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  • 1.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Jacobsson, Lennart T. H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Department of Clinical Sciences, Section of Rheumatology, Malmö, Lund University, Lund, Sweden.
    Bergman, Stefan
    Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Löfvendahl, Sofia
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Smoking is associated with a worse self-reported health status in patients with psoriatic arthritis: data from a Swedish population-based cohort2015Ingår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, nr 3, s. 579-583Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to study possible associations between smoking habits and self-reported clinical features in a large population-based cohort of patients with psoriatic arthritis (PsA). All subjects with PsA who had sought health care in the period 2003-2007 were identified using a regional health-care register. In 2009, all those identified who were 18 years of age or more (n = 2,003) were sent a questionnaire with questions on smoking, health-related quality of life [EuroQol five-dimension (EQ-5D)questionnaire], function [Health Assessment Questionnaire (HAQ)], pain, fatigue, and global health. We performed age- and sex-adjusted regression analysis to compare health status outcomes in never and ever smokers. Altogether, 1,185 subjects (59 %) returned the questionnaire. Mean age was 57 years (SD 13.5), and 58 % were women; 38 % were never smokers and 62 % were ever smokers. Mean age at disease onset was 38.2 years (SD 13.2) and 41.2 years (SD 13.6), respectively (p = 0.001). In age- and sex-adjusted data, ever smokers reported worse EQ-5D (p = 0.009); worse reports of global health (p = 0.01), pain (p = 0.01), and fatigue (p = 0.04); and a higher number of painful body regions (p = 0.04) compared to never smokers. In this population-based PsA cohort, patients who were ever smokers reported worse health status than never smokers. Besides being a possible result of a worse PsA in ever smokers, impaired health status could also be an effect of unstudied comorbidities. Further longitudinal studies are needed to gain a better understanding of cause and effect. However, smoking cessation should be recommended because of general health considerations as well as disease-specific issues.

  • 2.
    Bremander, Ann
    et al.
    Lund University, Lund, Sweden & Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Englund, Martin
    Lund University, Lund, Sweden & Boston University School of Medicine, Boston, Massachusetts, USA.
    Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis2011Ingår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 63, nr 4, s. 550-556Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the rate of common comorbidities and cardiovascular disease in patients with ankylosing spondylitis (AS) compared with the general population seeking health care.

    METHODS: This cohort study included 935 subjects (67% men) ages ≥20 years diagnosed with AS and the adult background population in Southern Sweden. During 2004 to 2007 we recorded the occurrence of physicians' diagnostic codes for a select number of comorbidities commonly associated with AS and cardiovascular disease and risk factors. We obtained standardized morbidity-rate ratios (SMRs) by dividing the observed morbidity rate in AS patients by the expected rate based on the corresponding rate of the disease in the general population of the county seeking health care.

    RESULTS: The highest SMRs were found for uveitis (34.35, 95% confidence interval [95% CI] 28.55-40.98) and inflammatory bowel disease (9.28, 95% CI 7.07-11.97). Also, we found increased SMRs for ischemic heart diseases (2.20, 95% CI 1.77-2.70), hypertension (1.98, 95% CI 1.72-2.28), and diabetes mellitus (1.41, 95% CI 1.10-1.78). Furthermore, the SMRs for psoriasis, osteoporosis, and atrioventricular blocks were also statistically significantly elevated.

    CONCLUSION: Inflammatory diseases affecting the eye and the digestive system were the most notable comorbidities in AS patients, but the rate for cardiovascular disease was also high. Using comprehensive longitudinal population-based register data is a promising tool to evaluate the excess consultation rate and total burden of rheumatic disease on patients and society. Copyright © 2011 by the American College of Rheumatology.

  • 3.
    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 Sweden2011Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 70, nr 6, s. 943-948Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Strömbeck, Britta
    et al.
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Department of Rheumatology, University Hospital, Malmö, Sweden.
    Jacobsson, Lennart T. H.
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Department of Rheumatology, University Hospital, Malmö, Sweden.
    Bremander, Ann
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Englund, Martin
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden.
    Heide, Anders
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Swedish Social Insurance Agency, Region Skåne, Sweden.
    Turkiewicz, Aleksandra
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden.
    Patients with ankylosing spondylitis have increased sick leave—a registry-based case-control study over 7 yrs2009Ingår i: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 48, nr 3, s. 289-292Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Using prospectively collected registry data to investigate sick leave (sickness benefit and sickness compensation) over a 7-yr period in patients with AS in comparison with population-based controls matched for age, sex and residential area.

