Treatment-related changes in serum neutrophil gelatinase-associated lipocalin (NGAL) in psoriatic arthritis: results from the PIPA cohort study.

OBJECTIVES: Obesity and psoriatic arthritis (PsA) have a complicated relationship. While weight alone does not cause PsA, it is suspected to cause worse symptoms. Neutrophil gelatinase-associated lipocalin (NGAL) is secreted through various cell types. Our objective was to assess the changes and trajectories in serum NGAL and clinical outcomes in patients with PsA during 12 months of anti-inflammatory treatment. METHOD: This exploratory prospective cohort study enrolled PsA patients initiating conventional synthetic or biological disease-modifying anti-rheumatic drugs (csDMARDs/bDMARDs). Clinical, biomarker, and patient-reported outcome measures were retrieved at baseline, and 4 and 12 months. Control groups at baseline were psoriasis (PsO) patients and apparently healthy controls. The serum NGAL concentration was quantified by a high-performance singleplex immunoassay. RESULTS: In total, 117 PsA patients started a csDMARD or bDMARD, and were compared indirectly at baseline with a cross-sectional sample of 20 PsO patients and 20 healthy controls. The trajectory in NGAL related to anti-inflammatory treatment for all included PsA patients showed an overall change of -11% from baseline to 12 months. Trajectories in NGAL for patients with PsA, divided into treatment groups, showed no clear trend in clinically significant decrease or increase following anti-inflammatory treatment. NGAL concentrations in the PsA group at baseline corresponded to the levels in the control groups. No correlation was found between changes in NGAL and changes in PsA outcomes. CONCLUSION: Based on these results, serum NGAL does not add any value as a biomarker in patients with peripheral PsA, either for disease activity or for monitoring.

Increased prevalence of sleep disturbance in psoriatic arthritis is associated with inflammatory and non-inflammatory measures.

OBJECTIVES: To examine the prevalence of sleep disturbances, quantified by the Pittsburgh Sleep Quality Index (PSQI), in patients with psoriatic arthritis (PsA), psoriasis (PsO) and healthy controls (HCs), explore associations between PSQI and clinical and patient-reported outcomes, and evaluate the effect of treatment on PSQI. METHOD: Patients were included from the Parker Institute's PsA patient cohort to evaluate the prevalence of sleep disturbances. Univariate and multivariate regression analyses were used to explore associations between sleep disturbance and outcome measures. Treatment effect in PsA patients was assessed with a mixed-effect model for repeated measures. RESULTS: In total, 109 PsA patients, 20 PsO patients, and 20 HCs were included. Sleep disturbances were reported by 66.1% of PsA patients, 45.0% of PsO patients, and 15.0% of HCs. Univariate regression analyses revealed statistically significant associations (p < 0.001) between PSQI and Disease Activity Score (DAS28CRP), tender points, visual analogue scale (VAS) patient global and pain, Psoriatic Arthritis Impact of Disease fatigue, Health Assessment Questionnaire (HAQ), and painDETECT score. Multivariate regression analysis demonstrated VAS patient global, VAS pain, and tender points as being independently associated with PSQI. The mixed-effect model revealed no effect of treatment. CONCLUSION: More PsA patients than PsO patients and HCs reported sleep disturbances. Sleep disturbances were associated with inflammatory and non-inflammatory measures possibly explaining the limited effect of treatment. This demonstrates the need for interdisciplinary approaches to improve the management of sleep disturbance in PsA.Trial registration: ClinicalTrials.gov (NCT02572700).

Comparing patient-reported outcomes entered at home versus at hospital, and testing touch screens for initial recruitment to scientific trials in arthritis patients.

OBJECTIVES: Touch screens for entering patient-reported outcomes (PROs) are available at all Danish departments of rheumatology reporting to the nationwide DANBIO registry. This project comprises two substudies in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (AxSpA), aiming to (A) investigate the feasibility of first line patient recruitment for research via touch screens, and (B) compare PROs collected at hospital versus at home, including patient preferences. METHOD: Substudy A: using a touch screen, patients answered whether we could contact them about a clinical research project (yes/no). Characteristics of patients who accepted/declined were explored using chi-squared and Mann-Whitney U-tests. Substudy B (randomized crossover agreement study): a random sample of patients from the accepting group in substudy A was contacted by telephone. According to prespecified power and sample size estimation, 56 patients were included. After randomization, 50% of patients entered PROs and information on comorbidities and lifestyle from home and then at hospital, and 50% first from hospital and then at home. Finally, they stated their preference for data entry (hospital/home/equally good). Differences in PROs entered from home and in the hospital were compared (limits of agreement, 95% confidence intervals, and intraclass correlation coefficients). RESULTS: The touch-screen invitation was accepted by 428/952 patients (45%). Patients who accepted and those who declined had similar PROs and demographics. Substudy B was completed by 42 patients (22 RA, 20 AxSpA). They had no significant differences between PROs and lifestyle/comorbidity data entered from home and hospital, except for AxSpA patients on the Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Disease Activity Index item 5. The preferred method of data entry was hospital (10%), home (50%), and equally good (40%). CONCLUSION: Touch screens seem feasible for first line research recruitment. PROs collected from home were similar to the touch-screen solution. Patients preferred data entry from home.

