important they understand and feel they have control over the situation. To support the wellbeing of these children and their involvement in care, it is important to investigate their views of the care process and their everyday life (2).

    Objectives: The purpose of this study is to describe our experiences of using different activities and techniques during interviews with children with JIA.

    Methods: Children (n=23) from two rheumatic pediatric clinics in Sweden, age 8 - 17, diagnosed with JIA since at least two years were interviewed individually or in focus groups. All interviews focused on experiences and preferences of participating in care situations. Among the younger children, age 8 - 12, we used activities such as sentence completion, to express three wishes, draw and tell, and role-play with Barbie dolls. Among the older ones, age 13 – 17, we used sentence completion, to express three wishes and post-IT tabs for brainstorming and subsequent discussion. During all interviews we used open-ended questions.

    Results: Sentence completion and three wishes were two weak techniques for most of the children regardless of age. The younger children often responded to these techniques with silence or responses like “I don't know”. The older children responded with intense reflection and thinking, and predominately came up with one wish only. Techniques that were powerful in activating discussions were draw and tell and role-play with Barbie dolls for the younger children. Using Post-IT tabs and discussions was a good starter for discussions for the older children in focus groups.

    Conclusions: There is reason to reflect on what techniques researchers use when interviewing children, as the prospects of capturing children's perspectives in research is largely dependent on the researcher's ability to engage children in the interview situation. Different interview methods should be used depending on the age of the informants, the purpose of the investigation, and the capabilities, such as the health status, of the child. In this study, we experienced that the participants ability to express their experiences and preferences can be facilitated with practical techniques, like drawing and role-play with Barbie dolls for younger children and Post-IT tabs for children in older age groups.

    References:

    Bertilsson L. Andersson-Gäre B. Fasth A. Forsblad-d'Elia H. A 5-year prospective population-based study of juvenile chronic arthritis: onset, disease process, and outcome. Scandinavian journal of rheumatology 2012; 41(5): 379-382.

    Coyne I. Hayes E. Gallagher P. Regan G. Giving children a voice: investigation of children's experiences of participation in consultation and decision-making in Irish hospitals. Office of the Minister for Children 2006; 3576.

    Acknowledgements: Thanks to: The Swedish Rheumatic Foundation, Stig Thunes Foundation and Norrbacka Eugenia Foundation.

    Disclosure of Interest: None declared

  • 17.
    Gossec, L.
    et al.
    Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), Paris, France & Department of rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France.
    Smolen, J. S.
    Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria & Second Department of Medicine, Hietzing Hospital, Vienna, Austria.
    Ramiro, S.
    Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
    de Wit, M.
    EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, United Kingdom.
    Cutolo, M.
    Research Laboratory and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto, Italy.
    Dougados, M.
    Medicine Faculty, Paris Descartes University, Paris, France & Rheumatology B Department, APHP, Cochin Hospital, Paris, France.
    Emery, P.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Landewé, R.
    Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands & Atrium Medical Center, Heerlen, The Netherlands.
    Oliver, S.
    North Devon, United Kingdom.
    Aletaha, D.
    Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
    Betteridge, N.
    EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, United Kingdom.
    Braun, J.
    Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, Herne, Germany.
    Burmester, G.
    Department of Rheumatology and Clinical Immunology, Charité—University Medicine Berlin, Germany.
    Cañete, J. D.
    Arthritis Unit, Department of Rheumatology, Hospital Clínic and IDIBAPS, Barcelona, Spain.
    Damjanov, N.
    Belgrade University School of Medicine, Belgrade, Serbia.
    FitzGerald, O.
    Department of Rheumatology, St. Vincent's University Hospital and Conway Institute, University College Dublin, Dublin, Ireland.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Helliwell, P.
    Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom.
    Kvien, T. K.
    Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
    Lories, R.
    Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Belgium & Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
    Luger, T.
    Department of Dermatology, University Hospital Münster, Münster, Germany.
    Maccarone, M.
    A.DI.PSO. (Associazione per la Difesa degli Psoriasici)—PE.Pso.POF (Pan European Psoriasis Patients’ Organization Forum), Rome, Italy.
    Marzo-Ortega, H.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    McGonagle, D.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    McInnes, I. B.
    Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
    Olivieri, I.
    Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy.
    Pavelka, K.
    Institute and Clinic of Rheumatology Charles University Prague, Czech Republic.
    Schett, G.
    Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
    Sieper, J.
    Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany.
    van den Bosch, F.
    Ghent University Hospital, Ghent, Belgium.
    Veale, D. J.
    Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St. Vincent's University Hospital, Dublin, Ireland.
    Wollenhaupt, J.
    Schoen Klinik Hamburg, Rheumatology and Clinical Immunology, Hamburg, Germany.
    Zink, A.
    Department of Rheumatology and Clinical Immunology, German Rheumatism Research Centre Berlin, Charité—University Medicine Berlin, Germany.
    van der Heijde, D.
    Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
    European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no 3, 499-510 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.

    METHODS: A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.

    RESULTS: The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.

    CONCLUSIONS: These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion. © 2015 BMJ Publishing Group Ltd & European League Against Rheumatism.

  • 18.
    Hagel, Sofia
    et al.
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden.
    Petersson, Ingemar F
    Department of Orthopedics, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Lindqvist, Elisabet
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden.
    Bergknut, Charlotte
    Department of Orthopedics, Lund University, Lund, Sweden.
    Englund, Martin
    Department of Orthopedics, Lund University, Lund, Sweden.
    Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no 7, 1212-1216 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: To study 21st century trends in healthcare utilisation by patients with rheumatoid arthritis (RA) compared with the general population.

    Methods: Observational cohort study. Using Swedish healthcare register data, we identified 3977 Region Skåne residents (mean age in 2001, 62.7 years; 73% women) presenting with RA (International Classification of Diseases-10 codes M05 or M06) in 1998-2001. We randomly sampled two referents from the general population per RA patient matched for age, sex and area of residence. We calculated the year 2001-2010 trends for the annual ratio (RA cohort/referents) of the mean number of hospitalisations and outpatient clinic visits.

    Results: By the end of the 10-year period, 62% of patients and 74% of referents were still alive and resident in the region. From 2001 to 2010, the ratio (RA cohort/referents) of the mean number of hospitalisations for men and women decreased by 27% (p=0.01) and 28% (p=0.004), respectively. The corresponding decrease was 29% (p=0.005) and 16% (p=0.004) for outpatient physician care, 34% (p=0.009) and 18% (p=0.01) for nurse visits, and 34% (p=0.01) and 28% (p=0.004) for physiotherapy. The absolute reduction in number of hospitalisations was from an annual mean of 0.79 to 0.69 in male patients and from 0.71 to 0.59 in female patients. The corresponding annual mean number of consultations in outpatient physician care by male and female RA patients changed from 9.2 to 7.7 and from 9.9 to 8.7, respectively.

    Conclusions: During the first decade of the 21st century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, overall inpatient and outpatient healthcare utilisation by a cohort of patients with RA decreased relative to the general population. Copyright Article author (or their employer) 2012.

  • 19.
    Haglund, Emma
    et al.
    Spenshult R&D center, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult R&D center, Oskarström, Sweden & Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Spenshult R&D center, Oskarström, Sweden & Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
    Gender differences in educational needs to manage the disease in individuals with spondyloarthritis2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, 140-141 p.Article in journal (Refereed)
  • 20.
    Haglund, Emma
    et al.
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Spenshult R & D center, Oskarström, Sweden.
    Bremander, Ann
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund & & Spenshult R & D center, Oskarström, Sweden.
    Petersson, I.F.
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Dept. of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Bergman, Stefan
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Spenshult R & D center, Oskarström, Sweden.
    Self-reported disease characteristics do not explain why younger women with SpA are less physically active than older women with the disease2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, 159-159 p.Article in journal (Refereed)
    Abstract [en]

    Background Exercise is a commonly used treatment for patients with spondyloarthritis (SpA) but younger women reach WHOs recommended level of physical activity (PA) to a less extent than peers in the general population (Haglund, 2012).

    Objectives To study if self-reported disease characteristics in patients with SpA can explain why younger women are less physically active than older women with the disease.

