Rheumatoid Arthritis: Uhlig T

Uhlig T. · No affiliation provided · Tidsskr Nor Laegeforen. · Pubmed #12822006 links to  free full text

This publication has no abstract.

Uhlig T. · No affiliation provided · Tidsskr Nor Laegeforen. · Pubmed #10806895 No free full text.

This publication has no abstract.

Uhlig T, Christie A. · Nasjonalt revmatologisk rehabiliterings- og kompetansesenter, Revmatologisk avdeling, Diakonhjemmet sykehus, Postboks 23 Vinderen, 0319 Oslo. · Tidsskr Nor Laegeforen. · Pubmed #17279112 links to  free full text

Abstract: Patients with serious rheumatic disease do not only need treatment for the medical consequences of their disease, but also for the psychological, social and economic consequences. This article gives an overview of specialized rehabilitation within rheumatology in Norway and presents the National Resource Centre for Rehabilitation in Rheumatology (NRRK). NRRK offers treatment to patients with complicated inflammatory rheumatic disease. Rehabilitation at NRRK is multidisciplinary, client-centred, goal-directed and coping-oriented, and offers rehabilitation when no satisfactory service is available on a local or regional level. Documentation of treatment effects after rehabilitation at NRRK is briefly presented. Several self-reported health status variables (fatigue, coping, physical function, and several quality of life dimensions in SF-36) improved during the rehabilitation stay and up to 6 months follow-up. Cost aspects are of great importance for rehabilitation services in rheumatology, but have only been evaluated to a minor degree. Documenting effects of rehabilitation interventions remains an important challenge; evaluation should include the whole rehabilitation concept.

Kvien TK, Uhlig T. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Scand J Rheumatol. · Pubmed #16234180 No free full text.

Abstract: Assessment of health-related quality of life (HRQoL) is relevant for the patients and is important in both clinical research and daily clinical practice. Generic and disease-specific instruments for assessment of HRQoL are reviewed. Changes in HRQoL provide important information on randomized controlled clinical trials as well as on observational studies. The floor effect is a limitation of many of the scales, especially in patients with less severe disease. Feasibility and low test-retest reproducibility limit the use of many of the instruments in clinical practice, especially when they are used for individual treatment decisions. Electronic transferral of data from patients to the health professionals by, for example, internet or a personal digital assistant (PDA), opens up new opportunities for frequent patient reports and improved access to the data.

Uhlig T, Kvien TK. · Department of Rheumatology, Diakonhjemmet Hospital, N-0319 Oslo, Norway. · Ann Rheum Dis. · Pubmed #15286008 links to  free full text

Abstract: During the past decades a number of studies have examined the incidence of rheumatoid arthritis (RA) in different geographical settings and at different times. Some studies from the 1970s and 1980s reported a higher incidence of RA than seen during recent years, where reported incidence numbers seems to have flattened out at a lower level. Besides a real time dependent decline of RA incidence, changing methodology in classification may be an equally important explanation. Today we may assume that annually 25-50 people from a population of 100,000 will develop typical RA.

Kvien TK, Uhlig T. · Oslo City Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Clin Exp Rheumatol. · Pubmed #14969062 No free full text.

Abstract: The Oslo experience with early rheumatoid arthritis (RA) is based on studies performed within the setting of a register of RA patients and of the longitudinal follow-up of patients with early RA. This article discusses some relevant issues for research on early arthritis: whether the current RA classification criteria are appropriate, the shift in incidence toward elderly patients, and the heterogeneity of the disease. Our data clearly show that 3 of the items of the classification criteria are infrequently fulfilled early in the disease and that RA most frequently starts after the age of 60. Our data also suggest that disease onset may be defined either as symptom onset or as when the classification criteria are fulfilled. The choice between these 2 options does not seem to influence the longitudinal results.

Uhlig T, Finset A, Kvien TK. · National Resource Center for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Curr Opin Rheumatol. · Pubmed #12598801 No free full text.