An oral health programme for schoolchildren in Kuwait 1986-97.

OBJECTIVES: To assess whether it was possible to implement an oral health programme in Kuwait which followed guidelines underlying the public Danish Child Oral Health Service, and thereby improve the oral health of Kuwaiti children. DESIGN: Successive cross-sectional surveys were carried out in one governorate in Kuwait (Al-Ahmadi) during the period 1986-97 interrupted by the Gulf War. Data were collected by clinical examinations. SETTING: The programme was initiated by the Ministry of Health in Kuwait in order to improve the community services through a school-based oral health care programme. PARTICIPANTS: The study population comprised incrementally all children in the four primary school classes in the governorate. INTERVENTIONS: The children received bi-weekly tooth brushing instructions with fluoridated toothpaste and fluoride rinsing, fissure sealing, oral health education, and restorative treatment of dental caries. OUTCOME MEASURES: The children were clinically examined each year before the start of the treatment. Dental caries was scored at surface level in accordance with the Danish registration system, using the WHO criteria for dental caries. RESULTS: The average participation rate was 94%. The percentage of caries-free children, exemplified by second class, increased from 64% in 1987 to 78% in 1990, dropped to 71% in 1992 and increased again to 79% in 1997. CONCLUSION: It is concluded that it has been possible to adapt the principles from the Danish Child Oral Health Service programme to Kuwait, that parents and teachers accepted the principle of treating the children during school hours, and that the oral health of the children improved. Whether the improvement in the oral health is due to the programme or to changes in the society is discussed.

Dental caries and dental fluorosis among 4-, 6-, 12- and 15-year-old children in kindergartens and public schools in Kuwait.

The purpose of the present study was 1) to describe the occurrence of dental caries and fluorosis among children in kindergartens and public schools in Kuwait, and determine their need for dental health care, 2) to describe changes in caries prevalence and experience from 1982 to 1993 and 3) to provide a baseline for the evaluation of the preventive oral health programmes starting in Kuwait in 1994. The study population comprised 3,500 4-, 6-, 12- and 15-year-old children in kindergartens and public schools in Kuwait, selected by stratified cluster sampling. Dental caries was scored by surface in accordance with WHO criteria, and dental fluorosis was registered by Dean's index (modified). The mean deft was 4.6 at age 4 years, and 6.2 at age 6; 8 and 11 percent of the decay had been treated by extractions or fillings in the two respective age groups. Among the 6-, 12- and 15-year-old children DMFT was 0.2, 2.6 and 3.6 respectively; 12 and 14 percent of the decayed teeth of 12- and 15-year-old children had been treated. As to the 4- and 6-year-old children, 19 and 9 percent were caries-free in the deciduous teeth, while 86, 21 and 14 percent of the 6-, 12- and 15-year-old children were caries-free in the permanent teeth. Among the 4-year-old children 47 percent had caries in the front teeth. None of the children had severe dental fluorosis, but 6 percent at 12 and 15 years showed mild to moderate, but manifest, dental fluorosis. The survey revealed that caries experience as well as caries prevalence had increased since 1982, although there was a marked increase in the number of filled tooth surfaces in all age cohorts. However, in 1993 the DMFT of 12-year-old children was still well within WHO's global goal for the year 2000, whereas the prevalence of dental caries among 6-year-old was considerably higher than the WHO goal.

Dental knowledge, attitudes and behavior among Kuwaiti mothers and school teachers.

In one region in the state of Kuwait children in first grade have been offered a systematic dental health care program. The purpose of this study was to assess (1) dental knowledge, attitudes, and health behavior among the mothers of children in first grade, and (2) dental knowledge and attitudes of schoolteachers, and their involvement in health education. Before the children were enrolled in the program 187 mothers (response 76%) were interviewed. Self-administered questionnaires were used to collect data on schoolteachers (n = 135, response 695). Most of the mothers (74%) answered that dental caries is caused by sweets/candy; the role of bacteria was mentioned by 9%. Half of the mothers were aware of the harmful effect of sugary drinks, and 50% knew about the preventive effect of fluoride. Knowledge about causes and prevention of periodontal disease was diffuse. According to the mothers, 68% of the children were in need for dental treatment; 37% were seen by a dentist once a year for symptomatic reasons, and 49% brushed their teeth at least twice a day. Sixteen-percent of the mothers helped their child in brushing every day. Sugar consumption among mothers and children was high, e.g. 66% of the children had chocolate bars and 44% had soft drinks several times a day. The level of dental knowledge was higher among teachers than mothers; the mothers were mostly informed through television/radio, while teachers had received information from various sources, including the dentists. The teachers responded positively to prevention of dental diseases among children and should be considered key persons in dental health education. For the Kuwaiti children and the mothers the active involvement principle, group presentations, and one-to-one communications are recommended for the school based dental health program.