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  • 1.
    Bergman, Stefan
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Spenshult Research and Development Center, Halmstad, Sweden.
    Lifestyle factors were seldom discussed with patients visiting a rheumatology clinic2013In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, no Special issue, Supplement 10, p. S982-S983, Meeting Abstract: 2307Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: There is increasing evidence that lifestyle factors are of importance for outcome of rheumatic diseases, and lifestyle interventions should be a natural part of management.

    The aim was to study if lifestyle factors (diet, physical activity, smoking and alcohol use) were discussed with patients on a regular visit to a specialized rheumatology clinic.

    Methods: A questionnaire was distributed to 318 patients visiting an outpatient clinic, and 223 (70%) responded. The questionnaire assessed if lifestyle factors (diet, physical activity, smoking and alcohol use) were discussed at the visit. If not, it also assessed if the patients themselves felt that this discussion would have been desirable.

    Results: The questionnaire was answered by 69 (31%) men and 154 (69%) women, and 69% were younger than 65 years. Diet was more frequently discussed with men (14.7% vs. 4.8%) although more women (11.6% vs 4.4%) would have desired it to be discussed. 83% of the patients did not consider that it was needed to discuss at all. Physical activity was discussed with 28% of the patients, without any significant difference between men and women. Only 8% of those not having this discussion thought that they needed it. Smoking was discussed with 15%, without any significant difference between men and women. Alcohol use was discussed with more men than women (15.9% vs. 4.0%). Of those not having this discussion 3% of the women but none of the men thought that they needed it.

    Conclusion: Although recommended as part of management, lifestyle factors are seldom discussed with the patients, and this discussion is not actively thought for by the patients. Lifestyle factors are more frequently discussed with men although women would have desired to have this discussion to a higher extent. There is a need for health care to actively take the initiative and discuss lifestyle as part of regular care.

  • 2.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Jacobsson, Lennart T. H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Research and Development Centre Spenshult, Halmstad, Sweden.
    Petersson, Ingemar
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Smoking is Associated with Worse and More Widespread Pain, Worse Fatigue, General Health and Quality of Life in a Swedish population Based Cohort of Patients with Psoriatic Arthritis2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S777-S778, article id 1828Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: Smoking has been found to be associated with an increased risk of developing psoriatic arthritis (PsA)1. The purpose of this study was analyse possible associations of smoking habits with self-reported clinical features in a large population based cohort of patients with a diagnosis of PsA.

    Methods: All health care seeking subjects with a diagnose of PsA according to ICD 10 codes (given at least once by a rheumatologist/internist or twice by any other physician) were identified by a regional health care register during 2003-20072. In 2009 all identified subjects aged 18 years or older (n=2003) were invited to participate in a cross sectional questionnaire survey. The questionnaire included self-reported data on smoking (never smokers or ever smokers), age at disease onset, physical function (HAQ, 0-3 best to worst), pain, fatigue and global health (numerical rating scales 0-10 best to worst) health related quality of life (EQ-5D, 0-1 worst to best), and number of painful regions noted on a pain mannequin (0-16, best to worst). Linear regression analysis was performed and all data were controlled for sex and age.

    Results: Response rate was 77% whereof 369 patients (18%) declined participation and 1185 (59%) returned the questionnaire,  mean age 57.5 (SD 13.5) years and 58% were women. 1173 subjects responded to the smoking question whereof 448 (38%) were never smokers and 725 (62%) were ever smokers.

    Mean age at disease onset was 42.3 (SD 13.4) years in never smokers vs. 46.0 (SD 13.2) in ever smokers. Never smokers vs. ever smokers had mean HAQ 0.59 (SD 0.6) vs. 0.71 (SD 0.6),  mean pain 3.9 (SD 2.4) vs.4.4 (SD 2.5),  mean fatigue 4.4 (SD 2.8) vs. 5.0 (SD 2.7),  mean global health 3.9 (SD 2.4) vs. 4.4 (SD 2.3), mean EQ-5D 0.68 (SD 0.23) vs. 0.63 (SD 0.26) and mean no of painful regions were 7.2 (SD 4.0) vs. 7.9 (SD 4.3).

