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Objectives: The etiology of fibromyalgia (FM) is disputed, and there is no established cure. Quantitative data on how this may affect patients' healthcare experiences are scarce. The present study aims to investigate FM patients' pain-related healthcare experiences and explore factors associated with high satisfaction and pain relief., Methods: An anonymous, online, and patient-administered survey was developed and distributed to members of the Norwegian Fibromyalgia Association. It addressed their pain-related healthcare experiences from both primary and specialist care. Odds ratios for healthcare satisfaction and pain relief were estimated by binary logistic regression. Directed acyclic graphs guided the multivariable analyses., Results: The patients ( n = 1,626, mean age: 51 years) were primarily women (95%) with a 21.8-year mean pain duration and 12.7 years in pain before diagnosis. One-third did not understand why they had pain, and 56.6% did not know how to get better. More than half had not received satisfactory information on their pain cause from a physician, and guidance on how to improve was reported below medium. Patients regretted a lack of medical specialized competence on muscle pain and reported many unmet needs, including regular follow-up and pain assessment. Physician-mediated pain relief was low, and guideline adherence was deficient. Only 14.8% were satisfied with non-physician health providers evaluating and treating their pain, and 21.5% were satisfied (46.9% dissatisfied) with their global pain-related healthcare. Patients' knowledge of their condition, physicians' pain competence and provision of information and guidance, agreement in explanations and advice, and the absence of unmet needs significantly increased the odds of both healthcare satisfaction and pain relief., Conclusions: Our survey describes deficiencies in FM patients' pain-related healthcare and suggests areas for improvement to increase healthcare satisfaction and pain relief. (REC# 2019/845, 09.05.19)., (© 2024 the author(s), published by De Gruyter.)

Objectives: Studies assessing relative mortality risks across the spectrum of systemic inflammatory rheumatic diseases are largely missing. In this study, we wanted to estimate standard mortality ratios (SMRs) and causes of death in an ethnically homogeneous cohort covering all major CTDs and primary systemic vasculitides (PSVs)., Methods: We prospectively followed all incident CTD and PSV cases included in the Norwegian CTD and vasculitis registry (NOSVAR) between 1999 and 2015. Fifteen controls for each patient matched for sex and age were randomly drawn from the Norwegian National Population Registry. Causes of death were obtained from the National Cause of Death Register, death certificates and hospital charts., Results: The cohort included 2140 patients (1534 with CTD, 606 with PSV). During a mean follow-up time of 9 years, 279 of the patients (13%) died, compared with 2864 of 32 086 (9%) controls (P < 0.001). Ten years after diagnosis, the lowest survival was 60% in dcSSc, 73% in anti-synthetase syndrome (ASS) and 75% in lcSSc. In the CTD group, the highest SMRs were observed in dcSSc (SMR 5.8) and ASS (SMR 4.1). In the PSV group, Takayasu arteritis (SMR 2.5) and ANCA-associated vasculitis (SMR 1.5) had the highest SMRs. Major causes of death were cardiovascular disease (CTD 27%, PSV 28%), neoplasms (CTD 25%, PSV 27%), chronic respiratory disease (CTD 20%, PSV10%) and infections (CTD 9%, PSV 16%)., Conclusion: We observed premature deaths across the spectrum of CTDs and PSVs, with highest SMRs in dcSSc and ASS. The overall mortality was highest in the CTD group.

Aabstract Introduction Chronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain is reported to be 35-53% in cross sectional studies of both genders. For many years, it has been a common opinion among medical doctors that chronic pain may indeed reduce a person's quality of life, but not affect life expectancy. However, over the previous two decades, reports about mortality and cause of death in individuals with chronic pain have been published. So far, several studies conclude that there is an increased mortality in patients with chronic pain, but it is not clear what causes this. Increased occurrences of cardio-vascular death or cancer death have been reported in some studies, but not verified in other studies. Aims of the study The aims of this study were to estimate the mortality rate in females with different extent of pain, to identify potential risk factors for death and to investigate if the causes of death differ according to prior reported pain. Methods This is a prospective population-based study of all women between 20 and 50 years registered in Arendal, Norway, in 1989 (N = 2498 individuals). At follow-up in 2007, 2261 living females were retraced, 89 had died. All subjects received a questionnaire containing questions about chronic pain (pain ≥ 3 months duration in muscles, joints, back or the whole body) as well as 13 sub-questions about pain-modulating factors, non-specific health complaints and sleep problems, by mail in 1990, 1995 and 2007. Only subjects who answered the questionnaire in 1990 were included in the analyses. Of the deceased, 71 had answered the questionnaire in 1990. A multivariate model for cox regression analysis was used in order to clarify if chronic pain, sleep problems, feeling anxious, frightened or nervous and number of unspecific health were risk factors for death. The causes of death of 87 of the deceased individuals were obtained by linking the ID-number with the Norwegian Cause of Death Registry. Results The ratio of deceased responders was 2% (14/870) among those with no pain versus 5% (57/1168) among those with chronic pain at baseline. When separating into chronic regional pain and chronic widespread pain, the mortality rate was respectively 4% and 8% in the different groups. Age adjusted hazard ratio for mortality rate in individuals with initially chronic pain was [HR 2.5 (CI 1.4-4.5)] compared to pain free individuals. In the multivariate analysis, having chronic pain [HR 2.1 (1.1-4.2)] and feeling anxious, frightened or nervous [HR 3.2 (1.8-5.6)] were associated with increased risk of death. There was no difference in death from cardiovascular disease or malignancies between the groups of pain free individuals vs. the group of individuals with chronic pain. Conclusion The mortality rate was significantly higher for individuals with chronic pain compared to pain free individuals, adjusted for age. In addition, feeling anxious, frightened or nervous were risk factors for death. There was an increase in all-cause mortality.

