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Objectives To estimate the internal consistency, test–retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients’ personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied. Design Test–retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days. Participants The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour. Results The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test–retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods. Conclusion Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test–retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.

With the ameliorating prognosis of rheumatoid arthritis (RA), the role of comorbidities as causes of work disability (WD) may increase. The aim of this study was to determine the contribution of psychiatric and cardiovascular (CV) comorbidities as the leading causes of long-term WD among patients with recent-onset RA.Between 2000 and 2007, all incident, working-age and non-retired RA patients were identified from a Finnish nationwide register. From other registers, we identified the RA patients who were granted a permanent or temporary disability pension by 31 December 2008. The incidences of disability pensions with CV diseases (ICD-10 codes I00-I99) or psychiatric disorders (F20-F69) as the leading causes were assessed and compared with the general population.We identified a cohort of 7831 patients with RA. During follow-up, 1095 patients were granted a disability pension. After adjusting for competing risks, the 9-year cumulative incidence of WD caused by RA, a psychiatric comorbidity, or a CV disease was 11.9, 1.3, and 0.5%, respectively. Compared to the general population, the age- and sex-specific standardized incidence ratio (SIR) of WD due to psychiatric comorbidities was 0.99 [95% confidence interval (CI) 0.80-1.23] and due to CV disease 1.75 (95% CI 1.23-2.51).In the study cohort with recent-onset RA, the 9-year cumulative incidence of disability pensions caused by psychiatric or CV comorbidities was only 11% or 4%, respectively, of that caused by RA itself. Compared to the general population, the risk of WD due to CV disease was increased.

Objective The purpose of the present study was to gain a comprehensive view of the quality of life and socio-economic conditions in a more representative sample of patients with diastrophic dysplasia than previously presented. Methods The study sample comprised 115 patients with diastrophic dysplasia, aged over 18 years. The patients were contacted, and 68 patients (59%) agreed to participate in the study. They answered a structured questionnaire, which included the items of RAND-36 and Finn-Health Assessment Questionnaire (Finn-HAQ) questionnaires. The Finn-HAQ items were linked to the categories of the International Classification of Functioning, Disability and Health (ICF). Population controls for matching the participating patients for age and sex were identified in the Finnish population registry. Demographic and social factors (educational status, employment status and household income) were collected in separated questions. Results RAND-36 showed significantly lower physical functioning in the group of diastrophic dysplasia patients than in the control group. Also, the differences in scores for energy and social functioning were significant. In the mental component scales, no significant difference was found between the groups. When compared with the controls, we found significantly lower levels in all 3 ICF components of functioning in the group of patients when Finn-MDHAQ items linked to ICF were used. Almost 75% of patients with diastrophic dysplasia belonged to the group of people with minor/low income. Some or clear worsening of economic situation due to diastrophic dysplasia was reported by 25 (58%) female and 17 (68%) male patients. Conclusion In their daily living, patients with diastrophic dysplasia have marked physical difficulties, which affect their quality of life, participation in society and their financial situation. It seems that the mental situation is not greatly affected, but a more detailed study is needed to evaluate and illuminate the psychological consequences of this severe skeletal dysplasia. Overall, the pieces of information in the present study are of high importance when designing and reorganizing rehabilitation and in supportive therapy and treatment of patients with diastrophic dysplasia.

Management of patients suffering from chronic pain is based on long-term therapeutic relationship. The main objectives of the treatment are pain relief, restoration of function and improvement of quality of life. Interventions for treatment and rehabilitation need to be planned in agreement with the patient. Non-pharmaceutical interventions form the basics of the treatment. If medication is needed, it should be tailored to meet the individual needs of the patient according to the etiology and intensity of pain, comorbidities and psychosocial situation.

The objectives of the study were to examine the initial, first-year anti-rheumatic outpatient therapy in patients with incident SLE, as well as the concomitant use of drugs for certain comorbidities, compared to the use in the general population. The Finnish nationwide register data on special reimbursements for medication costs was screened to identify the inception cohort of 566 adult SLE patients (87% females, mean age 46.5 ± 15.9 years) over the years 2000–2007. The patients were linked to the national Drug Purchase Register. Of those, 90% had purchased at least once some disease-modifying anti-rheumatic drugs (DMARDs) during the first year. Hydroxychloroquine was the most common (76%), followed by azathioprine (15%) and methotrexate (13%). With the exception of increase in mycophenolate mofetil, the proportions remained stable over the whole study period 2000–2007. Drugs for cardiovascular diseases, dyslipidemia, diabetes mellitus, hypothyroidism and obstructive pulmonary disease were more frequently purchased than in the sex- and age-adjusted population, with rate ratios ranging from 1.6 to 7.8. Over the years 2000–2007, almost all the patients with incident SLE in Finland started with a DMARD. Higher percentages of SLE patients were on medication for several common chronic diseases than in the population as a whole.

Lower back pain is globally the most common problem interfering with functional capacity, and the recognition of causes that are serious and require specific therapy is essential in its diagnosis. Provision of information for a person suffering from lower back pain is essential. In some patients psychosocial factors prolong the back pain and potential incapacity for work. For their evaluation several internationally validated surveys have been developed, which can be used to facilitate the identification of higher-risk patients. By using electronic data, our aim is to develop in Finland the assessment of individual risk of patients with lower back pain and their appropriate treatment.

We examined the relative impact of baseline anxiety, depression and fear of movement on health related quality of life at 12-month follow-up after a multidisciplinary pain management programme. One hundred and eleven patients who had chronic musculoskeletal pain (mean age 45 years, 65% women) attended during 2003–2005 a multidisciplinary three-phase pain management programme with a total time frame of six to seven months, totalling 19 days. The Beck Anxiety Inventory was used to rate anxiety, the Beck Depression Inventory depression, the Tampa Scale of Kinesiophobia fear of movement. The generic 15D questionnaire was used to assess health related quality of life. Baseline data were collected at admission, follow-up data at 12 months. Mean health related quality of life increased significantly from baseline to 12-month follow-up. Anxiety at baseline predicted significant negative change in the health related quality of life, depression predicted significant positive change in the health related quality of life. Fear of movement did not predict any significant change in the health related quality of life. We concluded that patients with chronic musculoskeletal pain and mild to moderate depression benefit from a multidisciplinary pain management programme in contrast to anxious patients. The findings imply further research with bigger sample sizes, other than HRQoL outcome measures as well as with other groups of patients.