    Methods In a cross-sectional population based cohort study in southern Sweden, 1121 women (51.7% of the total SpAScania cohort) were identified by a health care register and responded to a questionnaire survey in 2009. The primary outcome was self-reported level of physical activity (PA) based on the WHOs recommendation. Self-reported pain (VAS), global health (VASglobal, BASG),health related quality of life (EQ-5D), disease activity (BASDAI), physical function (BASFI), self-efficacy pain and symptoms (ASES), anxiety (HADa), depression (HADd), education level, smoking habits and reported severity of the skin disease psoriasis (NRS) were reported. Younger (≤35 years of age, n=127) and older women (>35, n=994) and the disease subgroups AS/USpA (n=441) and PsA (n=680) were compared with regard to characteristic symptoms. T-test and chi-square test was used to analyze group differences, exact p-values are reported.

    Results Out of the 1121 women in the cohort, 1094 answered the questions concerning PA. There were no significant differences between younger/older women with AS/USpA reaching recommended level of PA (71% vs. 77%, p=0.23). In younger women with PsA there was a trend to not reaching the recommended level of PA to the same extent (58% vs. 70%, p=0.06).

    When comparing younger and older women concerning characteristic variables, there were significant worse self-reported VASglobal (3.9 vs. 4.5, p=0.004), BASDAI (4.2 vs 4.8, p=0.008), BASFI (2.4 vs. 3.8, p<0.001), BASG (3.6 vs. 4.4, p=0.001), ASES pain (53 vs. 49, p=0.02), ASES symptom (59 vs. 55, p=0.04) and HAD depression (3.7 vs. 4.6, p=0.04) in the older women.

    When stratified on the disease subgroups, VASglobal (3.8 vs. 4.3, p=0.05) and BASFI (2.6 vs. 3.6, p=0.002) were significantly worse for older women with AS/USpA (n=372) compared to the younger group (n=69). Older women with PsA (n=622) reported significantly worse VASpain (3.9 vs. 4.7, p=0.02), BASFI (2.2 vs. 3.9, p<0.001), BASG (3.5 vs. 4.5, p=0.004), ASES pain (54 vs. 57, p=0.01) and symptom (61 vs. 53, p=0.01), HAD depression (3.8 vs. 4.7, p=0.04) compared to the younger group (n=58). There was an inverse relationship regarding severity of psoriasis, were younger women with PsA have a tendency to report a more severe skin disease (3.9 vs. 3.2, p=0.09). When comparing characteristics for young women reaching or not reaching healthy PA, no differences were found.

    Conclusions Young women with SpA do not reach recommended level of PA in the same extend as in the population. There were no explanations found when comparing common self-reported variables in younger and older women with SpA in a defined cohort. The relationship needs to be studied further also from a qualitative aspect.

  • 21.
    Haglund, Emma
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bremander, Ann
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Strömbeck, Britta
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Jacobsson, Lennart T. H.
    Department of Rheumatology, Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Turkiewicz, Aleksandra
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Geborek, Pierre
    Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Englund, Martin
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
    Prevalence of spondyloarthritis and its subtypes in southern Sweden2011In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 70, no 6, 943-948 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the prevalence of spondyloarthritis and its subtypes.

    METHODS: The Swedish healthcare organisation comprises a system where all inpatient and outpatient care is registered by a personal identifier. For the calendar years 2003-7, all residents aged ≥ 15 years in the southernmost county of Sweden (1.2 million inhabitants) diagnosed by a physician with spondyloarthritis (ankylosing spondylitis (AS), psoriatic arthritis (PsA), inflammatory arthritis associated with inflammatory bowel disease (Aa-IBD) or undifferentiated spondylarthritis (USpA)) were identified. To obtain valid point estimates of prevalence by the end of 2007, identification numbers were cross-referenced with the population register to exclude patients who had died or relocated.

    RESULTS: The authors estimated the prevalence of spondyloarthritis (not including chronic reactive arthritis) as 0.45% (95% CI 0.44% to 0.47%). The mean (SD) age of patients with prevalent spondyloarthritis by the end of 2007 was 53 (15) years. Among the component subtypes, PsA accounted for 54% of cases, AS 21.4%, USpA 17.8% and Aa-IBD 2.3% with a prevalence of 0.25%, 0.12%, 0.10% and 0.015%, respectively. The remaining 6.4% had some form of combination of spondyloarthritis diagnoses. The prevalence of spondyloarthritis at large was about the same in men and women. However, the subtype PsA was more prevalent in women and AS was more prevalent in men.

    CONCLUSION: In Sweden the prevalence of spondyloarthritis leading to a doctor consultation is not much lower than rheumatoid arthritis. PsA was the most frequent subtype followed by AS and USpA, and the two most frequent subtypes PsA and AS also display some distinct sex patterns.

  • 22.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Olsson, C.
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden; The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Improving triage to appropriate treatment level by using a combination of screening tools in patients at risk of developing chronic back pain2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 1531-1532 p.Article in journal (Refereed)
  • 23.
    Haglund, Emma
    et al.
    R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden & Department of Clinical Sciences Lund, Section of Orthopedics, Musculoskeletal Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Predictors of Work Productivity in a Population Based Cohort of Individuals with Spondyloarthritis2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A127-A127 p.Article in journal (Refereed)
    Abstract [en]

    Background: Spondyloarthritis (SpA) often causes work disability and predictors concerning the ability to stay productive while at work are scarcely studied in this group.

    Objectives: The aim was to study predictors of reduced productivity while at work and possible differences between gender and the SpA subgroups (Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA) and Undifferentiated SpA (USpA)) in a defined cohort in southern Sweden.

    Methods: 1253 out of 1773 health care seeking individuals with SpA age 18-67 years (identified by a health care register in southern Sweden) responded to a questionnaire survey in 2009 and to the follow-up in 2011, 2,5 years later. Self-reported presenteeism, defined as reduced productivity at work (0-100%, 0= no reduction) due to SpA, individual´s characteristics, lifestyle factors, disease duration, health related quality of life (EQ-5D), disease activity (BASDAI), physical function (BASFI), self-efficacy pain and symptom (ASES), anxiety (HADa), depression (HADd) were measured. The main outcome productivity at work was dichotomized based on mean value, with values over 25% regarded as a reduced productivity. The Pearson's correlation coefficient and multivariate logistic regression analyzes were used to study predictors of reduced productivity.

    Results: At follow up 757 individuals reported that they were working and of those 720 responded to the productivity question. The mean age was 50 years and 49% were men. Based on the health care register 177 (24.6%) were diagnosed with AS, 373 (51.8%) with PsA and 170 (23.6%) with USpA. The mean reduction of productivity was 25% (95% CI 23%>27%) (n=720), women reported higher reduction than men (mean 28% vs. 22%, p<0.001). In the multiple logistic regression analyzes a reduced productivity at follow-up was predicted by a reduced productivity at baseline (OR 1.04, 95% CI 1.03-1.05). Other predictors (controlled for age, sex, disease subgroup and productivity at baseline) were low education level (OR 2.14, 95% CI 1.51-3.04), smoking (1.73; 1.22-2.45), worse score in quality of life (EQ-5D) (0.22; 0.003-0.14), worse disease activity (BASDAI) (1.47; 1.29-1.67), lower physical function (BASFI) (1.42;1.27-1.58), lower self-efficacy (ASES) pain (0.97; 0.97-0.98) and symptom (0.97; 0.96-0.98), higher score of anxiety (HADa) (1.09; 1.05-1.14) and depression (HADd) (1.15; 1.08-1.22). Disease duration, absenteeism and physical activity level had no predictive value.

    Conclusions: Reduced productivity at follow-up was not only predicted by productivity 2,5 years earlier, but also by other aspects of the individuals whole life situation. These different factors could be of clinical importance in order to influence the ability to maintain productivity at work in individuals with SpA.

    Disclosure of Interest: E. Haglund Grant/research support from: The project was supported by an unrestricted grant from Abbott., I. Petersson Grant/research support from: The project was supported by an unrestricted grant from Abbott., A. Bremander Grant/research support from: The project was supported by an unrestricted grant from Abbott., S. Bergman Grant/research support from: The project was supported by an unrestricted grant from Abbott.

  • 24.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ conceptions of drug information given by the rheumatology nurse2009In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, no Suppl. 3, 781-781 p.Article in journal (Refereed)
    Abstract [en]

    Background: Pain, stiffness and functional restriction of the joints are the main problems for patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases have a need for daily intake of several drugs. Compliance in drug treatment is higher amongst patients that have been given drug information by a nurse at repeated occasions from the start of the treatment. In the development of patient information, it is essential to take advantage of patients' experiences.

    Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases conceive drug information given by a rheumatology nurse.

    Methods: The study had a descriptive qualitative design with a phenomenographic approach. When employing such an approach, the main aim is to describe how a phenomenon is conceived by different individuals. Fifteen patients with rheumatic diseases who had received a new drug during a hospital visit were approached, agreed to take part in the study and were interviewed. Strategic sampling in terms of sex, age, marital status, education, rheumatic diseases, and illness duration, was carried out in order to achieve variation in conceptions of the phenomenon.

    Results: Three descriptive categories emerged: (1) Autonomy (own responsibility and participation), (2) Power (knowledge and motivation), (3) Security (trust, care and accessibility). Autonomy was based on the patients' experiences from taking their own responsibility and participation. Power meant to gain knowledge and motivation to take the drug. Security was to receive trust, experience care, and to have accessibility to a rheumatology nurse.

    Conclusion: Patients with rheumatic diseases experiences that drug information from a rheumatology nurse gives them autonomy, power and security. These could be essential for the patients to manage their daily life, where drug treatment is one part.

    Disclosure of Interest: None declared

  • 25.
    Larsson, Ingrid
    et al.
    R&D Centre, Spenshult, Oskarström, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.
    OP0094-HPR Person-Centred Care (PCC) May Improve Health Care Consumer Skills More than Regular Care - an RCT in Patients with CIA Undergoing Biological Therapy2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, 104-104 p.Article in journal (Refereed)
    Abstract [en]

    Background: In person-centred care (PCC) a holistic approach, individualized care, empowerment and self-management are cornerstones. Patients are seen as persons with resources and are encouraged to take an active role in their own health care to become skilled or effective consumers of health care. Little is known of the impact of PCC vs. regular care on patients’ skills as health care consumers.

    Objectives: To study the impact on effective consumers’ skills over 12 months in patients undergoing biological therapy and randomly assigned to either a nurse-led rheumatology clinic (NLC) based on PCC or to a rheumatologist-led clinic (RLC) as measured by the Effective Consumer Scale (EC17).

    Methods: A 12 month RCT in 107 patients with chronic inflammatory arthritis.1 Inclusion criteria were ongoing biological therapy and a DAS28 ≤3.2. All patients met a rheumatologist at inclusion and after 12 months, while the 6 month follow-up was performed in the assigned group, either at a NLC (PCC) or at an RLC (regular care). Outcome measure was the EC17, developed and endorsed by the OMERACT to measure skills in decision-making, navigation and negotiation with health care professionals (0-100, worse to best). Minimally Important Difference (MID) of EC17 was calculated (≥ 0.5 SD of the mean baseline score)2 and patients categorized in three EC17 groups: improvement, no change or deterioration of consumer skills. Differences between intervention groups and EC17 groups were calculated with Chi2. Global health, pain and HAQ were measured for descriptive purposes.

    Results: A total of 101 patients completed the EC17 at baseline (mean 84 SD 10) and after 12 months. Twelve patients had baseline scores higher than 95 and a MID in improvement could not be measured why they were excluded, leaving 89 patients in the trial (mean age 53 SD 12 years, mean disease duration 16 SD 11 years, 54% women, RLC n=44, NLC n=45). At baseline mean (SD) DAS28 was 2.05 (0.68), global health 22 (17), pain 23 (18) and HAQ 0.55 (0.51). A larger proportion of patients improved according to EC17 in the NLC compared with the RLC (42% vs. 23%), and a smaller proportion deteriorated (16% vs. 23%; table). The differences were not statistically significant (p=0.14), probably due to a small sample size.

    Table. Proportion of patients who deteriorated (≥5 units), remained stable or improved (≥5 units) in EC17 over 12 months monitored at a NLC or an RLC, total n= 89.

    EC17 deterioration

    NLC 16%   (n=7)

    RLC 23%    (n=10)

    EC17 stable

    NLC 42%   (n=19)

    RCL 54%   (n=24)

    EC17 improvement

    NLC 42%   (n=19)

    RLC 23%   (n=10)

    Conclusions: A nurse-led rheumatology clinic based on person-centred care resulted in a greater proportion of patients who reported a long term improvement in skills as consumers of health services compared with patients monitored by a rheumatologist-led clinic. Larger studies are needed to confirm the result.

    References: 1. Larsson I, et al. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs 2014;70(1):164-75.

    2. Strand V, et al. It's good to feel better but it's better to feel good and even better to feel good as soon as possible for as long as possible. Response criteria and the importance of change at OMERACT 10. J Rheumatol 2011;38(8):1720-7.

  • 26.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Teleman, Annika
    R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, Suppl. 3, 139-140 p.Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic inflammatory arthritis (CIA) treated with biological therapy are usually monitored by rheumatologists. Research shows that a nurse-led rheumatology clinic is safe and effective in monitoring biological therapy (1) and contributed added value in patients within rheumatology care, because the encounter with the nurse led to a sense of security, familiarity and participation (2).

    Objectives: To compare the cost of monitoring biological therapy in a nurse-led rheumatology clinic with those of a rheumatologist-led clinic in patients with low disease activity or in remission.

    Methods: Cost comparison was based on data from a 12 month randomised controlled trial (1). A total of 107 patients were randomly assigned to either a rheumatologist-led clinic or to a nurse-led rheumatology clinic. The purpose of the intervention was to replace one of two annual monitoring visits at the rheumatologist-led clinic (control group; n=54) by a visit to a nurse-led rheumatology clinic (intervention group; n=53), based on person-centred care. Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. All outpatient visits, team rehabilitation and all the telephone advice at the Rheumatology Clinic were registered for the patients who participated in the trial. Main outcome measures were direct costs related to rheumatology care during the 12 month follow-up period.

    Results: After 12 months 97 patients completed the study. At the inclusion the patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. There was no mean difference in changes in clinical outcome between the two groups (DAS28 -0.06; p=0.66). The total annual cost of team rehabilitation in rheumatology care, per patient monitored by the nurse-led rheumatology clinic was €580 compared with €1278 for monitoring by a rheumatologist-led clinic, translating in a €698 (55%) lower annual cost. The annual cost of just the outpatient rheumatology care provided by rheumatologist and rheumatology nurse, per patient was €457 for monitoring by the nurse-led rheumatology clinic compared with €598 for monitoring by a rheumatologist-led clinic, translating in a €141 (24%) lower annual cost.

    Conclusions: Patients with stable CIA undergoing biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic compared to a rheumatologist-led clinic, with no difference in clinical outcome as measured by DAS28.

    References

    1. Larsson et al. (2014). Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs, 70(1): 164-175.
    2. Larsson et al. (2012). Patients’ experiences of a nurse-led rheumatology clinic in Sweden – a qualitative study in patients undergoing biological therapy. Nurs Health Sci, 14(4): 501-507.
  • 27.
    Lindqvist, E. K.
    et al.
    Department of clinical sciences, Lund university, section of Rheumatology, Lund, Sweden.
    Bremander, Ann
    Department of clinical sciences, Lund university, section of Rheumatology, Lund, Sweden.
    Hørslev-Pedersen, K.
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Grotle, M.
    National resource center for rehabilitation in rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
    Vliet Vlieland, T.
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands.
    STAR-ETIC group,
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands.
    Course and outcome of rehabilitation care in different rheumatological diagnosis groups. A descriptive study using the STAR-ETIC registry2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A784-A785 p.Article in journal (Refereed)
  • 28.
    Lindström, Ulf
    et al.
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden.
    Haglund, Emma
    Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Patients with Non-AS Axial SpA Have Similar Prevalence Compared to AS, but Worse Perceived Health. Results from a Population Based Study2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A667-A668 p.Article in journal (Refereed)
    Abstract [en]

    Background: Non-radiographic axial spondyloarthritis (SpA) is emerging as a treatable disease comparable to ankylosing spondylitis (AS), but less well studied. Previous studies have described a reversed gender distribution, with AS being more prevalent in the male population and non-radiographic axial SpA more prevalent in the female population. Recent studies have also indicated a similar benefit from treatment with TNF-inhibitors.