Abstract: Comprehensive rehabilitation involving multidisciplinary involvement of healthcare professionals is available to patients with rheumatic diseases. Studies were reviewed on the effectiveness of such programs for patients with chronic low back pain, widespread pain, and rheumatoid arthritis. When effects on the various outcome measures are demonstrated, improvements can only with difficulty be attributed to a specific component of a comprehensive program. Economic analyses for the effectiveness of comprehensive programs are scarce, but are needed by policy makers to allow optimal allocation of resources. Preferably the overall performance of comprehensive rehabilitation programs, not the individual components, should be evaluated.

Kvien TK, Uhlig T, Kristiansen IS. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Drugs. · Pubmed #11693461 No free full text.

Abstract: Tumour necrosis factor (TNF) antagonists or blocking agents represent a major advance in the treatment of rheumatoid arthritis (RA), but their use raises economic concerns because of the high drug cost. Population-based patient registers with clinical data allow the estimation of the proportion of patients with RA who are eligible for TNF antagonist therapy according to recent consensus statements on TNF-targeted therapy. Data were derived from a representative county-based (500,000 population) register of patients with RA. Of 894 patients aged between 18 and 70 years, 636 (71%) [females 80%, mean (SD) age 53.6 (12.2) years and mean (SD) disease duration 12.2 (9.3) years] had a clinical and radiographic examination. The eligibility for TNF-targeted therapy was estimated from the following criteria: (i) previous or current therapy with at least one disease-modifying antirheumatic agent (DMARD); and (ii) active disease. Disease activity criteria were set to 28-swollen joint count (28-SJC) > or = 6, 28-tender joint count > or = 6, and erythrocyte sedimentation rate (ESR) > or = 28 mm/hour or C-reactive protein (CRP) > or = 20 mg/L. Sensitivity analyses were performed varying some of these disease activity parameters. Of the 636 patients, as many as 526 (83%) had previously or were currently using DMARDs and 98 (15%) fulfilled both the DMARD and activity criteria, thus being the maximum number of patients considered for TNF-targeted therapy. If the most stringent criteria were used (ever DMARD, 28-SJC > or = 12 and ESR > or = 50 mm/hour or CRP > or = 40 mg/L) only 15 of the 626 (2%) would be candidates for TNF-targeted therapy. In a population of 1 million, assuming a prevalence of 2000 patients with RA under the age of 70 years, the number of candidates for TNF-targeted therapy would be 40 to 300, depending on the disease activity criteria. Stringent ESR and CRP criteria would lead to a major reduction in the number of eligible patients. These utilisation data imply annual drug costs in the range of $US 480,000 to $US 3,600,000 for TNF antagonists for RA per 1 million population. Further economic evaluations are needed to determine for which groups such treatment is warranted from a health economics perspective.

Vis M, Havaardsholm EA, Haugeberg G, Uhlig T, Voskuyl AE, van de Stadt RJ, Dijkmans BA, Woolf AD, Kvien TK, Lems WF. · Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands. · Ann Rheum Dis. · Pubmed #16606653 No free full text.

Abstract: OBJECTIVES: To examine whether treatment with anti-tumour necrosis factor (TNF) alpha prevents loss of bone mineral density (BMD) at the spine and hip (generalised) and in the hands (local) of patients with rheumatoid arthritis, and to study the changes in markers of bone metabolism, including receptor activator of the NFkappaB ligand (RANKL) and osteoprotegerin (OPG), during anti-TNF treatment. PATIENTS AND METHODS: 102 patients with active rheumatoid arthritis, who were treated with infliximab during 1 year, were included in this open cohort study. The BMD of the spine and hip (dual x ray absorptiometry) and hands dual x ray radiogrammetry was measured before the start of treatment and after 1 year. Changes in osteocalcin formation, beta-isomerised carboxy terminal telopeptide of type 1 collagen (beta-CTx, resorption), RANKL and OPG were determined at 0, 14, 30 and 46 weeks. RESULTS: The BMD of the spine and hip was unchanged during treatment with infliximab, whereas BMD of the hand decreased significantly by 0.8% (p<0.01). The BMD of the hip in patients with a good European League Against Rheumatism response showed a favourable change compared with patients not achieving such a response. Serum beta-CTx and RANKL were both considerably decreased compared with baseline at all time points. The decrease in beta-CTx was associated with the decrease in Disease Activity Score of 28 joints and C reactive protein during the 0-14 weeks interval. CONCLUSION: In patients with rheumatoid arthritis treated with infliximab, spine and hip bone loss is arrested, whereas metacarpal cortical hand bone loss is not stopped. The outcome of the study also supports a relationship between clinical response, in terms of reduced inflammatory activity, and changes in bone loss of the spine, hip and hands.