Introduction Chronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain can be up to 50% in both genders. However, the prevalence of chronic widespread pain is significantly higher in females than in males. Chronic widespread pain is seen as the end of a continuum of pain. There is rather sparse knowledge about the incidence of pain in initially pain free individuals and the course of self-reported pain over time. Moreover, little is known about risk factors for incidence of chronic pain or prognostic factors for the course of self-reported pain. We believe that such knowledge may contribute to develop strategies for treatment at an early stadium of the pain condition and thereby reduce the prevalence of chronic pain included chronic widespread pain. Aims of the study The aims of this study were threefold: (1) to calculate the incidence of self-reported musculoskeletal pain in a female cohort, (2) to describe the course of pain and (3) to investigate whether or not health complaints and sleep problems are predictive factors for onset of pain or prognostic factors for the course of pain. Methods This is a prospective population-based study of all women between 20 and 50 years who were registered in Arendal, Norway, in 1989 (N = 2498 individuals). A questionnaire about chronic pain (pain >3 months duration in muscles, joints, back or the whole body), modulating factors for pain, sleep problems and seven non-specific health complaints was mailed to all traceable women, in 1990 (N =2498), 1995 (n = 2435) and 2007 (n = 2261). Of these, 1338 responded on all three occasions. Outcome measures were presence and extent of chronic pain. Results The prevalence of chronic pain was 57% in 1990 and 61% in 2007. From 1990 to 2007, 53% of the subjects changed pain category. The incidence of chronic pain in initially pain free individuals during follow-up was 44%, whereas the recovery rate was 25%. Impaired sleep quality predicted onset of chronic pain. There was a linear association between the number of health complaints and the incidence of chronic pain in initially pain free individuals. Equivalent results were found for persistence of pain and worsening of pain. Conclusion The prevalence of chronic pain was rather stable throughout the follow-up period, but the prevalence of chronic widespread pain increased. Individual changes in pain extent occurred frequently. The presence of sleep disturbances and number of health complaints predicted onset, persistence and worsening of pain. Implications Sleep problems must be thoroughly addressed as a possible risk factor for onset or worsening of pain. Elimination of sleep problems in an early phase is an interesting approach in treating chronic pain. More research is needed to illuminate the possible pathogenetic relations between pain, non-specific health complaints, sleep problems and also depression.

Background: We propose that the distribution of skin lesions in psoriasis may be assessed using parametric maps on a pixel-by-pixel basis., Material and Methods: We processed 428 patient-drawn self-descriptions of the psoriasis lesions on a supplied body template. We compared 195 patients with a confirmed diagnosis of psoriatic arthritis (PsA) with 89 who had this diagnosis rejected (Psor). Additionally, 28 Psor cases supplied drawings performed after 3 weeks of climate therapy (PsorCT) to test the treatment efficacy. The drawings were scanned, lesion areas were segmented, followed by construction of parametric maps of lesion distributions and calculation of statistical differences between groups., Results and Discussion: In PsorCT, the lesions occupied 11.2% (0-42%) [median (min.-max.)] of the body area. The area decreased to 2.4% (6-11%) after heliotherapy. The differences were statistically significant for all the areas studied and spread evenly over the body surface. PsA had a relatively low psoriasis lesion occupancy of 2.5% (0-42%) compared with Psor 9.8% (0-34%), which is attributed to the difference in recruitment. Correcting for this, we demonstrate a clear tendency for the head, palms, feet, groin and nails to be preferred lesion sites in PsA in contrast to psoriasis., Conclusion: Pixel-based analysis of self-reported skin lesion distributions is a powerful tool to assess systematic differences due to treatment or disease variants.

Adult rheumatic and psoriatic patients in Norway have been offered state-funded treatment in a warm climate since 1976. The offer has since then been extended to other patient groups with chronic diseases. We here present a program, which mainly consists of intensive physical treatment in a warm, sunny and dry climate, for adults with chronic rheumatic disease. The article is based on available statistics and literature found by searching Medline, PubMed and Cochrane. Patients are selected for the program according to diagnosis, physical function and disease severity and activity. The majority of the patients have rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis. The treatment is demanding and is not suitable for all. There are two closing dates for applications, 1. October and 1. February.