    METHODS: We investigated 122 (21 women and 101 men) outpatients with AS in South Sweden, born 1942 or later, from rheumatology specialist care for their sick leave during a 7-yr period. Mean (S.D.) age was 43 (11) yrs and mean (S.D.) disease duration was 20 (11) yrs. Two controls per case, matched for age, sex and residential area were selected from the Swedish National Population Register. Data concerning sick leave for cases and controls, based on the subjects' unique 10-digit personal identification number, were retrieved from the national register of the Swedish Social Insurance Agency.

    RESULTS: More AS patients than controls were registered for sickness benefit (52 vs 36%, P < 0.01) and sickness compensation (42 vs 11%, P < 0.001). Cases had an increased risk for sick leave compared with controls with a relative risk of 1.8; 95% CI 1.5, 2.1; and cases had more days with sick leave than controls (median number of more days per year 30; 95% CI 2, 72).

    CONCLUSIONS: Using the Swedish Social Insurance Agency's registers for sick leave, we found that patients with AS in rheumatology specialist care in South Sweden have an increased level of sick leave compared with controls. These population-based registers have a great potential for studies of the effects of different interventions on sick leave. © 2009 The Author(s).

  • 5.
    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 later2004Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 63, nr 4, s. 402-407Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Thorstensson, Carina A.
    et al.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Roos, Ewa M.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    How do middle-aged patients conceive exercise as a form of treatment for knee osteoarthritis?2006Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, nr 1, s. 51-59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose. To describe conceptions, as registered by a semi-structured interview, of exercise as treatment among sixteen middle-aged patients with moderate to severe knee osteoarthritis.

    Method. Sixteen patients (aged 39 – 64) with symptomatic, radiographic knee osteoarthritis and previous participants in an exercise intervention, were interviewed. The qualitative data obtained were analysed using phenomenographic approach.

    Results. Four descriptive categories containing 13 conceptions emerged: Category 1) To gain health included five conceptions; to experience coherence, to experience well-being, to be in control, to experience improved physical functioning, to experience symptom relief; 2) To become motivated included three conceptions; to experience inspiration, to be prepared to persevere, to experience the need to exercise; 3) To experience the need for support included three conceptions; to have structure, to receive guidance, to devote time; 4) To experience resistance included two conceptions; to hesitate, to deprecate.

    Conclusion. Patients with knee osteoarthritis and knee pain, previously participating in exercise intervention, are aware of the health benefits of exercise, but have many doubts and concerns about exercise as treatment. These aspects should be considered when designing patient information and treatment programmes. Furthermore, a hesitative and resistive perception of exercise as a concept could have major influences on the implementation of health programmes. © 2006 Taylor & Francis.

  • 7.
    Thorstensson, Carina A.
    et al.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Rheumatology, Lund University, Lund, Sweden.
    Roos, Ewa M.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Orthopedics, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Orthopedics, Lund University, Lund, Sweden.
    Ekdahl, Charlotte
    Dept. of Physical Therapy, Lund University, Lund, Sweden.
    Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858]2005Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 6, artikel-id 27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life. Methods: Patients aged 36-65, with OA grade III (Kellgren & Lawrence) were recruited. They had been referred for radiographic examination due to knee pain and had no history of major knee injury. They were randomized to a twice weekly supervised one hour exercise intervention for six weeks, or to a non-intervention control group. Exercise was performed at ≥ 60% of maximum heart rate (HR max). The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up occurred at 6 weeks and 6 months. Results: Sixty-one subjects (mean age 56 (SD 6), 51 % women, mean BMI 29.5 (SD 4.8)) were randomly assigned to intervention (n = 30) or control group (n = 31). No significant differences in the KOOS subscales assessing pain, other symptoms, or function in daily life or in sport and recreation were seen at any time point between exercisers and controls. In the exercise group, an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group (mean change 4.0 vs. -0.7, p = 0.05). The difference between groups was still persistent at 6 months (p = 0.02). Conclusion: A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA. Some effect was seen on quality of life in the exercise group compared to the control group. © 2005 Thorstensson et al; licensee BioMed Central Ltd.

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