Grotle M, Garratt A, Løchting I, Kjeken I, Klokkerud M, Uhlig T, Hagen KB. · National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, University of Oslo, Oslo, Norway. · J Rehabil Med. · Pubmed #19543670 No free full text.

Abstract: OBJECTIVE: To develop the Rehabilitation Patient Experiences Questionnaire for patients undergoing rehabilitation for rheumatological disorders. METHODS: Development of the instrument was based on literature review and adaptation of the Patient Experiences Questionnaire. The instrument was piloted and then administered in a multicentre cohort study of 12 rehabilitation units. RESULTS: The survey included 435 patients, of which 412 (94.7%) responded to the Rehabilitation Patient Experiences Questionnaire. Following principal component analysis, the initial 27 items were reduced to 18 items and 4 scales: rehabilitation care and organization, information and communication, availability of staff, and social environment. Item--total correlations ranged from 0.77 to 0.87. Cronbach's alpha exceeded the criterion of 0.7, and was 0.87, 0.86, 0.78, and 0.77 for the 4 scales, respectively. Construct validity was supported by correlations between the 4 scales and responses to individual questions, which were largely in the direction as hypothesized. Overall, patients reported good experiences. There were statistical differences across the rehabilitation settings in staff availability (p = 0.001) and social environment (p = 0.002), but no difference in care and organization and information/communication (p > 0.05). CONCLUSION: The 18-item Rehabilitation Patient Experiences Questionnaire is a promising outcome measure of experiences related to rehabilitation in patients with rheumatic diseases across different clinical settings. :

Mjaavatten MD, Haugen AJ, Helgetveit K, Nygaard H, Sidenvall G, Uhlig T, Kvien TK. · Department of Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway. · J Rheumatol. · Pubmed #19487273 No free full text.

Abstract: OBJECTIVE: To investigate the distribution of joint involvement in a cohort of patients with very recent onset arthritis and describe the disease characteristics in these patients. METHODS: A very early arthritis clinic (NOR-VEAC) was established as a multicenter study. General practitioners were asked to refer patients presenting with at least 1 swollen joint of maximum 16 weeks' duration. Clinical and laboratory markers were examined. RESULTS: We included 634 patients during the first 3 years, with mean (25th-75th percentile) arthritis duration of 30 (11-63) days. Monoarthritis was present in 243 (38.3%) patients, 216 (34.1%) had oligoarthritis, and 175 (27.6%) polyarthritis. Patients with polyarthritis were older, had longer duration of arthritis, and were more frequently anti-cyclic citrullinated peptide antibody and rheumatoid factor-positive. Patients in all 3 joint pattern groups (mono-/oligo-/polyarthritis) reported substantial effect on physical function, pain, and fatigue and had elevated levels of acute-phase reactants. Knee or ankle arthritis was most frequent in patients with mono- and oligoarthritis, whereas small joint involvement was most frequent in patients with polyarthritis. CONCLUSION: Patients with recent-onset arthritis report a substantial influence on health status. Mono- and oligoarthritis are at least as frequent as polyarthritis. Polyarthritic patients more frequently exhibit features associated with a worse outcome.

Uhlig T, Kvien TK, Pincus T. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Ann Rheum Dis. · Pubmed #18957489 No free full text.

Abstract: AIM: To examine the test-retest reliability of the rheumatoid arthritis (RA) core disease activity measures and derived composite indices. METHODS: A total of 28 stable patients with RA had 2 complete assessments within 1 week, which included the 7 RA core disease activity measures and derived disease activity indices (28-joint Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), RA Disease Activity Index (RADAI) and Routine Assessment of Patient Index Data (RAPID3)). The intraclass correlations (ICC), the smallest detectable difference (SDD) and minimal detectable change as percentage of the maximum score (MDC%) were estimated as measures of test-retest reliability. RESULTS: Correlations for the disease activity indices were high. SDDs (MDC%) to detect a true improvement or deterioration with 95% confidence were: DAS28 1.32 (14.4%), SDAI 8.26 (9.6%), CDAI 8.05 (10.6%), RAPID3 1.48 (14.8%) and RADAI 1.49 (14.9%). Thus, SDDs were rather high, and the MDC% values were of a similar magnitude of 10% to 15% for all seven core data set measures. CONCLUSIONS: SDDs of the DAS28, SDAI and CDAI were close to limits to detect important improvement. Clinicians should be aware of measurement error. Nonetheless, RA core data set measures and indices obtained from a health professional, laboratory and patient self-report had similar reliability.