Objective The aim of this study was to clarify the association of fear of movement and physical activity among patients with chronic musculoskeletal pain. Methods The sample comprised 93 patients participating in a multidisciplinary pain management programme. The purpose of the programme was to regain overall functioning by means of physical and functional exercises, education and personal pain management training. Tampa Scale of Kinesio-phobia and Leisure Time Physical Activity questionnaires were completed at baseline, and at 6-month and 12-month follow-ups. Results At baseline, low and medium kinesiophobia groups showed more leisure-time physical activity than did the high kinesiophobia group (p = 0.024). At a 6-month follow-up the high kinesiophobia group had increased their physical activity index to the level of the low and medium kinesiophobia groups and maintained that change to 12-month follow-up. The effect sizes of the change in the physical activity index and pain intensity at the 12-month follow-up were both moderate (0.56) in the high kinesiophobia group. Conclusion The change in physical activity and kinesiophobia was associated with the level of baseline kinesiophobia. Multidisciplinary rehabilitation seems to produce favourable effects in terms of physical activity and pain among the high kinesiophobia patients.

Loneliness among frail older people predicts increased use of health services, early institutionalisation and increased mortality. The objective of this study was to determine the effects of a new rehabilitation model on loneliness among frail older people. This randomized controlled multi-centre trial with a 12-month follow-up was implemented in Finland. A total of 708 community-dwelling people aged 65+ years with progressively decreasing functional capacity participated. Participants were randomly allocated to the intervention group (n = 343) or to the control group (n = 365). The intervention consisted of a network-based group rehabilitation programme designed for frail older people. A 0.9-fold decrease in the proportion of participants feeling lonely was observed in the intervention group and a 1.1-fold increase in the control group. The results suggest that a physically orientated rehabilitation programme may reduce emotional loneliness.

We aimed to determine the effect of manipulation under anesthesia in frozen shoulder patients. A blinded randomized trial with a 1-year follow-up was performed at 3 referral hospitals in Southern Finland. We randomly assigned 125 patients with clinically verified frozen shoulder to the manipulation group (n = 65) or control group (n = 60). Both the intervention group and the control group were instructed in specific therapeutic exercises by physiotherapists. Clinical data were gathered at baseline and at 6 weeks and 3, 6, and 12 months after randomization. The 2 groups did not differ at any time of the follow-up in terms of shoulder pain or working ability. Small differences in the range of movement were detected in favor of the manipulation group. Perceived shoulder pain decreased during follow-up equally in the 2 groups, and at 1 year after randomization, only slight pain remained. Manipulation under anesthesia does not add effectiveness to an exercise program carried out by the patient after instruction.

Background and Purpose. Therapeutic exercise has been shown to be beneficial in decreasing pain and in increasing functioning in patients with chronic low back pain. However, longitudinal follow-up studies are small in number, and often limited in the numbers of subjects due to drop-outs. In addition there is a shortage of real control groups in most cases. The purpose of the present study was to describe long-term changes in intensity of low back pain and in functioning for two study groups five years after undertaking a home exercise programme. Method. This was a randomized follow-up study over five years. Fifty-seven subjects were reassessed with questionnaires five years after their initial recruitment for an intervention study. A home exercise group (n = 29), with training once a day, and a control group (n = 28), without exercise, were included in the present study protocol. The primary outcome measurements included a questionnaire on the intensity of low back pain (Borg CR-10 scale) and on functioning (Oswestry Disability Index; ODI). The confounding physical activity was controlled with metabolic unit (MET) values. Results. The CR-10 and ODI scores decreased during the first three months in both study groups. During the follow-ups, the corresponding indicators of the home exercise group remained below baseline values. The CR-10 score was significantly lower in the home exercise group (p = 0.01) during the last five-year follow-up session compared with the control group. Overall physical activity decreased slightly during the five-year follow-up, but there were no differences between the two study groups. Conclusions. The present randomized study indicates that supervised, controlled home exercises lead to reduced low back pain, and that positive effects were preserved over five years. Copyright © 2007 John Wiley & Sons, Ltd.

To explore the cost of the statutory inpatient rehabilitation system in Finland and its impact on the functional and work capacity of patients with early rheumatoid arthritis (RA).In the Finnish Rheumatoid Arthritis Combination-Therapy trial (FIN-RACo), 195 patients with recent-onset RA, 162 of them available for the work force, were randomly assigned to two different drug treatment strategies for 2 years. Otherwise, the patients received routine multidisciplinary care and, if their functional or work capacity was endangered, were referred to inpatient rehabilitation. After a 5-year follow-up, data on rehabilitation, sick leave, and RA-related disability pensions were obtained from official registers.Of the 162 patients, 49 (30%) underwent inpatient rehabilitation at an average cost of EURO5400. The rehabilitated patients more often worked in white-collar jobs and had more pain and a worse Health Assessment Questionnaire (HAQ) score (1.0 vs. 0.78; p = 0.01) at baseline. Their HAQ scores remained higher throughout follow-up (p0.001); no change appeared over inpatient periods [mean 0.01; 95% confidence interval (CI) -0.13 to 0.16]. No independent impact of rehabilitation on the HAQ score emerged in an adjusted generalized estimating equations (GEE) model (p = 0.55). Nor did any improvement in work capacity appear: average lost productivity (human capital approach) per patient-year was EURO10 155 (95% CI 6994-14 196) before and EUR 12 839 (95% CI 8589-19 139) after the start of rehabilitation.For patients with recent-onset RA, the Finnish statutory inpatient rehabilitation system had no positive impact on either functional or work capacity during the first few years, despite its considerable cost.

