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1. Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study

Author

Metcalfe Andrew J, Andersson Maria LE, Goodfellow Rhian, and Thorstensson Carina A

Subjects
Osteoarthritis, Bilateral, Unilateral, Cohort, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background The aim of this study was to document the development of bilateral knee osteoarthritis over a 12 year period using a middle-aged population-based cohort with knee pain at inclusion. Methods One hundred and forty three patients aged 35 to 54 were recruited from a population based cohort of 279 subjects who had knee pain at baseline and assessed with clinical and radiographic data, with 5 and 12 year follow up. The data was analysed with regard to the development and progression of uni- and bilateral knee osteoarthritis over 12 years. A definition of KL = 1 was used to define radiographic disease. Results 24 of the 30 (80%) patients with unilateral disease at baseline developed bilateral disease after 12 years. At baseline 37 patients (26%) had bilateral disease, whereas that number increased to 65 (52%) at 5 years and 100 (70%) at the 12 year follow up. The most common pattern was medial compartment involvement in both knees. Six patients had lateral compartment disease in one knee and medial in the other whereas only two had lateral compartment disease bilaterally. Conclusions Bilateral knee osteoarthritis is very common with time, as the majority of sufferers will eventually develop radiographic disease in both knees. Clinicians need to be aware of the ‘joint at risk’ and researchers need to remember to account for both knees when assessing the relationship between physical function, pain and structural disease. The other knee should not be used for comparison, even if it appears to be normal at baseline.

Published
2012
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2. Serum levels of Cartilage Oligomeric Matrix Protein (COMP) increase temporarily after physical exercise in patients with knee osteoarthritis

Author

Roos Ewa M, Thorstensson Carina A, Andersson Maria LE, Petersson Ingemar F, Heinegård Dick, and Saxne Tore

Subjects
Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background COMP (Cartilage oligomeric matrix protein) is a matrix protein, which is currently studied as a potential serum marker for cartilage processes in osteoarthritis (OA). The influence of physical exercise on serum COMP is not fully elucidated. The objective of the present study was to monitor serum levels of COMP during a randomised controlled trial of physical exercise vs. standardised rest in individuals with symptomatic and radiographic knee OA. Methods Blood samples were collected from 58 individuals at predefined time points before and after exercise or rest, one training group and one control group. The physical exercise consisted of a one-hour supervised session twice a week and daily home exercises. In a second supplementary study 7 individuals were subjected to the same exercise program and sampling of blood was performed at fixed intervals before, immediately after, 30 and 60 minutes after the exercise session and then with 60 minutes interval for another five hours after exercise to monitor the short-term changes of serum COMP. COMP was quantified with a sandwich-ELISA (AnaMar Medical, Lund, Sweden). Results Before exercise or rest no significant differences in COMP levels were seen between the groups. After 60 minutes exercise serum COMP levels increased (p < 0.001). After 60 minutes of rest the serum levels decreased (p = 0.003). Median serum COMP values in samples obtained prior to exercise or rest at baseline and after 24 weeks did not change between start and end of the study. In the second study serum COMP was increased immediately after exercise (p = 0.018) and had decreased to baseline levels after 30 minutes. Conclusion Serum COMP levels increased during exercise in individuals with knee OA, whereas levels decreased during rest. The increased serum COMP levels were normalized 30 minutes after exercise session, therefore we suggest that samples of blood for analysis of serum COMP should be drawn after at least 30 minutes rest in a seated position. No increase was seen after a six-week exercise program indicating that any effect of individualized supervised exercise on cartilage turnover is transient.

Published
2006
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3. A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis – results of clinical relevance

Author

Hafström,Ingiäld, Ajeganova,Sofia, Andersson,Maria LE, Bala,Sidona-Valentina, Bergman,Stefan, Bremander,Ann, Forslind,Kristina, Malm,Karina, and Svensson,Björn