Uhlig T, Moe R, Reinsberg S, Kvien TK, Cieza A, Stucki G. · National Resource Center for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Ann Rheum Dis. · Pubmed #18625628 No free full text.

Abstract: BACKGROUND: The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the ICF, representing relevant aspects in the functioning of patients with RA. OBJECTIVES: To study the responsiveness of the ICF Core Set for RA in rheumatological practice. METHODS: A total of 46 patients with RA (72% women, mean (SD) age 53.6 (12.6) years, disease duration 6.3 (8.0) years) were interviewed at baseline and again after 6 months treatment with a disease-modifying antirheumatic drug (DMARD), applying the ICF Core Set for RA with qualifiers for problems on a modified three-point scale (no problem, mild/moderate, severe/complete). Patient-reported outcomes included Modified Health Assessment Questionnaire (MHAQ) and Short-Form 36 (SF-36) health survey, and disease activity was calculated. Responsiveness was measured as change in qualifiers in ICF categories, and was also compared with change in patient-reported outcomes. RESULTS: After 6 months of DMARD treatment, improvement by at least one qualifier was seen in 20% of patients (averaged across all ICF categories), 71% experienced no change and 9% experienced worsening symptoms. Findings were similar across the different aspects of functioning. Mainly moderate effect sizes were seen for 6-month changes in the ICF Core Set for RA, especially in patients with improved health status, with similar effect size for disease activity. The components in the ICF Core Set for RA were only weakly associated with patient-reported outcomes and disease activity. CONCLUSIONS: The ICF Core Set for RA demonstrated moderate responsiveness in this real-life setting of patients where minor changes occurred during treatment with DMARDs.

Uhlig T, Heiberg T, Mowinckel P, Kvien TK. · Department of Rheumatology, Diakonhjemmet Hospital, N-0319 Oslo, Norway. · Ann Rheum Dis. · Pubmed #18218667 No free full text.

Abstract: OBJECTIVES: During the last decades major advances have occurred in the treatment of patients with rheumatoid arthritis (RA), and improvements in the burden of the disease have been suggested. We examined whether there was a secular change towards less severe disease from 1994 to 2004 among patients within the representative setting of the Oslo Rheumatoid Arthritis Register (ORAR). METHODS: All living patients in the ORAR received a postal questionnaire in 1994, 1996, 2001 and 2004, including the Modified Health Assessment Questionnaire (MHAQ), SF-36, Arthritis Impact Measurement Scales 2 (AIMS2) and visual analogue scales for the patient global assessment of disease severity, pain and fatigue. A mixed model approach was used for longitudinal analysis adjusting for sex, age, co-morbidity, and for disease duration and DMARD if indicated. RESULTS: The numbers of respondents aged between 20 and 79 years in 1994, 1996, 2001 and 2004 were 931, 1025, 829 and 914 patients with similar demographic characteristics (mean age in 1994 was 60.6 years, mean disease duration 12.6 years, 78% females). Health status in the population with RA was consistently improved in all dimensions of health, and this improvement was statistically significant for the physical dimension, global health and pain over the 10-year period until 2004. Both year of examination and year of disease onset had an effect on measures of longitudinal health status outcome. CONCLUSIONS: Health status in RA improved from 1994 to 2004, probably due to access to better and more aggressive treatments.

Odegård S, Kvien TK, Uhlig T. · Department of Rheumatology, Diakonhjemmet Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway. · J Rheumatol. · Pubmed #18050381 No free full text.