    Objectives: The aim of this study was to estimate the prevalence of non-radiographic axial SpA and compare the patient reported outcome measures (PROMS) to that of AS, in Southern Sweden.

    Methods: All health care seeking individuals, ≥18 years, given a SpA-diagnosis, according to the ICD-10 (M45.9, M072, M460, M461, M468, M469, M074, M705 and L405 or M071 or M073), either in primary or specialized care, (N = 5771), during 2003 - 2007, were identified through the regional health care register in Skåne, a county in Southern Sweden with 1.2 million inhabitants (SpAScania cohort). In 2009 they were all sent a questionnaire (response rate; 48%), including questions concerning inflammatory back pain (IBP), the SpA-associated comorbidities constituting the ASAS-criteria (IBD, Ps, Uveitis/tendinitis, heredity), PROMS (BAS-indices, VAS-pain/fatigue/global, EQ5D) and previous/current medication.Non-AS axial SpA was defined as having an ICD10 code supporting a diagnosis of SpA without having one of AS (M45.9), in combination with > 3 months of back pain the last year and the presence of ≥2 of the SpA associated comorbidities. Record review support the notion of using AS as a substitute for radiographic changes. For the “non imaging arm” of the ASAS criteria for axial disease, we used the ICD10 codes above as a substitute for HLA-B27 status. Assuming similar answers from the questionnaire non-responders, prevalence rates were estimated for non-AS axial SpA and AS.

    Results: Among responders 742 had an AS-diagnosis and 640 fulfilled the study criteria for non-AS axial SpA. The frequency of men was 60.5% in the AS group and 29.5% in the non-AS axial SpA group. The prevalence of AS was 0.13% (95% CI; 0.115-0.148) and for non-AS axial SpA 0.11 % (95% CI; 0.096-0.130), with a reverse gender distribution. The means of the PROMs and frequency of comorbidities were higher in the non-AS axial SpA vs both the AS, and the subgroup of AS individuals reporting back pain (BP) > 3months during the last year. Self-reported present use of TNF-inhibitors were similar between the groups (Image 1).

    Conclusions: Prevalence rates for AS and non-AS axial SpA were similar, with a reverse gender distribution. The results suggest that at a population level the proportion with non-AS axial SpA is at least as large as that of AS and report lower levels of perceived health status and similar frequencies of SpA-related comorbidities (except psoriasis) and treatment with TNF-inhibitors, supporting the validity for the used definition in future research.

    Disclosure of Interest: None Declared

  • 29.
    Löfvendahl, S.
    et al.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, I.F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Haglund, Emma
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Jacobsson, L.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Jöud, A.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Duration between symptom onset and spondyloarthritis diagnosis – Changes over a decade2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, 431-431 p.Article in journal (Refereed)
    Abstract [en]

    Background The delay of diagnosis after symptom onset for various subgroups of spondyloarthritis (SpA) is considerable. Increasing focus on this over the last decades may have decreased this delay (1-2).

    Objectives To study the duration between symptom onset and date of diagnosis of SpA and its subgroups: ankylosing spondylitis (AS), psoriatic arthritis (PsA), and unspecified spondyloarthritis (USpA). A special focus was to study the change over the past decade.

    Methods The Swedish SpAScania cohort (N=5,771, = all patients diagnosed with SpA between 2003 and 2007 in primary or secondary care in the Skåne region, total n=1.3 million 2013) was used. We analyzed patients (n=952) identified as having AS (n=173), PsA (n=579) or USpA (n=200) by a rheumatologist or internist at least one time or by any other physician twice during 2003 to 2007 responding to a postal survey in 2009 and 2011. The survey included questions on years for start of symptoms and diagnosis. All patients included had a self-reported diagnosis of SpA between 1997 and 2007 in the survey 2009. The information from 2009 was used to calculate the duration between symptom onset and date of diagnosis and the response from the 2011 survey to investigate the reliability of these answers (647 patients responded to the survey in both 2009 and 2011 and were hence eligible for reliability analysis). The mean duration (years) was calculated (95% CI), both unadjusted and adjusted for sex, age and year of diagnosis.

    Results The overall mean duration between symptom onset and date of a SpA diagnosis was 6.8 years (95% CI: 6.3-7.3), without any obvious secular change up through 2007. The mean duration for AS was 9.0 (95% CI: 7.8-10.3), for PsA 6.0 (5.4-6.6) and USpA 7.2 (95% CI: 6.1-8.3). There was an overall good consistency between the self-assessed year of symptom start, measured in 2009 and in 2011 (ρ=0.58). However, there was a variation between subgroups, consistency being higher in AS (ρ =0.84) and lower in PsA (ρ =0.53).

    Conclusions The duration between symptom onset and diagnosis was longest for AS and shortest for PsA with USpA in between. Up to 2007 there was no significant trend for any decrease in such delay for any of the subgroups.

    References

    1. Sorensen J, Hetland ML. Duration of symptoms before diagnosis in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Ann Rheum Dis 2013;72(Suppl3):80.

    2. Salvadorini G, Bandinelli F, DelleSedie A, Riente L, Candelieri A, Generini S. Ankylosing spondylitis: how diagnostic and therapeutic delay have changed over the last six decades. Clin Exp Rheumatol. 2012 Jul-Aug;30(4):561-5.

    Disclosure of Interest None declared

  • 30.
    Malm, Karina
    et al.
    Lund University, Lund, Sweden, Spenshult Research and Development Center, Oskarström, Sweden & Capio Movement, Halmstad, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersson, Maria
    Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Center, Oskarström, Sweden.
    THU0628-HPR Lifestyle Habits Relates to Quality of Life in Patient with Longstanding Rheumatoid Arthritis2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, 1318-1318 p.Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness, impaired muscle function and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) and these may be related to lifestyle habits such as physical activity, diet, smoking and alcohol.There is limited knowledge about how patient with longstanding RA understand their lifestyles habits in relation to their disease and quality of life.

    Objectives: To describe experiences of how lifestyle habits relate to quality of life in patients with longstanding RA.

    Methods: A qualitative study with a deductive content analysis design, including 17 patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort. BARFOT is a long time follow up study of early RA. Informants were strategically selected by gender (ten women and seven men), age (range 30-84 years), disease duration (8-23 years), function as measured by HAQ, and quality of life as measured by EQ5D. Semi-structured interviews focused on four lifestyle habits (main categories); Physical activity, Diet, Smoking, and Alcohol. The interviews were recorded, transcribed verbatim and coded into subcategories within each of the four main categories.

    Results: In patients with longstanding RA quality of life was related to the four given main categories (lifestyle habits). Each main category included two to three subcategories; (1) Physical activity means barrier, opportunities and well-being, (2) Diet means shame, well-being and social relationship, (3) Smoking means reward and fear, and (4) Alcohol means ambivalence and social relationship.

    Conclusions: In longstanding RA, lifestyle habits relates to quality of life through both positive and negative experiences. This has to be taken into account in clinical care for a better understanding of how patients conceive and adherer to advice on lifestyle.

    References: Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.

    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.

  • 31.
    Malm, Karina
    et al.
    Spenshult Research and Development Center, Oskarström, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria
    Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden.
    Quality of Life in Patient with Established Rheumatoid Arthritis: A Qualitative Study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no Suppl 2, 1308Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) that may affect quality of life. Quality of life is an individual experience composed of a wide range of factors, including physical health, psychological state, level of independence, social relationships, and the patients' relationship to salient features of their environment. There is a need to describe and assess quality of life in chronic diseases like established RA. Previous research has mainly focused on disease-specific instruments for assessing quality of life. A deeper understanding of patients' experience of quality of life in established RA is important in both clinical research and daily clinical practice.

    Objectives: To describe variations in patients' experiences of quality of life in established RA.

    Methods: The study had a qualitative design with a phenomenographic approach, including 22 interviews with patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort, BARFOT, a long time follow up study of early RA. Patients were strategically selected by gender (14 women and 8 men), age (30 to 84 years old), disease duration (8–23 years), function as measured by HAQ (0–1.38), and quality of life as measured by EQ5D (0.52–1.00). The interviews were recorded, transcribed verbatim and coded into categories.