Subjects
Research and Reviews [Open Access Rheumatology]
Abstract

Ingiäld Hafström1, Sofia Ajeganova2,3, Maria LE Andersson4,5, Sidona-Valentina Bala6,7, Stefan Bergman5,8, Ann Bremander4,5,9, Kristina Forslind4,10, Karina Malm5,11, Björn Svensson4 1Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden; 2Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; 3Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; 4Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden; 5Spenshult Research and Development Center, Halmstad, Sweden; 6Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden; 7Department of Medicine, Section of Rheumatology, Helsingborg’s Hospital, Helsingborg, Sweden; 8Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 9Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 10Department of Research and Education, Skånevård Sund, Region Skåne, Helsingborg´s Hospital, Helsingborg, Sweden; 11Rheumatology, Capio Movement, Halmstad, SwedenCorrespondence: Ingiäld HafströmRheumatology Unit, R92, Karolinska University Hospital, 141 86 Stockholm, SwedenTel +46 73 699 6235Email ingiald.hafstrom@karolinska.sePurpose: At the end of the twentieth century, the outcome of rheumatoid arthritis (RA) was shown to be unsatisfactory and new therapeutic strategies were introduced. This initiated a register-based long-term study of early RA, the Better Anti-Rheumatic PharmacOTherapy (BARFOT) study. The aims were to evaluate the disease course and to acquire knowledge for improved care.Patients and methods: BARFOT is a multicentre observational study of patients with early RA, consecutively included 1992–2006. The patients are followed in daily practice according to a structured protocol for 15 years and data recorded in a web-based register. Also, through linkage of the BARFOT register to national registers we have acquired information on comorbidity and mortality.Results: In all, 2857 patients have been included and over 80 scientific articles have been published. Phenotypic characteristics at disease onset, i.e. gender, smoking habits and autoantibody profiles have been addressed. The disease course over 15 years was described. Early predictors for persistent disease activity, impaired function, joint damage and co-morbidities have been identified. Treatment strategies have been studied. A randomized sub-study gave strong support for the treatment of recent RA with low-dose prednisolone in combination with disease-modifying anti-rheumatic drug. Furthermore, the impact of lifestyle factors, such as smoking, alcohol consumption, body weight and physical activity has been addressed.Conclusion: A register-based study like BARFOT has provided a basis for optimal long-term management of patients with RA. In addition, the register has made it possible to perform a diversity of studies of RA addressing various issues of major relevance to the patients.Keywords: patient reported outcomes, PRO, disease progression, prognostic factors, lifestyle, observational study, registry

Published
2019

4. A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis - results of clinical relevance

Author

Hafström, Ingiäld, Ajeganova, Sofia, Andersson, Maria LE, Bala, Sidona-Valentina, Bergman, Stefan, Bremander, Ann, Forslind, Kristina, Malm, Karina, Svensson, Björn, Clinical sciences, and Rheumatology

Subjects
PRO, Medicine(all), Disease progression, Registry, lifestyle, prognostic factors, Lifestyle, Prognostic factors, Observational study, REGISTRY, Disease Progression, observational study, patient reported outcomes, PRO, Patient reported outcomes, Original Research
Abstract

Purpose: At the end of the twentieth century, the outcome of rheumatoid arthritis (RA) was shown to be unsatisfactory and new therapeutic strategies were introduced. This initiated a register-based long-term study of early RA, the Better Anti-Rheumatic PharmacOTherapy (BARFOT) study. The aims were to evaluate the disease course and to acquire knowledge for improved care. Patients and methods: BARFOT is a multicentre observational study of patients with early RA, consecutively included 1992-2006. The patients are followed in daily practice according to a structured protocol for 15 years and data recorded in a web-based register. Also, through linkage of the BARFOT register to national registers we have acquired information on comorbidity and mortality. Results: In all, 2857 patients have been included and over 80 scientific articles have been published. Phenotypic characteristics at disease onset, i.e. gender, smoking habits and autoantibody profiles have been addressed. The disease course over 15 years was described. Early predictors for persistent disease activity, impaired function, joint damage and comorbidities have been identified. Treatment strategies have been studied. A randomized sub-study gave strong support for the treatment of recent RA with low-dose prednisolone in combination with disease-modifying anti-rheumatic drug. Furthermore, the impact of lifestyle factors, such as smoking, alcohol consumption, body weight and physical activity has been addressed. Conclusion: A register-based study like BARFOT has provided a basis for optimal longterm management of patients with RA. In addition, the register has made it possible to perform a diversity of studies of RA addressing various issues of major relevance to the patients.

Published
2019
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5. Supplementary_file_COREQ_SOM-19-0166R1 – Supplemental material for Factors influencing physical activity in patients with early rheumatoid arthritis: A mixed-methods study

Author

Qvarfordt, Maria, Andersson, Maria LE, and Larsson, Ingrid

Subjects
FOS: Veterinary sciences, 111199 Nutrition and Dietetics not elsewhere classified, Cardiology, 170199 Psychology not elsewhere classified, 111799 Public Health and Health Services not elsewhere classified, 110604 Sports Medicine, FOS: Health sciences, 110306 Endocrinology, 110308 Geriatrics and Gerontology, 111099 Nursing not elsewhere classified, 111708 Health and Community Services, 160807 Sociological Methodology and Research Methods, 111702 Aged Health Care, 111403 Paediatrics, 110904 Neurology and Neuromuscular Diseases, 110203 Respiratory Diseases, 110315 Otorhinolaryngology, 70706 Veterinary Medicine, FOS: Clinical medicine, 110319 Psychiatry (incl. Psychotherapy), FOS: Sociology, FOS: Psychology, 110599 Dentistry not elsewhere classified, 110323 Surgery, 110305 Emergency Medicine, 111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified, 111299 Oncology and Carcinogenesis not elsewhere classified, 110314 Orthopaedics
Abstract

Supplemental material, Supplementary_file_COREQ_SOM-19-0166R1 for Factors influencing physical activity in patients with early rheumatoid arthritis: A mixed-methods study by Maria Qvarfordt, Maria LE Andersson and Ingrid Larsson in SAGE Open Medicine