Abstract: OBJECTIVE: To calculate the average age- and sex-specific annual incidence of rheumatoid arthritis (RA) linked to clinically important levels of health status after 10 years, and to study time trends in 10-year disease status during a 6-year period. METHODS: Patients between 20 and 79 years of age with onset of RA from 1988 to 1993 (n = 550) were asked to participate in a 10-year followup examination. Two hundred sixteen patients in different age and sex groups from 6 different annual cohorts met during the period 1998-2003. Study variables included demographic variables, medication, swollen, tender and deformed joint counts, erythrocyte sedimentation rate, Disease Activity Score (DAS28), Health Assessment Questionnaire, and pain and fatigue on a 100 mm visual analog scale and Arthritis Impact Measurement Scale 2. Age- and sex-specific incidences of RA exceeding clinically important levels 10 years after disease onset were calculated using the Poisson distribution with 95% confidence intervals. Analysis of covariance and logistic regression were used to test the influence of time on 10-year DAS28 and presence of deformed joints. RESULTS: The average annual incidence of cases exceeding clinically important levels in disease activity and health status 10 years after disease onset increased with higher age and was highest among women. There was a tendency to lower disease activity 10 years after disease onset in the latest cohorts compared to the earliest cohorts. CONCLUSION: These results from population-based RA incidence cohorts provide important information to healthcare planners and support findings of secular decline in disease burden.

Uhlig T, Loge JH, Kristiansen IS, Kvien TK. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · J Rheumatol. · Pubmed #17516624 No free full text.

Abstract: OBJECTIVE: To compare levels of health-related quality of life (HRQOL) among patients with rheumatoid arthritis (RA) to those of the general population. METHODS: Disease burden was assessed using a generic health status instrument (Medical Outcome Study Short Form-36) for measurements of HRQOL and SF-6D to calculate utility scores in representative patients aged 20 to 79 years from the Oslo RA Register (n = 1052), and in individuals in the general population (n = 2323). Comparisons were performed with respect to sex and age, and standardized difference scores (s-scores) were calculated for comparisons with the norm. RESULTS: HRQOL in patients with RA was reduced compared to the general population on all scales of the SF-36 for both males and females and for all age groups. s-scores adjusted for age and education ranged from -1.39 for physical functioning to -0.27 for mental health. The overall difference in utility was 0.16 and ranged from 0.13 (in female patients below 50 yrs) to 0.20 (patients 50-60 years). This implies that RA of 1 year duration entails a disease burden of 14-20 quality-adjusted life-years in 100 RA patients. CONCLUSION: RA inflicts a substantial disease burden, and the disease affects all HRQOL dimensions as measured by the SF-36 in both sexes and in all age groups. Physical functioning is predominantly affected, but RA has social and mental consequences.

Lie BA, Viken MK, Odegård S, van der Heijde D, Landewé R, Uhlig T, Kvien TK. · Institute of Immunology, Rikshospitalet-Radiumhospitalet Medical Center, N-0027 Oslo, Norway. · Ann Rheum Dis. · Pubmed #17472988 No free full text.

Abstract: OBJECTIVE: To investigate whether the PTPN22 1858T risk variant is associated with the rate of radiographic progression in rheumatoid arthritis (RA). METHODS: A longitudinally followed cohort of 238 Norwegian patients with RA (the EURIDISS cohort) was genotyped for the PTPN22 1858C-->T polymorphism. Radiographic damage was assessed by hand radiographs at baseline and after 1, 2, 5 and 10 years, and the radiographs were scored with the Sharp method modified by van der Heijde (Sharp-van der Heijde score) by a single experienced reader. Baseline serum levels of rheumatoid factor and anti-cyclic citrullinated peptide autoantibodies were also examined. RESULTS: The reported association between RA susceptibility and carriage of the T allele (34.4% in patients vs 21.4% in controls; odds ratio 1.92, 95% confidence interval 1.36 to 2.71, p = 0.0002) was confirmed. An association between annual progression rate of Sharp-van der Heijde score and T-allele carriers (p = 0.01),was also found, which was also present when only patients positive for the shared epitope were analysed (p = 0.03). This association was also maintained in multivariate analyses adjusting for shared epitope and demographic variables. CONCLUSIONS: An association between the PTPN22 risk variant and increased progression rate for structural damage was found. The results indicate that the PTPN22 gene may not only be associated with disease susceptibility, but also with disease progression.