    The regression analysis showed that ever smokers had worse pain with age-sex adjusted parameter estimates (B) = 0.38 (95% CI 0.09 ; 0.67), worse fatigue B = 0.34 (95% CI 0.02 ; 0.66), worse global health B = 0.36 (95% CI 0.09 ; 0.64), worse EQ-5D B = -0.04 (95% CI -0.07 ; -0.01) and an increased no of painful regions B = 0.54 (95% CI 0.02 ; 1.07) compared with never smokers.

    Conclusion: In this population based PsA cohort, patients who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended due to general health perspectives and also due to disease specific issues.

  • 3.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Haglund, Emma
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Jacobsson, Lennart T.H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Smoking Is Associated with Worse and More Widespread Pain, Worse Disease Activity, Function, Fatigue and Health Related Quality of Life in Patients with Axial Spondyloarthritis: Results From a Population Based Cohort2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S43-S43, article id 95Article in journal (Refereed)
    Abstract [en]

    Background: In subjects with early axial Spondyloarthritis (SpA) smoking has recently been associated with earlier onset of disease, worse lesions of the sacroiliac joints and in later stages syndesmophyte progression. The aim was to study associations of smoking habits with self-reported information in a large population based cohort of patients with axial SpA.

    Methods: A cross-sectional questionnaire survey performed in 2009 included all health care seeking subjects aged >18 years with a diagnosis of SpA according to ICD 10 codes identified by a regional health care register (n=3711). Smoking habits were studied in patients with ankylosing spondylitis (AS, ICD M45) and in patients who fulfilled criteria for “non AS axial SpA” (without having one of AS). Criteria for non AS axial SpA were based on data from the questionnaire: pain for 3 months or more during the last 12 months together with 2 or more features out of 5 (inflammatory back pain, history of psoriasis, uveitis/tendinitis, inflammatory bowel disease or heredity). The questionnaire included data on smoking (never smokers vs. ever smokers), disease activity (BASDAI) physical function (BASFI), general health (BAS-G) all measured with numerical rating scales 0-10 (best to worst), health related quality of life (EQ-5D, 0-1 worst to best), pain, fatigue (numerical rating scales 0-10 best to worst) and number of painful regions noted on a pain mannequin (0-16 best to worst). Linear regression analysis was performed and all data were controlled for sex and age.

    Results:

    Response rate was 76% whereof 2167 (58%) returned the questionnaire and 18% declined participation in the study. 598 subjects had an AS diagnose and 572 fulfilled the criteria for non AS axial SpA.

    The AS group had a mean age of 54 (SD14) years and 35% were women. Never smokers constituted 48% of the AS group. Ever smokers had worse scores in all studied variables compared with never smokers.

    The linear regression analysis showed that ever smokers in the AS group had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.60 (95% CI 0.21 ; 1.00), BASFI B = 0.51 (95% CI 0.11 ; 0.91) and fatigue B = 0.51 (95% CI  0.06 ; 1.00) . There was a tendency to worse scores for ever smokers also in EQ-5D B = -0.04 (95% CI -0.09 ; 0.001)

    Mean age in the non AS axial SpA group was 55 (SD 14) years and 68% were women. Never smokers constituted 38% of this group. Also in the non AS axial SpA group the linear regression analysis showed that ever smokers had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.59 (95% CI 0.23 ; 0.94), BASFI B = 0.59 (95% CI 0.17 ; 1.00), pain B = 0.45 (95% CI 0.08 ; 0.82) and fatigue B = 0.43 (95% CI  0.03 ; 0.83), no of painful areas B = 0.73 (95% CI  0.06 ; 1.46) and also in EQ-5D B = -0.06 (95% CI -0.11 ; -0.002).                                                                                                                                                

    Conclusion: In a large population based axial SpA cohort, both patients with AS and non AS axial SpA who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended not only due to general health perspectives but also due to disease specific issues.

    References

    1Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Chung HY, Machado P, van der Heijde D, D'Agostino MA, Dougados M. Ann Rheum Dis. 2012 Jun;71(6):809-16.