Published
2019
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6. Factors influencing physical activity in patients with early rheumatoid arthritis : A mixed-methods study

Author

Qvarfordt, Maria, Andersson, Maria LE, Larsson, Ingrid, Qvarfordt, Maria, Andersson, Maria LE, and Larsson, Ingrid

Abstract

Objective: The goal of this study was to provide a greater understanding of physical activity in patients with early rheumatoidarthritis. The aim was twofold: first to explore if physical activity was associated with factors in the clinical picture of rheumatoid arthritis in this patient group, and second, to explore factors influencing physical activity in patients with early rheumatoid arthritis. Methods: A total of 66 patients with early rheumatoid arthritis were included in the study. A sequential explanatorymixed-methods design was used, where quantitative data from a questionnaire were analysed with Mann–Whitney, post hocKruskal–Wallis and χ2 test in order to detect differences between groups, and find possible associations between physical activity and independent variables, such as disease activity, health-related quality of life and physical function. Qualitative datawere collected in a follow-up questionnaire with open-ended questions that focused on factors influencing physical activity. Results: Associations between physical activity, disease activity and health-related quality of life were seen in patients withearly rheumatoid arthritis together with strong negative correlations between physical activity and physical function. Patientson sick leave showed the strongest associations between disease-related variables and lower levels of physical activity.The findings from the qualitative analysis showed that physical limitations, awareness as a motivational factor and external environment factors influenced physical activity in patients with early rheumatoid arthritis. Conclusion: The results showed a complex underlying motive where physical, psychological and environmental factors influenced the physical activity in patients with early rheumatoid arthritis. In order to provide more effective health interventions, it is important to consider the complex nature of practicing physical activity, where a person-centred approach should be considered. Factors s

Published
2019
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10. Quality of life in patients with established rheumatoid arthritis : A phenomenographic study

Author

Malm, Karina, Bergman, Stefan, Andersson, Maria LE, Bremander, Ann, Larsson, Ingrid, Malm, Karina, Bergman, Stefan, Andersson, Maria LE, Bremander, Ann, and Larsson, Ingrid

Abstract

OBJECTIVE: Patients with rheumatoid arthritis perceive reduced quality of life in several domains, such as physical health, level of independence, environment and personal beliefs, compared with the healthy population. There is an increasing interest in quality of life in clinical and medical interventions. Few studies have explored patients' individual conceptions of quality of life, and interviews can thus complement quantitative studies. There is a need for a deeper understanding of the patients' experiences of quality of life, with regard to living with a long-term condition such as rheumatoid arthritis. The aim of this study was to explore the variation of ways in which patients with established rheumatoid arthritis understand the concept of quality of life. METHODS: The study had a qualitative design with a phenomenographic approach, which was used to describe variations in how individuals experience their quality of life. The study is based on interviews with 22 patients with established rheumatoid arthritis enrolled in the BARFOT (better anti-rheumatic pharmacotherapy) study. RESULTS: The concept of quality of life could be understood in three different ways: (1) independence in terms of physical functioning and personal finances, (2) empowerment in how to manage life and (3) participation as an experience of belonging in a social context. CONCLUSION: The different conceptions of quality of life reflect the complexity in the concept, including physical, psychological and social aspects. This complexity is important to have in mind when health professionals support patients in enhancing their quality of life. © The Author(s) 2017, Funding: Swedish Rheumatism Association, the County Council of Halland Research fund, and the Norrbacka-Eugenia Foundation

Published
2017
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13. The Effect of Stopping Smoking on Disease Activity in Rheumatoid Arthritis (RA). Data from BARFOT, a Multicenter Study of Early RA.

Author

Andersson ML, Bergman S, and Söderlin MK

Abstract

Objective: We studied the effect of stopping smoking on disease activity in patients with RA., 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), C-reactive protein (CRP), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), anti-CCP, general health and pain visual analog scales (VAS), EULAR response and treatment were registered at inclusion and at follow-up 2, 5 and 8 years. In 2010, a self-completion postal questionnaire was sent to 2,102 patients, enquiring about lifestyle factors, including cessation of smoking., Results: A total of 1,460 adult RA patients with disease duration ≤2 years were included in this study. Seventeen percent smoked in 2010. In total, 127 patients stopped smoking after inclusion in the study. Smoking cessation after inclusion in the study was negatively associated with EULAR good outcome at 8 years (OR 0.44, 95% CI 0.22-0.86, p=0.02), controlled for age, disease duration, sex, socioeconomic class, smoking status, RF, and DAS28 at inclusion., Conclusion: Seventeen percent of the RA patients smoked in 2010 in this large Swedish RA cohort. Stopping smoking after onset of RA did not change the poor prognosis of smokers with RA, but all RA patients need to stop smoking because of the high risk of cardiovascular mortality and morbidity and the association of smoking with vasculitis and noduli in RA.

Published
2012
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