    Results: Four categories emerged from the patients' experiences of quality of life in established RA: well-being, freedom, empowerment, and participation. Quality of life as well-being meant pleasure and being physical active. Quality of life as freedom meant dependence or independence in the ability to manage daily life activities. Quality of life as empowerment meant different coping strategies, such as positive thinking and resources to manage fatigue, pain and physical function. Quality of life as participation meant togetherness in different contexts with other people.

    Conclusions: Quality of life in established RA could be understood by the patients in different ways. The patients experienced quality of life as well-being, freedom, empowerment, and participation. This is important knowledge when evaluating the concept of quality of life in RA research, and for health professionals when promoting quality of life in patients with RA.

  • 32.
    Meesters, Jorit
    et al.
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, LUMC, Leiden, Netherlands.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Petersson, Ingemar
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Englund, Martin
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden; Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, United States.
    Depression is More Common in Patients with Ankylosing Spondylitis as Compared to the General Population Seeking Health-Care2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A556-A556 p.Article in journal (Refereed)
    Abstract [en]

    Background: Ankylosing spondylitis (AS) affects physical function and health related quality of life. Depression has been reported to be frequent in AS patients. However, available epidemiological data are limited and estimates of the potentially increase in risk are lacking.

    Objectives: To compare the rate of doctor-diagnosed depression in a well-defined cohort of AS patients to the general health-care seeking population.

    Methods: The Skåne Health Care Register comprises data from each single health care consultation in the Skåne County, Sweden (population 1.2 million). Data include information about date of consultation and all ICD-10 diagnoses. Linking this register to the Swedish population register adds data regarding death and residency. We studied all patients who were registered with an AS diagnosis (ICD-10 code M45) at least once during 4 calendar years (2004 to 2007). To obtain depression rates we calculated the person-time from the day after the first occurrence of the AS diagnosis within the study period until the day of diagnosis of depression (F32 or F33) or another censoring event (death/relocation). We then obtained standardized depression-rate ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex specific rates of doctor-diagnosed depression in the general population of the county seeking care (reference population). A ratio >1 equals a higher rate of depression among AS patients than in the reference population of corresponding age and sex distribution.

    Results: We identified 935 AS patients, 67.2% men, mean age (SD) 52.3 (14.8) years. The reference population consisted of 761,210 subjects. During the 4-year observation period 10% (n=94) of the AS cohort had a doctor-diagnosed depression compared to 7% (n=66) to be expected based on data from the reference population. The standardized depression-rate ratio in men (1.41, 95% CI 1.04–1.87) and women with AS (1.43, 95% CI 1.05–1.91) were both significantly elevated in the same order of magnitude (Table).

    Conclusions: The rate of doctor-diagnosed depression was increased by about 40% in both male and female AS patients compared to the general population seeking care. Future challenges are to identify and treat the AS patients who suffer from depression as early as possible.

  • 33.
    Meesters, Jorit
    et al.
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
    Petersson, Ingemar
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Haglund, Emma
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Factors Associated with Anxiety and Depression in Spondyloarthritis Patients: Results from the Swedish Population Based SpA Scania Cohort2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A531-A532 p.Article in journal (Refereed)
    Abstract [en]

    Background: Anxiety and depression are more common among patients with rheumatic diseases and can influence treatment options and outcome. However insight in factors associated with anxiety and depression in patients with Spondyloarthritis (SpA) is scarce.

    Objectives: To identify factors associated with self-reported anxiety and depression in a well-defined population based cohort of patients with SpA.

    Methods: In 2009, 3711 adult SpA patients from the SpaScania cohort were identified and involved in a questionnaire survey including patient reported outcome measures (PROMs) to assess quality of life, physical and mental functioning. To assess depression and anxiety the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) was used. Each subscale ranges from 0-21; best to worst. HAD scores of ≥ 8 indicate probable cases of anxiety or depression.Differences in HADS subscale scores among the SpA subgroups were tested by using one-way ANOVA (p<.05). Associations between PROMs and the HADS subscales, were studied with linear regression analysis including each independent variable separately (adjusted for age, gender and disease duration) and presented as β-estimates (95%CI).

    Results: In total 2851 patients (76%) responded to the study invitation, 684 (18%) declined participation and 2167 (58%) returned the questionnaire. Mean age 55.4 (SD 13.9) years, mean disease duration 14.4 (12.1) years and 52% female. SpA subgroups were: Ankylosing spondylitis 501 (23%), Psoriatic arthritis 1171 (54%), and undifferentiated SpA 495 (23%).Mean HADS-A was 5.9 (4.3) and mean HADS-D 4.4 (3.6) respectively for the whole SpA group. In total 683 (32%) cases were classified as probable anxiety cases and 305 (14%) as probable depression cases. No differences in HADS were found among the different SpA subgroups for anxiety or depression (p>0.6).Higher scoring on HADS-A and HADS-D was associated with (table): lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL (EQ-5D), lower level of functioning (BASFI), higher disease activity (BASDAI), lower self-efficacy (ASES).

    Conclusions: Patients with SpA do report problems with anxiety and/or depression and associations appear highly multifactorial with a profile of impaired health in general. Screening patients with SpA for anxiety and depression in the clinic is important but using a simple proxy is discouraged. Instead HADS or other comprehensive instruments to assess anxiety or depression should be considered.

  • 34.
    Mogard, E.
    et al.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Lindqvist, E.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Risk factors for development and persistence of chronic widespread pain, in ankylosing spondylitis and undifferentiated spondyloarthritis2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 922-922 p.Article in journal (Refereed)
    Abstract [en]

    Background Chronic back pain is a prominent symptom in Spondyloarthritis (SpA), and an important contributor to diminished quality of life (1,2). Chronic pain can develop in intensity, become more spread, and progress to chronic widespread pain (2). Mechanisms for this are yet inconsistent (3), and in SpA, knowledge of progression to chronic widespread pain (CWP) is lacking.

    Objectives To study the development of CWP in patients with SpA, and to identify risk factors for development and persistence of CWP.

    Methods A cohort study with baseline and 2.5-year follow-up postal surveys. 644 patients (47% women) with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (SpA) answered both surveys, and were categorized as no chronic pain (NCP), chronic regional pain (CRP), and CWP. Logistic regression analyses, with CWP as the main outcome were performed. Due to multicollinearity, each risk factor candidate (disease duration, BMI, smoking, and different patient-reported outcome measures; PROMs) were analysed in separate logistic regression models together with a base model (age, sex, and SpA-subgroup).

    Results At follow-up, prevalence estimates for NCP, CRP and CWP were similar to those at baseline, but 38% of the patients had transitioned between the groups. A large group, 72% of the patients with initial CWP, also reported persistent CWP at follow-up (Figure). Risk factors (OR and 95% CI) for development of CWP from initial NCP/CRP were more pain regions (1.36; 1.20–1.53), pain intensity (1.35; 1.20–1.52), fatigue (1.25; 1.13–1.38), global health (1.35; 1.19–1.54), EQ-5D (0.05; 0.01 – 0.19), BASDAI (1.25; 1.07 – 1.45), BASFI (1.32; 1.16 – 1.50), ASES pain (0.97; 0.96 – 0.99), ASES symtom (0.98; 0.97 – 0.99), and HADb (1.10; 1.02 – 1.19). The risk factors for persistent CWP, compared to patients transitioning to NCP or CRP, were similar to those predicting development of CWP, but in addition, also higher age (1.02; 1.00–1.04), and female sex (1.82; 1.06–3.10), predicted the outcome. © 2017 BMJ Publishing Group Limited.

  • 35.
    Mogard, E.
    et al.
    Lund University, Lund, Sweden.
    Olofsson, T.
    Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kristensen, L-E
    Copenhagen University Hospital Fredriksberg and Bispebjerg, Copenhagen, Denmark.
    Kvistgaard Olsen, J.
    Copenhagen University Hospital Fredriksberg and Bispebjerg, Copenhagen, Denmark.
    Wallman, JK
    Lund University, Lund, Sweden.
    Lindqvist, E.
    Lund University, Lund, Sweden.
    Chronic Pain in Patients With Established Axial Spondyloarthritis and Assessment of Pain Sensitivity by Computerized Pneumatic Cuff Pressure Algometry: Results from the Spartakus Cohort2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 651-652 p.Article in journal (Refereed)
    Abstract [en]

    Background: Pain is a common symptom in all arthritides, and remains a problem also with better treatment options. In axial spondyloarthritis (ax-SpA), data on chronic pain remain scarce.