  • 4.
    Brodin, Nina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Eurenius, Eva
    Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Karolinska Institutet, Stockholm, Sweden.
    Nisell, Ralph
    Karolinska Institutet, Stockholm, Sweden.
    Opava, Christina H.
    Karolinska Institutet, Stockholm, Sweden.
    Almin, Ingrid
    Örebro University Hospital, Örebro, Sweden.
    Andersson, Britt
    Karolinska University Hospital–Solna, Stockholm, Sweden.
    Bertholds, Gunhild
    Skövde Hospital, Skövde, Sweden.
    Forsberg, Catarina
    Falun Hospital, Falun, Sweden.
    Haglund, Emma
    Spenshult AB, Oskarström, Sweden.
    Holmén-Andersson, Ann-Marie
    Sahlgrenska University Hospital, Mölndal, Sweden.
    Hultman, Anna
    Uppsala University Hospital, Uppsala, Sweden.
    Lennartsson, Claudia
    Karolinska University Hospital–Huddinge, Stockholm, Sweden.
    Norman, Elin
    Danderyd Hospital, Stockholm, Sweden.
    Coaching Patients With Early Rheumatoid Arthritis to Healthy Physical Activity: A Multicenter, Randomized, Controlled Study2008In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 59, no 3, p. 325-331Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis.

    Methods

    A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (≥30 minutes, moderately intensive activity, most days of the week).

    Results

    The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%; P > 0.05) and after (54% versus 44%; P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test; P = 0.000) (Grippit; P = 0.003), but not in any other variables assessed.

    Conclusion

    A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change. © 2008, American College of Rheumatology.

  • 5.
    Hagel, Sofia
    et al.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Who will achieve individually set goals after arthritis team rehabilitation?2013In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, no Special issue, Supplement 10, p. S898-S898, Meeting Abstract: 2110Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: To study goal achievement among patients with chronic inflammatory arthritis after arthritis rehabilitation performed in multidisciplinary team rehabilitation programs.

    Methods: 146 consecutive patients with rheumatoid arthritis (RA) and spondylarthritis (SpA), age 18 years or older, completing arthritis rehabilitation for 5 days or more at 2 rheumatology specialist units were included in this study.  At admission and discharge the patients were evaluated with measures on functioning (HAQ), self efficacy (ASES), psychological health (Hopkins Symptom Checklist – HSCL-25), pain and fatigue (NRS) and on health related quality of life (HRQoL) as captured by the EQ-5D and the SF-36. Comorbidity and social demographics was also reported. The patients, in cooperation with the health professionals, set individual goals for their rehabilitation period. At discharge the patients reported if the goal was achieved completely, partially or not at all.

    Non parametric statistical analyses were performed and Chi2 and Kruskal-Wallis analyses were used to study the relationship between goal achievement and baseline and change variables. 

    Results: 108/146 patients reported whether goals were achieved or not, and were included in further analyses. 76% were females and 55% had RA. At baseline median age was 54 years (IQR 17), median HAQ 0.88 (IQR 0.88), median HRQoL as captured by the EQ-5D 0.62 (IQR 0.57) and median psychological wellbeing according to HSCL-25 1.62 (IQR 0.68). The patients reported median fatigue 6.0 (IQR 4.0) and median pain 5.0 (IQR 3.0) when entering the rehabilitation program that lasted for median 18 days (IQR 2).

    58/108 patients (54%) rated their goal to be completely achieved, 40 patients (37%) reported partial goal achievement while 10 (9%) patients had not achieved their goal. Positive reporting of having followed the recommendations (compliance) during the rehabilitation period was obtained from 100 (93%) of the patients.

    Change after intervention and compliance did not affect reports of goal achievement after rehabilitation. Females reported goal achievement more often than men did (p=0.019). Those not achieving their goals reported less psychological wellbeing (HSCL-25, p=0.011) at admission together with reports of worse pain (SF-36bp, p=0.011). 

    Conclusion: 54% of the included patients reported complete goal achievement after arthritis team rehabilitation. Neither change after intervention nor compliance affected patients’ reports of goal achievement. Female patients were more prone to achieve their goals while patients experiencing less psychological wellbeing or more pain at baseline were less prone to report goal achievement.