Activating physiotherapy was used to support the principle of post stroke functional recovery as a learning process which requires both cognitive and physical actions. The purpose of the present preliminary study was to examine the influence of activating physiotherapy on stroke patients' cognitive and physical functions and independent living at home compared with traditional treatment over a 12-month follow-up.The 40 patients who received activating physiotherapy were compared with 40 patients receiving traditional therapy. Patients' physical functional capacity was measured one week and 12 months post stroke with the Barthel Index (BI), 10-m gait speed, the Postural Control and Balance for Stroke (PCBS) test, walking distances and patients' abilities to cope without outside help. Cognitive capacity was measured with specific neuropsychological tests: language, visuospatial functions, visual inattention and memory.Physical functional capacity improved significantly (p = 0.001) in both groups at the 12-month follow-up, but no significant differences were found between groups. However, the patients in the activating therapy group coped better without outside help (p = 0.042) and covered longer distances outdoors (p = 0.012). At follow-up all the measured cognitive functions had improved significantly in the activating therapy group and the change in memory in the same group differed significantly from that in the traditional therapy group (p0.001), where no significant improvement was observed.Activating therapy advanced stroke patients' cognitive and physical functional recovery and supported their return to independent life at home more than did traditional physiotherapy. In this respect activating therapy seems to have a beneficial influence on long-term stroke rehabilitation.

Classification to severe diseases, sciatic symptoms or non-specific back pain is recommended. Radiography in acute or subacute non-specific back pain is not recommended in the primary health care. In specialized care magnetic resonance imaging is the main imaging modality. Importance of patient information is emphasized. In acute non-specific pain avoidance of bed rest, advice and paracetamol are recommended. Indications for an emergency referral should be considered. In disabling pain for 6 weeks, multidisciplinary measures are needed. Pain over 3 months indicates intensive multidisciplinary rehabilitation, and also surgery may be considered.

[Abstract.] Objectives: To create reference values for the general Finnish population using the Tampa Scale of Kinesiophobia (TSK-FIN), to study gender differences in the TSK-FIN, to assess the internal consistency of the TSK-FIN, to estimate the prevalence of high levels of kinesiophobia in Finnish men and women, and to examine the association between kinesio-phobia and leisure-time physical activity and the impact of co-morbidities on kinesiophobia. Methods: The study population comprised 455 men and 579 women. Participants completed a self-administered questionnaire about their socio-demographic factors, leisure-time physical activity, co-morbidities and kinesiophobia. Results: The mean TSK-FIN score was significantly higher for men (mean 34.2, standard deviation (SD) 6.9) compared with women (mean 32.9, SD 6.5), with an age-adjusted p=0.004 for the difference between men and women. Cronbach’s alpha was 0.72, indicating substantial internal consistency. Men over 55 years of age and women over 65 years of age had a higher (p

Study Design. Descriptive prognostic study. Objectives. To identify outcome determinants of subacute low back pain. Summary of Background Data. The factors predicting recovery from prolonged back pain among working adults are largely unknown. Materials and Methods. One hundred sixty-four employed patients with subacute (duration of pain 4–12 weeks) daily low back pain were recruited from primary health care to a randomized study. Data on potential predictive factors were collected before randomization. In multiple regressions using repeated measures analysis, the treatment received was adjusted when determining the impact of the predictive factors. Dependent outcome variables used were pain, perceived functional disability, generic health-related quality of life, satisfaction with care, days on sick leave, use of health care, and costs of health care consumption measured, at 3-, 6-, and 12-month follow-ups. Results. Age and intensity of pain at baseline predicted most of the outcomes. The perceived risk of not recovering was a stronger determinant of outcome than gender, education, or self-rated health status (which did not have any predictive value) or body mass index, expectations of treatment effect, satisfaction with work, or the presence of radicular symptoms below the knee (only slight predictive value). The only factors predicting the duration of sick leave were the duration of sick leave at baseline and the type of occupation. Conclusion. Age and intensity of pain are the strongest predictors of outcome. Accumulation of days on sick leave is predicted by the duration of sick leave at entry and the type of work, but not by pain, perceived disability, or satisfaction with work.

Aktives korperliches Training ist eine weitverbreitete Therapie fur Patienten mit chronischen Nackenschmerzen; bisher konnte dessen Wirksamkeit jedoch noch nicht in randomisierten Studien nachgewiesen werden. Ziel dieser Studie war es, die Wirksamkeit von intensivem isometrischem Nackenmuskeltraining und leichterem Ausdauertraining zu evaluieren. Wir fuhrten eine Untersucher-verblindete randomisierte kontrollierte Studie von Februar 2000 bis Marz 2002 durch. Die Teilnehmer wurden von betriebsarztlichen Einrichtungen in Sud- und Ostfinnland rekrutiert, wobei 180weibliche Buroangestellte zwischen 25 und 53 Jahren mit chronischen unspezifischen Nackenschmerzen untersucht wurden. Die Patientinnen wurden randomisiert entweder einer von zwei Trainingsgruppen oder der Kontrollgruppe zugeteilt. Die Ausdauertrainingsgruppe fuhrte dynamische Nackenmuskelubungen durch (Anheben des Kopfes, ausgehend von Supinations- und Pronationshaltung). Die Krafttrainingsgruppe betrieb intensive isometrische Ubungen zur Kraftigung und Stabilisierung der Nackenmuskulatur mit Hilfe eines elastischen Bandes. Beide Trainingsgruppen fuhrten dynamische Ubungen fur Schultern und Arme mit Hanteln durch. Alle Gruppen wurden angewiesen regelmasig 3-mal pro Woche Aerobic und Stretching zu betreiben. Schmerzen und Storungen im Nackenbereich wurden mit Hilfe einer visuellen Analogskala, des Index fur Schmerzen und Storungen an Nacken und Schulter sowie des Vernon-Index fur Nackenbeschwerden festgestellt. Wahrend der Studie wurde die Stimmungslage bezuglich Depressionen berucksichtigt sowie die maximale Nackenmuskelkraft und das Bewegungsausmas der Nackenmuskulatur. Nach 12-monatiger Studiendauer hatten Schmerzen und Storungen im Nackenbereich in beiden Trainingsgruppen statistisch signifikant abgenommen im Vergleich zur Kontrollgruppe (p