    Objectives: To study pain distribution, duration and intensity in ax-SpA, and relate this to disease status and measurement of pressure pain sensitivity.

    Methods: Consecutive patients (n=115) with clinical ax-SpA diagnoses (ankylosing spondylitis (AS) or undifferentiated axial spondyloarthritis (USpA)) were examined and answered pain questionnaires. Patients were categorised as having no chronic pain (NCP), chronic regional pain (CRP) or chronic widespread pain (CWP). Pressure pain sensitivity was assessed by computerized pneumatic cuff pressure algometry (CPA) on the dominant lower leg, and pain threshold, pain tolerance and temporal summation (assessed by the temporal summation index, TSI) were recorded. Differences in disease status and pressure pain sensitivity between patients with CWP versus NCP were assessed (Chi-square or Mann-Whitney U-test). Pressure pain sensitivity was also compared between patients with/without unacceptable pain levels (VAS pain >40 versus ≤40; Mann-Whitney U-test).

    Results: Fifty percent of patients reported CWP, irrespective of clinical diagnosis (AS 47%, USpA 53%), and more women than men reported CWP (59% versus 37%, p<0.001). Only 18% of all patients reported NCP. Overall, higher disease activity, pain intensity, worse fatigue, global health and function were observed among patients with CWP compared to those with NCP. There was a trend towards lower pain tolerance in patients with CWP compared to NCP (Table). Lower pain tolerance and higher TSI scores were observed among patients reporting VAS pain >40 versus those with VAS pain scores ≤40 ((mean (SD)) 51.9 (21.2) versus 68.1 (28.1), p=0.007; 0.73 (0.60) versus 0.55 (0.59), p=0.045). 2017, BMJ Publishing Group Limited.

  • 36.
    Ndosi, M.
    et al.
    University of Leeds, Leeds, United Kingdom.
    Bremander, Ann
    Spenshult Hospital, Oskarström, Sweden.
    Hamnes, B.
    Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway.
    Horton, M.
    University of Leeds, Leeds, United Kingdom.
    Kukkurainen, M. L.
    The Finnish Society of Rheumatology Nurses, Heinola, Finland.
    Machado, P.
    Coimbra University Hospital, Coimbra, Portugal.
    Marques, A.
    Coimbra University Hospital, Coimbra, Portugal.
    Meesters, J.
    Leiden University Medical Center, Leiden, Netherlands.
    Stamm, T.
    Medical University of Vienna, Vienna, Austria.
    Tennant, A.
    University of Leeds, Leeds, United Kingdom.
    Torre-Aboki, J.D.L.
    Alicante’s General and University Hospital, Alicante, Spain.
    Vliet Vlieland, T.
    Leiden University Medical Center, Leiden, Netherlands.
    Zangi, H.
    NKRR, Diakonhjemmet Hospital, Oslo, Norway.
    Hill, J.
    University of Leeds, Leeds, United Kingdom.
    Validation of the Educational Needs Assessment Tool as a Generic Instrument for Rheumatic Diseases in 7 European Countries2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A149-A150 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: To validate the educational needs assessment tool (The ENAT) as a generic tool with which to assess the educational needs of patients with rheumatic diseases in European Countries.

    Methods: The study followed a quantitative cross-sectional design. Participants comprised a convenience sample of patients from 7 European countries with each of the following diagnostic group: ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), osteoarthritis (OA) and fibromyalgia syndrome (FMS). Rasch analysis was used to assess the construct validity of the adapted ENATs and cross-cultural invariance.

    Results: The sample comprised 3015 patients with mean (SD) age 52.6 (13.1), disease duration 13.7 (10.7) years, 1996 (66.2%) of which were female. Patient characteristics (stratified by diagnostic group) were comparable across countries except the educational background, which was variable.Initially, the data from each country and diagnostic group was fitted to the Rasch model separately, and then the pooled data from each diagnostic group. On each occasion the data were required to satisfy Rasch model expectations, after correction for local dependency by creating clusters of items known as teslets. The OA group was an exception as it only did so in country-specific datasets, not within the pooled data. There was no significant differential item functioning (DIF) by age, gender, disease duration or educational background, indicating that the ENAT works in the same way across different patient groups. Uniform cross-cultural DIF was present and this was accounted for by 'splitting' the testlets that were affected. Subsequently, DIF-adjusted conversion tables were calibrated, to enable parametric analyses fully adjusted for cross-cultural bias when comparison of multinational data is required.

    Conclusions: The ENAT is a cross-culturally valid and a reliable tool, providing accurate estimation of educational needs of people with rheumatic diseases. Further research is required for its cross-cultural use in OA.

    Disclosure of Interest: None Declared

  • 37.
    Ndosi, Mwidimi
    et al.
    Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN), Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Hamnes, Bente
    Department of Patient Education, Hospital for Rheumatic Diseases, Lillehammer, Norway.
    Horton, Mike
    Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Kukkurainen, Marja Leena
    The Finnish Society of Rheumatology Nurses, Helsinki, Finland.
    Machado, Pedro
    Rheumatology Department, Coimbra University Hospital, Coimbra, Portugal.
    Marques, Andrea
    Rheumatology Department, Coimbra University Hospital, Coimbra, Portugal.
    Meesters, Jorit
    Department of Rheumatology and Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
    Stamm, Tanja A.
    Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
    Tennant, Alan
    Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    de la Torre-Aboki, Jenny
    Department of Rheumatology, Alicante's General and University Hospital, Alicante, Spain.
    Vliet Vlieland, Theodora P. M.
    Department of Rheumatology and Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
    Zangi, Heidi A.
    Department of Rheumatology, National Resource Center for Rehabilitation in Rheumatology (NRRK), Diakonhjemmet Hospital, Oslo, Norway.
    Hill, Jackie
    Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN), Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Validation of the educational needs assessment tool as a generic instrument for rheumatic diseases in seven European countries2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no 12, 2122-2129 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To validate the educational needs assessment tool (ENAT) as a generic tool for assessing the educational needs of patients with rheumatic diseases in European Countries.

    METHODS: A convenience sample of patients from seven European countries was included comprising the following diagnostic groups: ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, systemic lupus erythematosus, osteoarthritis (OA) and fibromyalgia syndrome. Translated versions of the ENAT were completed through surveys in each country. Rasch analysis was used to assess the construct validity of the adapted ENATs including differential item functioning by culture (cross-cultural DIF). Initially, the data from each country and diagnostic group were fitted to the Rasch model separately, and then the pooled data from each diagnostic group.

    RESULTS: The sample comprised 3015 patients; the majority, 1996 (66.2%), were women. Patient characteristics (stratified by diagnostic group) were comparable across countries except the educational background, which was variable. In most occasions, the 39-item ENAT deviated significantly from the Rasch model expectations (item-trait interaction χ(2) p<0.05). After correction for local dependency (grouping the items into seven domains and analysing them as 'testlets'), fit to the model was satisfied (item-trait interaction χ(2) p>0.18) in all pooled disease group datasets except OA (χ(2)=99.91; p=0.002). The internal consistency in each group was high (Person Separation Index above 0.90). There was no significant DIF by person characteristics. Cross-cultural DIF was found in some items, which required adjustments. Subsequently, interval-level scales were calibrated to enable transformation of ENAT scores when required.

    CONCLUSIONS: The adapted ENAT is a valid tool with high internal consistency providing accurate estimation of the educational needs of people with rheumatic diseases. Cross-cultural comparison of educational needs is now possible. © 2013 BMJ Publishing Group Ltd & European League Against Rheumatism.

  • 38.
    Roos, E M
    et al.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden.
    Bremander, A B
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden.
    Englund, M
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden.
    Lohmander, L S
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden.
    Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis2008In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 67, no 4, 505-10 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In the present work, we describe the clinical course and predictors of change in self-reported outcomes and objectively assessed physical function over time in middle-aged subjects at high risk of, or with knee osteoarthritis (OA).

    METHODS: We examined 259 subjects (mean (SD) age 52.6 (10.4)) at mean 18 and 25 years after previous meniscectomy and 50 population-based age- and sex-matched reference subjects with the Knee injury and Osteoarthritis Outcome Score (KOOS), one-leg hop for distance and number of knee-bendings in 30 s. Radiographic OA was defined as equivalent to Kellgren and Lawrence grade 2 or worse.