  • 6.
    Hagel, Sofia
    et al.
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sweden & 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).
    Lindqvist, Elisabet
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sweden 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 21st century Health Care Utilization in a Rheumatoid Arthritis Cohort Compared to the General Population2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S31-S32, article id 73Article in journal (Refereed)
    Abstract [en]

    Statement of purpose: To study twenty-first century trends in health care utilization by rheumatoid arthritis (RA) patients compared to the general population. Methods: Observational cohort study; using Swedish health care register data, we identified 3977 Region Skåne residents (mean age year 2001, 62.7 years and 73% women) consulting for RA (ICD-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 hospitalizations and outpatient clinic visits. Results: By the end of the 10-year period 62% of RA 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 hospitalizations 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 (Figure 1 and 2). Figure 1.Health care utilization during the first decade of the twenty-first century by patients in a closed rheumatoid arthritis cohort and their matched referents from the general population. The y-axes show the mean number of visits per subject per calendar year. Figure 2.Health care utilization during the first decade of the twenty-first century by patients in a closed rheumatoid arthritis cohort and their matched referents from the general population. The y-axes show the mean number of visits per subject per calendar year. Conclusions: During the twenty-first century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, the overall inpatient and outpatient health care utilization by a cohort of RA patients decreased relative to the general population.

  • 7.
    Haglund, Emma
    et al.
    R&D Center Spenshult, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Bergman, Stefan
    Department of Rheumatology, Clinical sciences, Skåne University Hospital, Malmö, Sweden.
    Jacobsson, Lennart
    Department of Rheumatology, Clinical sciences, Skåne University Hospital, Malmö, Sweden.
    Strömbeck, Britta
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund, Sweden.
    Petersson, Ingemar
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund, Sweden.
    Work productivity in a population based cohort of patients with Spondyloarthritis2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no 10, p. S1015-S1015Article in journal (Refereed)
    Abstract [en]

    Background: Spondyloarthritis (SpA) often causes impaired function, activity limitations, affected health related quality of life and work disability. Work disability has been shown to be affected both in terms of absenteeism and in impaired productivity while working (presenteeism). In this group with increased socioeconomic costs there is also an increase in  the use of expensive pharmacotherapies. Thus, it is important to study factors related to the ability to stay productive while at work.

    Objective: The aim was to study factors associated with presenteeism in patients with SpA. Also to analyse possible differences in age, gender and SpA subtypes (ankylosing spondylitis, psoriatic arthritis and undifferentiated SpA).

    Methods: The analysis was based on 1773 patients seeking health care for SpA aged 18-67 years from southern Sweden, identified by a health care register. A questionnaire survey in 2009 included questions concerning self-reported presenteeism, defined as the percentage of impairment due to SpA while working 0-100, (0=no impact), was answered by 1447 individuals. Patients´ characteristics: disease duration, disease activity (BASDAI), physical function (BASFI), health related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy pain and symptom (ASES) and register based sick leave. The Pearson’s correlation coefficient and univariate analyses with ANOVA were used to study factors associated with presenteeism and t-test was used for group comparisons.

    Results: Fifty-five percent (n=802/1447) reported no impact on work presenteeism, while mean impairment was 20 (95% CI 18-21) (n=1447). Women reported higher impact on work presenteeism than men (mean impairment 23 vs. 17, p<0.001) but no statistically significant differences were found between the SpA subtype groups. Twenty-eight percent (n=504/1773) were registered for any sick leave (absenteeism > 14 days). Worse outcome in quality of life (EQ-5D), disease activity (BASDAI) and physical function (BASFI) all correlated to higher impact on work presenteeism (r >0.5, p <0.001), while sick leave (absenteeism) did not.  In the univariate analyses experiencing worse outcome in EQ-5D (β-est -9.6, p<0.001) BASDAI (β-est 7.8, p<0.001) and BASFI (β-est 7.3, p<0.001) were all associated to higher impact on presenteeism regardless of age, gender and disease subtype. Worse outcome of EQ-5D was associated to a higher degree impact on presenteeism in the younger women (18-52 yrs). Self-efficacy, anxiety, depression, disease duration and education level <12 years were all associated to higher impact on presenteeism but were not significant in all strata for age, gender and disease subtype.