Study Design. Randomized controlled trial Objectives. To investigate the effectiveness and costs of a mini-intervention, provided in addition to the usual care, and the incremental effect of a work site visit for patients with subacute disabling low back pain. of Background Data. There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain. Methods. A total of 164 patients with subacute low back pain were randomized to a mini-intervention group (A), a work site visit group (B), or a usual care group (C). Groups A (n = 56) and B (n = 51) underwent one assessment by a physician plus a physiotherapist. Group B received a work site visit in addition. Group C served as controls (n = 57) and was treated in municipal primary health care. All patients received a leaflet on back pain. Pain, disability, specific and generic health-related quality of life, satisfaction with care, days on sick leave, and use and costs of health care consumption were measured at 3-, 6-, and 12-month follow-ups. Results. During follow-up, fewer subjects had daily pain in Groups A and B than in Group C (Group A vs. Group C, P = 0.002; Group B vs. Group C, P = 0.030). In Group A, pain was less bothersome (Group A vs. Group C, P = 0.032) and interfered less with daily life (Group A vs. Group C, P = 0.040) than among controls. Average-days on sick leave were 19 in Group A, 28 in Group B, and 41 in Group C (Group A vs Group C, P = 0.019). Treatment satisfaction was better in the intervention groups than among the controls, and costs were lowest in the mini-intervention group. Conclusions. Mini-intervention reduced dally back pain symptoms and sickness absence, improved adaptation to pain and patient satisfaction among patients with subacute low back pain, without increasing health care costs. A work site visit did not increase effectiveness.

To assess cardiovascular (CV) mortality in early rheumatoid arthritis (RA), and the impact of RA medications on CV mortality.We identified all incident RA patients over 18 years of age diagnosed between 2000 and 2007 in Finland. Causes of death were analysed until the end of the year 2008. We used competing-risks regression models to assess the impact of different variables such as RA medications on CV mortality. CV mortality was compared with that of the age- and sex-specific general population.We identified 14,878 incident RA patients (68% women, 63% rheumatoid factor (RF) positive, mean age 55.8/57.5 years in men/women), of whom more than 80% received RA medications for longer than 90% of their individual patient-years. By the end of 2008, 1,157 patients died, 501 (43%) of whom of CV causes. The standardised mortality ratio (SMR) for CV deaths in the entire RA cohort was 0.57 (95% CI 0.52 to 0.62). Along with traditional CV risk factors, the presence of RF and the use of glucocorticoids was associated with a higher risk of CV death, whereas the use of methotrexate was associated with a lower risk.These nationwide results suggest that patients with recent-onset RA who receive consistent RA medication have no increased risk for CV mortality compared to the general population, at least in the early years of the disease. The use of methotrexate is associated with lower CV mortality, whereas the use of glucocorticoids is associated with a higher than average CV mortality.

The objectives of the study were to investigate mortality and causes of death in patients with recent-onset systemic lupus erythematosus (SLE) in Finland. Data for patients with SLE for the study were collected (2000–2007) from the nationwide register on decisions of special reimbursements for drugs, maintained by the Social Insurance Institution (SII) in Finland. Data on deaths of the patients were obtained from the official death certificate statistics of Statistics Finland until the end of 2008. Of the 566 incident SLE patients, median follow-up time was 5.4 (IQR 3.3, 7.1) years, and 30 patients (23 females, seven males) died in the years 2000 through 2008. Mean age at death was 67.8 ± 17.2 years for females and 62.3 ± 15.2 years for males. The 5-year survival rates were 94.8% (95%CI 92.0–96.6%) and 88.2% (95%CI 76.5–94.3%), respectively. The age- and sex-adjusted standardized mortality ratio was 1.48 (95%CI 1.01–2.12). Primary causes of death were cardiovascular diseases, malignancy and SLE itself. In conclusion, survival of the patients with SLE was inferior to that of the general population. Cardiovascular diseases were responsible for 37% of deaths.

The objective of this study is to present the paid expenditures and productivity costs of disability pensions (DP) due to spinal disorders (SD) in Finland during 1990–2010. This study is a register-based national study. All new cases aged 20–64 that were granted a DP due to SD were identified from the nationwide register maintained by the Finnish Centre of Pensions. The data included sex, age group, year of the DP decision, main cause of incapacity (diagnosis) leading to permanent DP and yearly paid expenditures for DPs. Annual productivity costs were estimated based on labour force participation rate and the employment rate adjusted gross domestic product. A total of 39,107 individuals (18,072 females, 21,035 males) received DPs during the study period. SDs generated 9,372 million euros extra cost during this period due to DP (females 3.5 billion, males 5.9 billion). The total DP expenditures paid increased during the first half of 1990s but decreased during the second half of 1990s (−44.8 %). For degenerative SD cases, the DP expenditure was 5.1 billion €, disc disease 3.5 billion € and for other SDs 0.7 billion €. Males, compared to females, were expected to have a rate 1.22 times greater costs due to DPs. The estimated total annual productivity costs due to SDs have been over six times higher than expenditures paid for DPs per year. The costs of DPs are different compared to occurrence rates due to salary and early retirement age differences between genders. Despite a significant decrease in DP-associated expenditures due to SDs after 1993, the annual expenditures have stayed on a high level in Finland.