    RESULTS: At first assessment, meniscectomised subjects reported worse pain, function and quality of life compared with the reference group (p<0.001). They also performed fewer knee-bendings per 30 s (27 vs 31, p = 0.02). The meniscectomised patients worsened over the 4-10-year observation time in all measured outcomes (p<0.001), and to a greater extent than the reference group in pain (-5, 95% CI -10 to 0) and one-leg hop (-11, 95% CI -18 to -3). Being a woman, or having radiographic knee OA, enhanced the worsening in self-reported and objectively assessed outcomes. Older age and a higher body mass index (BMI) influenced objectively assessed physical function, but not self-reported outcomes.

    CONCLUSION: Worsening over time in knee-related pain and function is greater in meniscectomised subjects compared with reference subjects. Rehabilitative efforts may be warranted in middle-aged meniscectomised patients, especially in women and those who have developed radiographic knee OA, who are at greater risk of worsening.

  • 39.
    Sundström, Björn
    et al.
    Umeå University, Umeå, Sweden.
    Johansson, Gunnar
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Johansson, Ingegerd
    Umeå University, Umeå, Sweden.
    Wållberg-Jonsson, Solveig
    Umeå University, Umeå, Sweden.
    Cardiovascular risk factors among patients with ankylosing spondylitis in comparison to the general population2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no Suppl. 3, 648Article in journal (Refereed)
    Abstract [en]

    Background:

    An increased risk of cardiovascular diseases (CVD) has been reported among patients with Ankylosing Spondylitis (AS). As of today, little is known what causes this increase.

    Objectives: The aim of this study was to evaluate whether traditional CVD risk factors, such as smoking, diet, physical activity and atherogenic blood lipids, differ among AS patients in comparison to the general population.

    Methods: Eighty-nine patients diagnosed with AS by fulfilling the modified New York criteria were identified in the databases of a community intervention programme, the Västerbotten Intervention Programme (VIP). The patients were compared with 356 controls matched for age, sex and study period. As part of the VIP, participants have completed questionnaires regarding diet, physical activity and smoking. Additionally, the VIP included measurement of blood pressure, height and weight, and blood samples analysed for cholesterol, serum triglycerides and blood glucose.

    Results: Levels of serum triglycerides (p<0.01) and cholesterol (p<0.01) were significantly lower in the patient group. Among the patients, the level of triglycerides was inversely correlated to the intake of total fat (rs = -0.25, p<0.05), monounsaturated fats (rs = -0.29, p<0.05) and positively correlated to the intake of carbohydrates (rs =0.26, p<0.05). These correlations were not seen among the controls. No significant differences were found between patients and controls regarding diet, physical activity, exercise frequency or smoking habits nor in measurements of body mass index (BMI), weight or blood pressure.

    Conclusions: The patients exhibited significantly lower levels of cholesterol and triglycerides compared with controls. There were correlations between diet and atherogenic blood lipids among the patients which were not found in the control group. The results suggest that there may be differences in fat metabolism among patients with AS in comparison with the general population.

  • 40.
    Söderlin, Maria
    et al.
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    The Effect of Socioeconomic Class and Immigrant Status on Disease Activity in Rheumatoid Arthritis. Data from BARFOT, A Multicenter Study of Early RA2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A395-A395 p.Article in journal (Refereed)
    Abstract [en]

    Background: There are no studies reporting the effect of immigrant status and socioeconomic status on outcome in rheumatoid arthritis (RA) in Sweden.

    Objectives: We wanted to study the effect of immigration and socioeconomic class on outcome in RA in Sweden.

    Methods: Between 1992 and 2005, 2,800 adult patients were included in the BARFOT early RA study in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire (HAQ), drug treatment and European League Against Rheumatism (EULAR) response criteria were applied up to 8 years. The patients completed in 2010 a questionnaire enquiring about demographics and lifestyle factors

    Results: A total of 139/1430 (9.5%) of the patients were immigrants. Immigrants had higher baseline mean HAQ (immigrants 1.2 vs. non-immigrants 0.97, p=0.001), DAS28 (5.6 vs. 5.2, p=0.0001), visual analog scale (VAS) pain (56 mm vs. 45 mm, p=0.0001), VAS global health (53 mm vs. 44 mm, p=0.0001) and tender joint count (TJC) (10 vs. 8, p=0.0001), these differences persisting up to 2 years of follow-up and for HAQ up to 8 years of follow-up. Immigrant status did not have effect on swollen joint count (SJC), ESR, CRP or EULAR response. Socioeconomic class did not have impact on treatment or outcome.

    Conclusions: Immigrants scored worse in pain, function and TJC up to 2 years of follow-up, but did not differ in objective measures of inflammation or EULAR outcome as compared to non-immigrants. This could be due to different perceptions of health and pain and/or the stress of immigration. Socioeconomic class did not have impact on treatment or outcome and this could be due to the relatively egalitarian society in Sweden.

    Disclosure of Interest: M. Söderlin Consultant for: Pfizer, Speakers bureau: Abbott, MSD, BMS, Pfizer, S. Bergman: None Declared, M. Andersson: None Declared

  • 41.
    Thorstensson, Carina A.
    et al.
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Petersson, I. F.
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Jacobsson, L. T. H.
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Department of Rheumatology, Malmö University Hospital, Malmö, Sweden.
    Boegård, T. L.
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Department of Radiology, County Hospital, Helsingborg, Sweden.
    Roos, E. M.
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Department of Orthopaedics, Lund University Hospital, Lund, Sweden.
    Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later2004In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 63, no 4, 402-407 p.Article in journal (Refereed)
    Abstract [en]

    Background: Reduced quadriceps strength is an early finding in subjects with knee osteoarthritis, but it is not clear whether it is a cause or a consequence of knee osteoarthritis.

    Objective: To determine whether reduced functional performance in the lower extremity predicts the incidence or progression of radiographic knee osteoarthritis.

    Design: Prospective, epidemiological, population based cohort study.

    Patients: 148 subjects (62 women), aged 35–54 (mean 44.8), with chronic knee pain from a population based cohort.

    Measurements: Predictors analysed were age, sex, body mass index, baseline knee pain, and three tests of lower extremity functional performance: maximum number of one-leg rises from sitting, time spent walking 300 m, and timed standing on one leg. Weightbearing tibiofemoral knee radiographs were obtained at baseline and after 5 years (median 5.1, range 4.2–6.1), and classified according to Kellgren and Lawrence as no osteoarthritis (Kellgren and Lawrence = 0, n = 94) or prevalent osteoarthritis (Kellgren and Lawrence ⩾1, n = 54).

    Results: Fewer one-leg rises (median 17 v 25) predicted incident radiographic osteoarthritis five years later (OR 2.6, 95% CI 1.1 to 6.0). The association remained significant after controlling for age, sex, body mass index, and pain. No significant predictor of radiographic progression in the group with prevalent osteoarthritis was found.

    Conclusion: Reduced functional performance in the lower extremity predicted development of radiographic knee osteoarthritis 5 years later among people aged 35–55 with chronic knee pain and normal radiographs at baseline. These findings suggest that a test of one-leg rises may be useful, and interventions aimed at improving functional performance may be protective against development of knee osteoarthritis.

  • 42.
    Torell, A.
    et al.
    Ängelholms sjukhus, Ängelholm, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult R&D center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult R&D center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult R&D center, Halmstad, Sweden.
    Symptoms of pain, fatigue and self-efficacy in young patients with spondyloarthritis: – a comparison between women and men2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 1515-1515 p.Article in journal (Refereed)
    Abstract [en]

    Background; The disease spondyloarthritis (SpA) have often an early onset, and can debuts already in teenagers or young adults.  Knowledge of how these patients reporting pain, fatigue and self-efficacy can help to better understand the characteristics of women and men with SpA.

    Objectives: To study the differences between young women and men with SpA with regards to self-reported questionnaires on pain, fatigue and self-efficacy.

    A cross sectional population based cohort were used to create a young patients with SpA.