Heiberg T, Kvien TK, Dale Ø, Mowinckel P, Aanerud GJ, Songe-Møller AB, Uhlig T, Hagen KB. · Centre for Education and Skill Training, Ulleval University Hospital, Oslo, Norway. · Arthritis Rheum. · Pubmed #17394232 links to  free full text

Abstract: OBJECTIVE: The patient perspective workshops at the Outcome Measures in Rheumatology Clinical Trials have included daily measures of health status (patient diary) and use of electronic tools for data collection in the research agenda. The objective of this study was to compare daily and weekly registrations of self-reported health status measures between personal digital assistant (PDA) and paper-pencil (PP) format regarding scores, variation, and feasibility. METHODS: Thirty-eight patients with stable rheumatoid arthritis recorded their health status during 84 days in a repeated crossover design, using PDA or PP format during four 21-day periods. Visual analog scales (VAS) for pain, fatigue, and global disease and the Rheumatoid Arthritis Disease Activity Index were scored daily; the Short Form 36 and Modified Health Assessment Questionnaire were scored weekly. RESULTS: The average scores and measures of variation of the 4 daily health status measures over 21 days did not differ significantly between PDA and PP formats in either of the 2 crossover periods. The values for the average range between the maximum and minimum values for daily measures were similar between the 2 formats, but showed considerable variation (e.g., range for pain VAS was 19-28 mm over each 21-day period). The time to complete the instruments was similar between the 2 formats. Missing daily data entries were generally low for both periods and somewhat higher for PDA. The majority of patients (82.9%) preferred using PDA. CONCLUSION: Daily assessments with PDA may be efficiently used for frequent data collection because this format performs similarly to the traditional PP format.

Odegård S, Finset A, Mowinckel P, Kvien TK, Uhlig T. · Department of Rheumatology, Diakonhjemmet Hospital, N-0319 Oslo, Norway. · Ann Rheum Dis. · Pubmed #17392351 No free full text.

Abstract: OBJECTIVE: To examine rheumatoid arthritis (RA) with short disease duration over 10 years, and to identify factors that are associated with the course of pain, depression and anxiety. METHODS: A cohort of 238 patients with RA (age 20-70 years, mean disease duration 2.3 years, 68% rheumatoid factor positive) was followed with assessments at baseline and after 1, 2, 5 and 10 years. Self-reported health status was assessed by pain on a 100 mm visual analogue scale, the Arthritis Impact Measurement Scales (AIMS), the 28-item version of General Health Questionnaires, and the Health Assessment Questionnaire. We also examined the erythrocyte sedimentation ratio, grip strength (kg) and radiographic progression of the hands (van der Heijde modified Sharp score). Repeated measures analyses of variance were used to explore the effect of time on measures of outcome among completers, whereas repeated measures analyses using a mixed model were applied to identify factors that were longitudinally associated with pain, depression and anxiety. RESULTS: At the various assessment points 30% had a visual analogue scale pain score of > or =40 mm, 5-13% had an AIMS depression score of > or =4.0 and 20-30% had an AIMS anxiety score of > or =4.0. The perceived level of pain was explained longitudinally by anxiety, disease activity, physical function and female gender, depression by high disease activity and anxiety, whereas anxiety was explained by low disease activity and depression. CONCLUSION: More patients had increased levels of anxiety (20-30%) than increased levels of depression (5-13%). Several factors, including anxiety, but not depression, were associated with the course of pain.

Hammer HB, Odegard S, Fagerhol MK, Landewé R, van der Heijde D, Uhlig T, Mowinckel P, Kvien TK. · Department of Rheumatology, Diakonhjemmet Hospital, Box 23, Vinderen, N-0319 Oslo, Norway. · Ann Rheum Dis. · Pubmed #17234650 No free full text.