Study Design. A register-based national study. Objective. To describe the occurrence of spinal disorders (SDs) resulting in disability pension (DP) in Finland during 1990–2010. Summary of Background Data. The indirect cost of SD is excessive. The most significant indirect cost is due to DP. There are no nationwide long-term studies of DP trends caused by SDs. Methods. The study setting consisted of Finnish working population (20–64 yr). All new cases were identified from the nationwide register maintained by the Finnish Centre of Pensions from the beginning of 1990 to the end of 2010. The data included sex, age group, year of the DP decision, and the main cause of incapacity (diagnosis) leading to DP. Main outcome measure was DPs due to SDs. Results. A total of 84,375 individuals (40,415 females; 43,960 males) received DP during the study period. Age- and sex-adjusted incidence rate ratio was 0.45 (95% CI: 0.44–0.46) between time periods of 1990–1994 and 2005–2010. In males, crude incidence in 1990–1994 was 21.0 (95% CI: 20.6–21.3) per 10,000 person-years and in 2005–2010, it was 11.1 (10.9 to 11.3). In females, it was 18.8 (95% CI: 18.5–19.1) and 11.4 (95% CI: 11.1–11.6). During the study period, the overall DP rate also decreased. Age- and sex-adjusted incidence rate ratio was 0.66 (95% CI: 0.65–0.67) between the time periods 1990–1994 and 2005–2010. However, the proportion of DPs due to the SDs of all new DPs was higher in the first half of 1990s than in 2005–2010 (adjusted proportion 19.6% [95% CI: 19.4–19.8] vs. 14.4% [95% CI: 14.2–14.6]). Conclusion. The occurrence of DPs due to SDs has decreased significantly during the period of 1990–2010 in Finland. On the basis of the register data, nonmedical factors and legislative reforms may explain the decrease of DPs more than treatments provided by health care. Conclusion. Level of Evidence: 3

Some reports suggest that the incidence of rheumatoid arthritis (RA) is declining and that people contract RA at an older age than before (1–3). We wanted to explore whether these trends are presen...

Study Design. A prospective, randomized double-blind comparative trial. Objectives. To evaluate tne efficacy and tolerability of nimesulide, a cyciooxygenase (COX)-2-seiective anti-inflammatory agent versus ibuprofen in patients with acute lumbosacral back pain. Summary of Background Data. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been more effective than placebo in patients with uncomplicated acute low back pain in previous randomized controlled trials. The efficacy and tolerability of a new COX-2-selective anti-inflammatory drug nave not yet been established. Methods. One nundred four patients aged 18-65 years with acute low back pain were enrolled. The patients were randomiy allocated either to oral nimesulide (100 mg twice daily for 10 days) or oral ibuprofen (600 mg three times daily for 10 days). Outcome measures on a visual analog scale were an average of the pain intensity and the pain relief, stiffness in the back, functional status, and the results of physical examinations. All side effects were recorded at each visit. Results. With both study therapies, there was a clear improvement in all measured parameters of the pain and back function parameters measured from the third day of treatment onward. The patients' capacity for daily tasks, showed improvement in both groups (P < 0.001), but a statistically significant difference was found between the two groups in favor of the nimesulide group (P < 0.05) after 10 days. Nimesulide was more effective than ibuprofen in improved lateral bending measurements (p < 0.026). Nimesulide and ibuprofen provided similar degrees of improvement in the modified Schober tests and in the pain intensity and back stiffness scores. More gastrointestinal side effects were reported with ibuprofen than nimesulide, and the comparison showed a trend (P = 0.067). Ten side effects occurred in the nimesulide group in 7 (13%) patients and 13 in the ibuprofen group in 11 (21%) patients. Conclusions. The results confirmed that the COX-2-selective inhibitor nimesulide is an effective and well-tolerated agent for use in general practices to treat acute iow back pain. The incidence of gastrointestinal side effects seems to be lower with nimesulide than with ibuprofen.

Objective: The aim of this study was to examine the types of pain management strategies used by patients with fibromyalgia. Methods: A total of 158 patients with primary fibromyalgia attended a clinical visit to confirm the diagnosis. They completed 3 questionnaires: (i) a self-made questionnaire, (ii) Beck Depression Inventory IA (BDI IA), and (iii) Finnish version of Fibromyalgia Impact Questionnaire. The self-made questionnaire included questions about: intensity of current pain; general well-being; pain management strategies, including pain medications; efficacy of the pain management methods; current health problems other than fibromyalgia. The pain management strategies were subcategorized (e.g. physical exercise, massage and heat treatment). The strategies were also divided into active and passive types. Results: The most frequently reported pain management strategies were physical exercise (54%), physical therapy (32%) and cold treatment (27%). The use of active pain management strategies, BDI IA < 10 points and age were independent predictors of the reported pain management efficacy. Patients who used active pain management strategies reported better efficacy with the BDI IA score ≥ 10 points. Conclusion: Active pain management strategies are most efficacious for fibromyalgia patients, regardless of the severity of fibromyalgia or optional comorbid depression.

Traumatic spinal cord injury is most common among men between 16 and 30 years. Prevention should be targeted both on traffic safety and individual behaviour Key issues in patient care are safe transfer from the place of injury to a hospital, diagnostic imaging (primarily CT, MRI if needed) and assessment of neurological injury by AIS-questionnaire, early surgical decompression and stabilisation for most cases, and treatment and rehabilitation starting from the emergency room and extending to life-long care carried out by a multi-professional team.

To study whether the work disability (WD) rates in early rheumatoid arthritis (RA) have changed in Finland, where the treatment of RA has long been active but has intensified further since 2000.All incident non-retired patients with RA of working age (18-64 years) in a nationwide register maintained by the Finnish Social Insurance Institution from 1 January 2000 to 31 December 2007 were identified. Patient cohorts were analysed in 2-year time periods (2000-1, 2002-3, 2004-5, 2006-7) and initial disease-modifying antirheumatic drugs (DMARDs) were elucidated from the drug purchase register. The incidence of continuous WD in the RA cohorts as well as in the entire Finnish population up to 31 December 2008 was analysed.A total of 7831 patients were identified (71% women, 61% rheumatoid factor-positive). Throughout the follow-up period the use of methotrexate and combination DMARDs as the initial treatment of early RA increased. During the first 2 years the incidence of RA-related continuous WD was 8.9%, 9.4%, 7.2% and 4.8% in the year cohorts, respectively (p0.001 for linearity). Compared with the entire Finnish population, the age- and sex-stratified standardised incidence ratio of a WD pension due to any cause was 3.69, 3.34, 2.77 and 2.80 in the year cohorts, respectively (p0.001 for linearity).Since 2000 the frequency of continuous WD in early RA has declined in Finland. The present data allow no explanatory analysis but, at the same time, increasingly active treatment strategies have been introduced.