    Methods: The study is created on a cross-sectional population based cohort of patients with SpA.  They were identified through a health care register by searching for ICD-10 codes for SpA between the years 2003-2007, responding to a questionnaire survey in 2009. 201 patients, 18-36, 29% with the diagnosis of ankylosing spondylitis, 39% with psoriatic arthritis, and 32% with undifferentiated spondyloarhtritis form a subgroup of young patients eligible for analysis.  The surveys including questions concerning self-reported pain (NRS 0-10 and pain mannequin), fatigue (NRS 0-10), self-efficacy (ASES 10-100, low-high). The pain mannequin was used to categorize patients into groups; non chronic pain, chronic regional pain or chronic generalized pain. Self-reported disease activity (BASDAI 0-10) and health related quality of life (EQ5D, 0-1) were used to describe the group. Characteristic symptoms are reported as mean, standard deviation (SD) and frequencies. Mann- Whitney U test and Chi2 test were used to study gender differences.

    Results: The mean age (SD) was, 30 (5) years, 60 % were women. The group reported disease activity (BASDAI) of 3.8 (2.3), quality of life 0.75 (0.16), and that they had their diagnosis for 7 (5) years. One third were smokers or former smokers, and 69 % reached WHO’s recommended level of health enhancing physical activity. Women reported higher pain 3.9 (2.4) compared to men 2.9 (2.1), p=0.001. In the group of both women and men 21 % reported regional chronic pain, 41 % generalized chronic pain and the remaining 38 % reported non chronic pain. More women reported regional and generalized chronic pain than men, p=0.026. Women reported more fatigue 5.0 (2.6) compared to men 3.9 (2.7), p=0.003, less self-efficacy for pain 53 (20), compared to men 59 (21), p=0.041 and for symptoms 59 (19) compared to men 65 (20), p=0.045.

    Conclusion: A significant proportion of both women and men reported symptoms consistent with chronic generalized pain. Women reported generally impaired health compared to men, with a greater percentage with chronic pain, higher rates of pain and fatigue and reduced self-efficacy to manage pain and symptoms. This information could be valuable for clinicians in the care of young patients with SpA. 

  • 43.
    Van der Elst, Kristien
    et al.
    University Hospitals Leuven, Leuven, Belgium.
    Bremander, Ann
    Spenshult Research and Development Center, Spenshult Hospital, Halmstad, Sweden.
    De Groef, Ann
    University Hospitals Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Spenshult Research and Development Center, Spenshult Hospital, Halmstad, Sweden.
    Mathijssen, Elke
    Sint-Maartenskliniek, Nijmegen, Netherlands.
    Vriezekolk, Joke
    Sint-Maartenskliniek, Nijmegen, Netherlands.
    Westhovens, Renee
    University Hospitals Leuven, Leuven, Belgium.
    van Eijk-Hustings, Yvonne
    Maastricht University Medical Center, Maastricht, Netherlands.
    European Qualitative Research Project on Patient-preferred Outcomes in Early Rheumatoid Arthritis (EQPERA): Rationale, Design and Methods of a Multi-country, Multi-center, Multi-language, Longitudinal Qualitative Study2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, 1488-1489 p.Article in journal (Refereed)
    Abstract [en]

    Background: Ample studies exist on outcome assessment from the patient perspective in Rheumatoid Arthritis (RA), but little is known about health and treatment preferences of recently diagnosed patients, and how these evolve over time. A Belgian qualitative study has set the scene (1), but knowledge on cross-cultural nuances in patient-preferred outcomes is lacking. To this end, EQPERA – European Qualitative research collaboration on Patient-preferred outcomes in Early Rheumatoid Arthritis– was founded.

    Objectives: EQPERA aims to unravel longitudinally preferences for treatment and health outcomes among patients with early RA across Belgium, the Netherlands and Sweden. To yield sound results, specific preparations for this cross-country qualitative study are reported here.

    Methods: Several steps have been undertaken to ensure trustworthiness of findings and consistency across countries in sampling, interviewing, analysis and project management: a detailed research protocol has been written; the interview guides have been translated following a structured forward-backward linguistic validation process; templates for data collection and a quality assurance reporting tool have been developed; and local staff has been trained and supervised by the project leader in implementing the study protocol. Each country will document changes with sufficient detail in their research logbook.

    Results: EQPERA will be a qualitative, explorative, longitudinal study with active involvement of patient researchers. In each country, a purposive sample of patients with early RA will be individually interviewed 3–6 months after start of the initial RA treatment and subsequently, the same participants will be invited back to take part in a focus group 12–18 months after RA treatment initiation. Data collection and analysis will be independently conducted by the local research teams in their native language. The local teams will analyze their interview data using the constant comparison method as detailed in Qualitative analysis guide of Leuven, after which Saldana's guiding questions will be adopted for analyzing change over time. Afterwards, a meta-synthesis of all locally gathered and interpreted data will be conducted to explore and describe patterns, similarities and differences across countries.

    Conclusions: This European project is a first step in gathering contextual findings on patient-preferred outcomes in early RA. Such knowledge is of crucial importance for tailoring therapeutic approaches in a timely and meaningful way. Our innovative, qualitative, longitudinal research design goes beyond the abilities of the frequently used cross-sectional designs in qualitative research. Large, multi-national qualitative projects are scarce in rheumatology research, thus applied data management and quality assurance strategies could be of interest to other researchers. © 2017, BMJ Publishing Group Limited

  • 44.
    Wikström, I.
    et al.
    Malmö University Hospital, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Nilsson, K.
    Malmö University Hospital, Sweden.
    Roos, E.
    Lund University, Sweden.
    Jacobsson, L. T. H.
    Lund University, Sweden.
    Validity and reliability of anew leisure index - The PSLS2007In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 66, no Suppl. 2, 661-661 p.Article in journal (Other academic)
  • 45.
    Åsenlöf, Pernilla
    et al.
    Uppsala University, Uppsala, Sweden.
    Demmelmaier, Ingrid
    Uppsala University, Uppsala, Sweden.
    Emilson, Christina
    Uppsala University, Uppsala, Sweden.
    Pettersson, Susanne
    Uppsala University, Uppsala, Sweden.
    Bergman, Stefan
    Spenshult Centre for Rheumatic Disease, Oskarström, Sweden.
    Step-Up: An Innovative Stepped-Care Protocol for Tailored Behavioral Medicine Treatment in the Management of Musculoskeletal Pain in Primary Care2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, A120-A120 p.Article in journal (Refereed)
    Abstract [en]

    Background: Multimodal rehabilitation and tailored behavioral medicine treatments should be provided to patients suffering from persistent and activity limiting pain according to current state-of-science. There is also evidence that a minimal intervention including 'stay-active advice' can produce effects comparable to effects of comprehensive treatment packages. Nevertheless, there is a gap of knowledge regarding which individuals who benefit the most from which modalities of pain treatment, at what time point, and with the highest cost-effectiveness. Accordingly, we have set up an innovative stepped-care protocol for the management of musculoskeletal pain in primary care, which is evaluated in a randomized controlled trial.

    Objectives: The aim is to compare effects and cost-effectiveness of a stepped care model including advice and tailored behavioral medicine pain treatment (experimental condition) with a stepped care model including advice and physical exercises (comparison condition) for patients with low back and neck pain and/or widespread pain including fibromyalgia in primary care. A further aim is to characterize patients who benefit/do not benefit from the respective steps i.e. treatments varying in dose and content.

    Methods: A stratified randomized stepped care design is applied. Stratification is based on primary care center and psychological risk profile. A consecutive selection is performed at primary care centers in southern, central and northern Sweden. After having received a minimal intervention (step 1) comprising 'stay-active advice', participants scoring high on the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) according to preset criteria are randomly allocated to an eight-week treatment in step 2. The experimental condition includes supervised physical exercises integrated with either (a) graded activity, or (b) hierarchical graded exposure depending on psychological risk profile. The comparison condition includes supervised physical exercises irrespective of risk profile. Primary outcome is pain-related disability complemented with a comprehensive set of secondary outcomes adhering to the IMMPACT recommendations.

    Results: The stepped-care design will be presented including illustrations of conclusions possible to draw with this kind of innovative design.

    Conclusions: There is a call for stepped-care interventions within pain intervention research, particularly in the primary care setting. However, published studies are still lacking. This study will contribute to an important progression of behavioral medicine pain treatments by the way treatments are tailored in accordance with psychological risk profile. This will be discussed to stimulate research activities and collaboration within this area of research and clinical implementation.

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