Abstract: OBJECTIVE: Calprotectin is a major leucocyte protein, shown to correlate well with laboratory and clinical assessments in several inflammatory rheumatic diseases, and large concentrations of calprotectin have been found in synovial fluid from patients with rheumatoid arthritis (RA). The objective of the present study was to examine correlations between calprotectin and joint damage. METHODS: 145 patients with RA were analysed cross sectionally with laboratory (calprotectin, C reactive protein (CRP), and erythrocyte sedimentation rate (ESR)), clinical (28 joint counts (tender, swollen), physician global VAS, DAS28 and RA Articular Damage score (RAAD)), and radiographic (plain hand radiographs; modified Sharp's method) measurements, on the same day. RESULTS: Calprotectin showed a highly significant correlation with measures of joint damage; modified Sharp score r = 0.43 (p<0.001) and RAAD r = 0.40 (p<0.001). The association with modified Sharp score and RAAD score was maintained after adjustment for CRP, ESR, rheumatoid factor, DAS28, sex, and age in a multiple regression analysis (p = 0.018 and p = 0.04, respectively), while neither CRP nor ESR showed any independent associations. Highly significant correlations (p<0.001) were also found between calprotectin and both laboratory and clinical markers of inflammation. CONCLUSION: Calprotectin was found to significantly and independently explain the variation in the radiological and clinical assessments of joint damage. Longitudinal studies are required to examine whether calprotectin may predict the progression of joint damage in RA.

Uhlig T, Lillemo S, Moe RH, Stamm T, Cieza A, Boonen A, Mowinckel P, Kvien TK, Stucki G. · National Resource Center for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Postboks 23 Vinderen, N-0319 Oslo, Norway. · Ann Rheum Dis. · Pubmed #17223659 No free full text.

Abstract: BACKGROUND: The comprehensive ICF Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the International Classification of Functioning, Disability and Health (ICF), representing relevant aspects in the functioning of RA patients. OBJECTIVES: To study the reliability of the ICF Core Set for RA in rheumatological practice, and to explore the metric of the qualifiers' scale. METHODS: 25 RA patients from an outpatient department of rheumatology were interviewed using the ICF Core Set for RA (76% females, mean (SD) age 57.5 (12.5) years, disease duration 15.9 (14.6) years). Interviews were performed independently by both a physiotherapist and an occupational therapist on the same day and again after one week by one of them. The severity of the patients' problems was quantified on a qualifier scale ranging from 0 (no problem) to 4 (complete problem). Analyses of intra-rater and inter-rater agreement, kappa statistics, and Rasch analyses were applied. RESULTS: Mean intra-rater (inter-rater) complete agreement for all categories was seen in 59% (47%) of observations, ranging from 29% (0%) to 96% (80%) for individual categories. Weighted kappa statistics with value > or =0.4 showed reliability in 86% of categories within raters, and in 43% of categories between raters. Improved inter-rater and intra-rater reliability was observed with a reduced number of qualifiers for the categories. CONCLUSIONS: Inter-rater and intra-rater reliability of the ICF Core Set of RA was low to moderate. The metric of the qualifiers' scale may be improved by reducing the number of qualifiers to three for all components.

Kvien TK, Uhlig T, Ødegård S, Heiberg MS. · Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, N-0319 Oslo, Norway. · Ann N Y Acad Sci. · Pubmed #16855148 No free full text.

Abstract: Many rheumatic diseases, including rheumatoid arthritis (RA) are more frequent in females than males. The objective of this article was to examine the female versus male perspective regarding prevalence/incidence, etiological factors, disease severity/outcomes, access to therapy and therapeutic responses. We also present results from some new analyses from the patient registers in Oslo to supplement existing literature in this area. We found that the prevalence of RA is higher in females than males, the incidence is 4-5 times higher below the age of 50, but above 60-70 years the female/male ratio is only about 2. Smoking is a consistent predictor of RA in males, but findings have been more inconsistent in females. We could not confirm that health status is worse in females than males when corrections were made for different disease duration and for the underlying tendency of healthy females to report worse subjective health status than males. Some studies and data presented here indicate that females have less access to health services. We also found that female sex reduces the likelihood of achieving treatment response with methotrexate and anti-tumor necrosis factor (anti-TNF) drugs by 30-50%. More research is needed to fully describe the differences between males and females regarding epidemiological data.