OBJECTIVE: Mortality, cause of death and risk indicators for death among patients with traumatic spinal cord injury were investigated over a 30-year period. DESIGN: A cross-sectional study with retrospective data. SUBJECTS: All patients (n = 1647) aged 16 years and over who had sustained traumatic spinal cord injury during the period 1976-2005, who were admitted to Kapyla Rehabilitation Centre, Helsinki, Finland, participated in the study. METHODS: Demographic and clinical data were collected from the registers of Kapyla Rehabilitation Centre. Cause-specific mortality was assessed using Statistics Finland's official cause-of-death register. RESULTS: During the observation period (1976-2007) 419 patients died. The main causes of death were respiratory disease (28%), cardiovascular disease (21%), suicide (10%) and external causes (9.5%). The mean age at death was 55.5 years for men and 58.2 years for women. Ten-year survival was 97.9%. Mortality was significantly affected by age at onset of injury, neurological level and extent of lesion. Survival of traumatic spinal cord injury patients was approximately 50% that of the general population, and survival of the general population was 80% during the follow-up period. CONCLUSION: These results support the need for improvements in long-term rehabilitative care and regular follow-up of patients with traumatic spinal cord injury. The importance of psychosocial follow-up services must be emphasized. Language: en

To establish a nationwide overview on drug treatment of juvenile idiopathic arthritis (JIA), which is the most frequent form of chronic arthritis (JA) in children and adolescents. The emphasis is on the first 12 months after diagnosis, and any changes in medication practices during the early years of the present millennium are registered.The Social Insurance Institution (SII) in Finland keeps a national register on individuals granted with a special reimbursement for medication of defined chronic diseases. From that register, we identified by the ICD-code of M08 all JA patients aged 16 years or under with an index day from 2000 through 2007. The prescription register of the SII showed the medication purchased for the patients. The register does not cover infused medications given in hospitals. We evaluated the first disease year's medication and the treatment strategy of the very first three months.Within our study period 2000-2007, the proportion of patients using methotrexate during the first year of treatment increased from 54 to 72% (p0.001). The combination of two or more DMARDs became more popular (increased from 16 to 21%) as the initial treatment strategy. These changes parallel a decrease in per oral glucocorticoids. The proportion of JA patients receiving TNFα-blockers during the first year after diagnose reached the level of about 5% during the years 2004 to 007.The drug treatment of patients with recent onset JA has become more intensive during the course of the new millennium in Finland, a fact expected to improve the disease outcome.

We investigated the implementation of pharmaceutical osteoporosis (OP) prevention in early rheumatoid arthritis (RA) in Finland.All incident RA cases from 2000 to 2007 were identified using the national register of the Social Insurance Institution (SII) as the sole source. The use of calcium and vitamin D preparations and OP drugs during the first year was evaluated.A total of 14,878 incident RA patients were found. They had a mean age of 56 (SD 15) and 68% were female. Nine per cent of the total number, which equated to 11% for women and to 5% men, had purchased OP drugs. The use of OP drugs increased over time: in the 2006-2007 period, relative risk (RR) for purchase was 1.62 (95% CI 1.38-1.92) for women and 2.1 (1.34-3.30) for men compared to the 2000-2001 period. Over the 2000-2005 period, 49% of females and 52% of males used glucocorticoids (GCs) during the first year. Among the GC-users, 38% of women and 24% of men also received calcium and vitamin D preparations by prescription, and 14% of women and 6% of men also used OP drugs. For GC users, the female sex, and older age increased the risk for OP use: the respective RRs were 1.45 (95% CI 1.31-1.61), 2.54 (95% CI 2.21-2.91), and 1.060 (95% CI 1.057-1.065).Patients with early RA are increasingly receiving OP drugs, and the use is more frequent among patients with known risk factors.

A randomized, placebo-controlled, double-blind, crossover study in 40 lumbar spinal stenosis patients with a 1-year follow-up showed that calcitonin had beneficial effects on the patients' symptoms without producing any notable side effects. Calcitonin had a clear analgesic effect. The mean of walking distance increased, but the crossover trend was not as good as the analgesic effect. Side effects such as erythema and nausea were usually mild and transient. Calcitonin therapy can be used as a conservative treatment in selected cases of lumbar spinal stenosis. When rest pain was mild or the walking distance was under 200-300 m because of neurogenic claudication, the effect of calcitonin seemed to be poor.

Objective:Acute stress in patients with rheumatoid arthritis (RA) should stimulate a strong stress response. After cryotherapy, we expected to observe an increase of hormones of the adrenal gland and the sympathetic nervous system.Methods:A total of 55 patients with RA were recruited for whole-body cryotherapy at −110°C and −60°C, and local cold therapy between −20°C and −30°C for 7 days. We measured plasma levels of steroid hormones, neuropeptide Y (sympathetic marker), and interleukin (IL)6 daily before and after cryotherapy.Results:In both therapy groups with/without glucocorticoids (GC), hormone and IL6 levels at baseline and 5 h after cold stress did not change over 7 days of cryotherapy. In patients without GC, plasma levels of cortisol and androstenedione were highest after −110°C cold stress followed by −60°C or local cold stress. The opposite was found in patients under GC therapy, in whom, unexpectedly, −110°C cold stress elicited the smallest responses. In patients without GC, adrenal cortisol production increased relative to other adrenal steroids, and again the opposite was seen under GC therapy with a loss of cortisol and an increase of dehydroepiandrosterone. Importantly, there was no sympathetic stress response in both groups. Patients without GC and −110°C cold stress demonstrated higher plasma IL6 compared to the other treatment groups (not observed under GC), but they showed the best clinical response.Conclusions:We detected an inadequate stress response in patients with GC. It is further shown that the sympathetic stress response was inadequate in patients with/without GC. Paradoxically, plasma levels of IL6 increased under strong cold stress in patients without GC. These findings confirm dysfunctional stress axes in RA.