    Conclusion: Quality of life, disease activity and physical function all affect work presenteeism in patients with SpA, regardless of age, gender and disease subtype. The results indicate that work presenteeism is affected in patients with all types of SpA and more affected in women. We also find that presenteeism and register based sick leave (absenteeism) may be related to different dimensions of the individuals and their disease.

  • 8.
    Larsson, Ingrid
    et al.
    Jönköping University, Jönköping, Sweden.
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult Hospital, R&D Center, Spenshult Hospital, Oskarström, Sweden.
    Treatment Outcomes From a Nurse-Led Rheumatology Clinic in Monitoring of anti-TNF Therapy – a Randomised Controlled Trial2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no 10, p. S667-S667, article id 1559Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic inflammatory arthritis (CIA) treated with anti-TNF therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission. The purpose of this trial was to compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients undergoing anti-TNF therapy with low disease activity or in remission.

    Methods: A randomized controlled trial (RCT) with a 12-month follow-up was conducted with 107 patients randomised into two groups with a 6-month follow up to a nurse-led rheumatology clinic based on a person-centred care (intervention group; n=53) or to a rheumatologist-led clinic (control group; n=54). The intention of the interventional trial was to replace one of the two annual rheumatologist monitoring visits by a nurse-led rheumatology monitoring visit for patients undergoing anti-TNF therapy. Inclusion criteria were patients undergoing anti-TNF therapy and Disease Activity Score 28 (DAS28) ≤3.2. The hypothesis was that the outcomes from nurse-led clinic will not be inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. Primary outcome was disease activity measured by DAS28.

    Results: After 12 months 47 patients in the intervention group and 50 patients in the control group completed the trial and there were no differences (p=0.66) in mean change of DAS28 between the intervention or control group. There were no differences (p>0.05) in mean change in Visual Analogue Scales (VAS) for pain, Health Assessment Questionnaire (HAQ), satisfaction or security with the rheumatology care  between the two groups, see table.

    Conclusion: In monitoring of anti-TNF therapy treatment outcomes for patients at a nurse-led rheumatology clinic are not inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. The follow-up care of anti-TNF therapy may advantageously be performed by a nurse-led clinic based on a person-centred care. The results from this trial demonstrated that patients with CIA undergoing anti-TNF therapy, with low disease activity or in remission, could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.

  • 9.
    Mogard, Elisabeth
    et al.
    Lund University, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research & Development Center, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Differences in spinal mobility measures in relation to disease duration and between subgroups with axial spondylarthritis2013In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, no Special issue, Supplement 10, p. S896-S896, Meeting Abstract: 2105Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: Spinal mobility is a core domain for research and clinical practice in Ankylosing Spondylitis (AS) but less studied in undifferentiated SpA (USpA). Our objective was to study the change of commonly used spinal mobility measures stratified on disease duration in patients with AS and differences in these measures in AS vs. USpA.

    Methods: Patients with AS or USpA were identified from a cohort attending a specialist clinic. A cross sectional studie were the first measures of spinal mobility for each patient recorded during 1999 to 2012 were analyzed. Disease duration was split into tertiles, (<17 years (G1), 18-30 years (G2) and >31 years (G3)). Differences between AS G1/G2/G3 were calculated with Kruskal-Wallis. Differences between AS and USpA were controlled for sex and disease duration (ANCOVA).

    Results: 126 patients with AS vs. 57 with USpA were included in the study, mean (SD) age 48.4 (13.7) vs. 41.6 (11.4) years and 23% vs. 46% were women. In AS, lumbar, and thoracic measures, vital capacity and the BASMI composite score were the first measures to deteriorate in relation to disease duration (G1 vs. G2, p<0.035). Late in the disease all measures had deteriorated (G1 vs. G3, p<0.036). Patients with USpA presented better scores in lumbar, hip and thoracic spinal measures (p<0.05), data controlled for sex and disease duration. In early disease (<17 years) also cervical measures (p<0.05) were less affected compared to patients with AS.

    Conclusion: The first measures to significantly change during the disease course in AS were the lumbar and thoracic mobility measures and the BASMI score. As expected, patients with USpA were less affected in mobility than patients with AS.

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