Kjeken I, Dagfinrud H, Mowinckel P, Uhlig T, Kvien TK, Finset A. · National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, boks 23 Vinderen, 0319 Oslo, Norway. · Arthritis Rheum. · Pubmed #16739186 links to  free full text

Abstract: OBJECTIVE: To examine levels of received information, involvement in medical decisions, and satisfaction with care, to explore factors related to current involvement in medical decisions, and to assess patients' unmet health care needs related to their disease. METHODS: A total of 1,193 patients with rheumatoid arthritis and ankylosing spondylitis completed self-reported health status questionnaires, including registration of sociodemographic data and questions about rheumatology care. Separate questions addressed information received, involvement in decisions, and satisfaction with care. Aspects of unmet health were assessed by an open-ended question. RESULTS: The majority of patients reported medium to high levels of received information, involvement in medical decisions, and satisfaction with care. High involvement in medical decisions was univariately associated with high levels of perceived information and satisfaction, as well as with lower age and a good health status. In the multivariate analyses, patient satisfaction (odds ratio [OR] 4.21) and a high level of received information (OR 7.85), age (OR 0.99), and >12 years of formal education (OR 1.46) remained as significant predictors to current involvement. Nearly one-third reported a variety of unmet health care needs, and this report was associated with poor health. CONCLUSION: The results indicate a need for a more flexible and patient centered care model, in which patients to a larger degree can decide which services they need and how these services should be delivered.

Strand EB, Zautra AJ, Thoresen M, Ødegård S, Uhlig T, Finset A. · Department of Behavioural Sciences and Statistics, Institute of Basic Medical Science, University of Oslo, POB 1111 Blindern, N-0317 Oslo, Norway. · J Psychosom Res. · Pubmed #16650588 No free full text.

Abstract: OBJECTIVE: The purpose of this study is to examine positive affect (PA) as a factor of resilience in the relationships between pain and negative affect (NA) in a sample of patients with rheumatoid arthritis. METHODS: Forty-three patients (30 women; mean age, 57 years) were interviewed weekly by telephone for 8 weeks. Multilevel modeling was applied to study the within-week relationships among the variables. RESULTS: There was a Pain x PA interaction effect on NA (beta=-0.05, P<.01) indicating a weaker relationship between pain and NA in weeks with more PA. Pain (beta=0.37, P<.002), interpersonal stress (beta=2.42, P<.001), depression (beta=0.26, P<.01), average perceived stress (beta=10.80, P<.001), and also weekly PA (beta=-0.1, P<.01) had a main effect upon NA. CONCLUSION: Positive affect is most influential in reducing NA during weeks of higher pain and may be a factor of resilience, helping patients experiencing pain fluctuations as less distressful than at lower levels of PA.

Odegård S, Finset A, Kvien TK, Mowinckel P, Uhlig T. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Scand J Rheumatol. · Pubmed #16393765 No free full text.

Abstract: OBJECTIVE: To explore the prevalence of work disability (WD) and to identify bio-psychological factors that predicts future WD in rheumatoid arthritis (RA) over a 7-year period. METHODS: Patients were selected from the Oslo RA register. The prevalence of WD was studied cross-sectionally among respondents <67 years (n = 526) in a postal survey. Mean age (SD) was 51.1 (11.9) years, mean disease duration 11.3 (9.4) years, and 49% of patients were RF-positive. The patients studied for predictive factors for WD were respondents in postal surveys both at baseline and at the 7-year follow-up, in work at baseline and still in working age (<67 years) at follow-up (n = 159). Mean age at baseline (SD) was 44.5 (9.7) years, mean disease duration 8.4 (6.6) years, mean years of formal education 12.7 (3.1) years, 48% were RF-positive. Assessments included socio-demographic variables and health status measures (MHAQ, AIMS2, SF-36, fatigue and pain on VAS 0-100 mm, self efficacy, and RAI as a measure for helplessness). RESULTS: Among the 526 respondents at baseline <67 years, the prevalence of WD was 40%. A high level of education was a predictor of reduced risk of work disability [odds ratio (OR) = 0.4, 95% confidence interval (CI) 0.1; 0.9], while female gender (OR 3.0, 95% CI 1.1; 8.0), physical disability (MHAQ-score) (OR = 3.9, 95% CI 1.2; 12.5) and helplessness over median RAI-score (OR = 3.0, 95% CI 1.4; 6.7) were independent predictors of increased risk for new work disability over 7 years. CONCLUSION: Physical disability, increased helplessness, low formal education, and female gender were found to be independent risk factors for new work disability over the 7-year study period.