Therapeutic exercise has been shown to be beneficial in decreasing pain and in increasing functioning in patients with chronic low back pain. However, longitudinal follow-up studies are small in number, and often limited in the numbers of subjects due to drop-outs. In addition there is a shortage of real control groups in most cases. The purpose of the present study was to describe long-term changes in intensity of low back pain and in functioning for two study groups five years after undertaking a home exercise programme.This was a randomized follow-up study over five years. Fifty-seven subjects were reassessed with questionnaires five years after their initial recruitment for an intervention study. A home exercise group (n = 29), with training once a day, and a control group (n = 28), without exercise, were included in the present study protocol. The primary outcome measurements included a questionnaire on the intensity of low back pain (Borg CR-10 scale) and on functioning (Oswestry Disability Index; ODI). The confounding physical activity was controlled with metabolic unit (MET) values.The CR-10 and ODI scores decreased during the first three months in both study groups. During the follow-ups, the corresponding indicators of the home exercise group remained below baseline values. The CR-10 score was significantly lower in the home exercise group (p = 0.01) during the last five-year follow-up session compared with the control group. Overall physical activity decreased slightly during the five-year follow-up, but there were no differences between the two study groups.The present randomized study indicates that supervised, controlled home exercises lead to reduced low back pain, and that positive effects were preserved over five years.

Background and Purpose. To determine the construct and predictive validity and sensitivity of the sub-scale items for postural changes, sitting balance and standing balance of the Postural Control and Balance for Stroke (PCBS) test over a 90-day follow-up. Method. In the initial phase of stroke the PCBS test scores were compared with values obtained for the Barthel Index (BI) and the four neuropsychological domains most widely studied in the literature: memory; language; visuo-spatial functions; and visual inattention. The ability of the PCBS test at an early stage to predict functional status, as measured by the BI, and tendency to falls at 90 days after stroke was studied. The sensitivity of the PCBS test in evaluating postural control was studied by comparing the changes between the initial and 90 days' measures, and by examining the ability of the test to discriminate between healthy people and stroke patients. Forty stroke patients (aged 51–89 years), measured 7 and 90 days post-stroke, and 35 healthy control subjects (aged 50–90 years) participated in the study. Results. Moderate correlations were found between the initial PCBS test and the BI (Spearman's r = 0.56–0.79) and a negative correlation between the sum variables for visual inattention and postural changes (Spearman's r = −0.39) and sitting balance (Spearman's r = −0.55). The score for postural changes predicted functional capacity (p < 0.002) and standing balance predicted falls at the three-month follow-up (p < 0.007). The PCBS test proved to be sensitive to change: the median change in the PCBS test scores during the three-month follow-up was 6.06. The control subjects mostly obtained maximum scores, indicating that the PCBS test was able to discriminate between healthy individuals and those with stroke. Conclusions. The results confirm that the PCBS test has good construct validity, good ability to predict functional capacity and safe moving, and it is sensitive to changes in balance control after stroke. Copyright © 2007 John Wiley & Sons, Ltd.

OBJECTIVE To study the feasibility and 1-year effects on subjective health and symptoms of a network-based geriatric rehabilitation intervention for frail elderly people. DESIGN A randomized, controlled trial. SUBJECTS A total of 741 frail elderly people who lived at home, aged > 65 years, without severe cognitive impairment (Mini Mental State Examination < 18), and eligible to receive Pensioners' Care Allowance (a benefit that is independent of personal income or insurance). The setting included 41 municipalities and 7 rehabilitation centres in Finland. METHODS Over a period of 8 months the intervention group received network-based rehabilitation for 3 in-patient periods (totalling 21 days) at rehabilitation centres and a home visit by a professional. Both groups received standard social and health services locally. Functional Independence Measure, subjective health, common symptoms and pain were assessed at baseline and 1-year follow-up. RESULTS After baseline measurements, 33 of those allocated to rehabilitation withdrew from the study. Of the 343 intervention subjects, 276 attended all 3 in-patient periods. At one year, there were no differences in symptoms between the groups. Subjective health was improved in the intervention group and impaired in the control group (p < 0.01). CONCLUSION The network-based geriatric rehabilitation programme was feasible for use among the frail elderly people and improved their subjective health.

Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short-term results have been reported so far. The aim of the present study was to evaluate the long-term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain. Altogether 180 woman with chronic, non-specific neck pain were randomized into three groups: neck muscle endurance training, neck muscle strength training and control groups. The main outcome measures included pressure pain threshold measurement at six muscle sites and on the sternum. Neck pain was assessed by a visual analogue scale (VAS). At the 12-month follow-up statistically significantly higher pressure pain threshold values were obtained in both training groups at all muscle sites compared to the baseline, while no significant change occurred in the controls. Significantly higher changes in pressure pain threshold were detected at all six sites in the strength training group and at four out of six sites in the endurance training group compared to the control group. This is the first study to show an increase in pressure pain thresholds as a result of long-term muscle training. A decrease in neck pain was associated with reduced pressure pain sensitivity in neck muscles, showing that the pressure pain threshold may be a useful outcome measure of the effectiveness of neck muscle rehabilitation.

STUDY DESIGN Randomized controlled trial. OBJECTIVES To Investigate the long-term effectiveness, costs, and effect modifiers of a mini-intervention, provided in addition to the usual care, and the incremental effect of a worksite visit for patients with subacute disabling low back pain (LBP). SUMMARY OF BACKGROUND DATA A mini-intervention was earlier proved to be an effective treatment for subacute LBP. Whether the beneficial effect is sustained is not known. Furthermore, modifiers of a treatment effect are largely unknown. METHODS A total of 164 patients with subacute LBP randomized into a mini-intervention (A, n = 56), a mini-intervention plus a worksite visit (B, n = 51), or the usual care (C, n = 57). Mini-intervention consisted of a detailed assessment of the patients' history, beliefs, and physical findings by a physician and a physiotherapist, followed by recommendations and advice. The usual care patients received the conventional care. Pain, disability, health-related quality of life, satisfaction with care, days on sick leave, and health care consumption and costs were measured during a 24-month follow-up. Thirteen candidate modifiers were tested for each outcome. RESULTS There were no differences between the three treatment arms regarding the intensity of pain, the perceived disability, or the health-related quality of life. However, mini-intervention decreased occurrence of daily (A vs., C, P = 0.01) and bothersome (A vs. C, P < 0.05) pain and increased treatment satisfaction. Costs resulting from LBP were lower in the intervention groups (A 4670 Euros, B 5990 Euros) than in C (C 9510 Euros) (A vs. C, P = 0.04; and B vs. C, not significant). The average number of days on sick leave was 30 in A, 45 in B, and 62 in C (A vs. C, P = 0.03; B vs. C, not significant). The perceived risk for not recovering was the strongest modifier of treatment effect. Mental and mental-physical workers in A and B were less often on sick leave than those in C. CONCLUSIONS Mini-intervention is an effective treatment for subacute LBP. Despite lack of a significant effect on intensity of low back pain and perceived disability, mini-intervention, including proper recommendations and advice, according to the "active approach," is able to reduce LBP-related costs. The perceived risk of not recovering was the strongest modifier of treatment effect. In alleviating pain, the intervention was most effective among the patients with a high perceived risk of not recovering.

ContextActive physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies.ObjectiveTo evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain.DesignExaminer-blinded randomized controlled trial conducted between February 2000 and March 2002.SettingParticipants were recruited from occupational health care systems in southern and eastern Finland.PatientsA total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain.InterventionsPatients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week.Main Outcome MeasuresNeck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures.ResultsAt the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P

Objectives To examine the first-year treatment of incident SLE. Methods The Finnish nationwide register data on special reimbursement decisions for SLE medication costs was screened to identify the inception cohort of adult SLE patient years 2000-2007. The cohort was shared in 2-year time periods according to index date. The patients were linked to prescription register, which includes drugs purchased from pharmacies. Both registries are maintained by the Social Insurance Institution. The first-year treatment of incident SLE was evaluated. Results A total of 566 subjects (87% females) were included in the incident cohort. Five percent of patients had not used any medicine and 80% had used some disease modifying anti-rheumatic drug (DMARD) during the first- year treatment. Prescriptions of mycophenolate mofetil as an initial treatment increased significantly throughout the time periods (2000-01, 2002-03, 2004-05 and 2006-07). Since year 2004 orally taken cyclophosphamide was not used in the first-year treatment of SLE. Conclusions Mycophenolate mofetil had a significant increasing trend in treatment of incident SLE during the study time. During the follow-up use of hydroxychloroquine and disease modifying anti-rheumatic drugs (DMARDs) was stable. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3086

Kivimaki J, Pohjolainen T. Manipulation under anesthesia for frozen shoulder with and without steroid injection. Arch Phys Med Rehabil 2001;82:1188-90. Objective: To study the effect of manipulating a shoulder with adhesive capsulitis (frozen shoulder) under anesthesia with and without corticosteroid injection. Design: Randomized trial. Setting: Hospital. Participants: Twenty-four patients referred for manipulation of a frozen shoulder. Intervention: The patients were randomized into 2 groups. One group received an injection of corticosteroid and manipulation; the other was only administered manipulation during anesthesia. Main Outcome Measures: The degree of shoulder mobility and pain before and after the manipulation. Results: Manipulation under anesthesia increased the mobility of the affected shoulder. Injection with lidocaine and betamethason did not enhance the effect of the manipulation. Conclusion: Manipulation under anesthesia without intraarticular corticosteroids is recommended as the therapy for frozen shoulder. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

In the catchment area of Helsinki University Central Hospital (in total 16 surgical hospitals) amputation was performed on 9 patients with frostbite in the upper extremities during 1984-1985. The population during the study period in this area was 1.165,000 inhabitants, corresponding to 24% of the whole population in Finland. All 9 patients were male and the mean age was 49 years (range 31-75). All amputations performed were of the fingers, the third, fourth and fifth fingers most frequently affected. Alcohol was a marked etiologic or contributing factor in most of the frostbites. Two patients were chronic schizophrenics showing no signs of alcohol abuse, but the remaining 7 were either acutely or chronically alcohol intoxicated: 5 patients were chronic alcoholics, one was an alcohol abuser without a definite diagnosis of alcoholism, and one patient with no previous history of alcohol abuse was alcohol intoxicated. Based on the present study it is clear that, in addition to the cold winters in Finland, other factors contribute to severe frostbite. These include many psychosocial factors such as alcoholism or mental disease, unbalanced marital status, occupation handicap and lack of regular residence.

Background Depression is a sizeable problem in rheumatoid arthritis (RA) but data on the antidepressant use is sparse. Objectives To investigate antidepressant initiations and the prevalence of antidepressant use among persons with recent-onset RA. Methods Persons (age ≥50) with incident RA (n=10356) during the years 2000-2007 were identified and data on their antidepressant purchases and comorbid conditions were obtained from the National Registers of Social Insurance Institution of Finland. Participants were categorized as former (antidepressant purchase during the year preceding RA diagnosis), new (first purchase after RA diagnosis) or non-users (no purchases during the study period) of antidepressants. Results Ten percent of participants (n=1034) were former users of antidepressants, and 9.4% (n=975) initiated the use after RA diagnosis. Cumulative incidence of antidepressant initiations among men was 4.8% (95% CI: 4.1 to 5.6) at two years after RA diagnosis and 11.4% (95% CI: 10.0 to 12.9) at the end of follow-up (mean: 4.4 years). For women, corresponding incidences were 7.1% (95% CI: 6.5 to 7.8) and 16.2% (95% CI: 14.9 to 17.5). Rate of antidepressant initiations was higher in women [HR 1.39 (95% CI: 1.21 to 1.60)]. The number of comorbidities before RA was linearly associated with antidepressant initiations (p Conclusions Antidepressant initiations were relatively frequent after RA diagnosis and significantly associated with comorbidity burden. This warrants the importance of psychological evaluation in early RA, especially among persons with several comorbidities. Disclosure of Interest None Declared