Autonomic Function Predicts Fitness Response to Short-Term High-Intensity Interval Training.

We tested the hypothesis that baseline cardiac autonomic function and its acute response to all-out interval exercise explains individual fitness responses to high-intensity interval training (HIT). Healthy middle-aged sedentary men performed HIT (n=12, 4-6×30 s of all-out cycling efforts with 4-min recovery) or aerobic training (AET, n=9, 40-60 min at 60% of peak workload in exercise test [Loadpeak]), comprising 6 sessions within 2 weeks. Low (LF) and high frequency (HF) power of R-R interval oscillation were analyzed from data recorded at supine and standing position (5+5 min) every morning during the intervention. A significant training effect (p< 0.001), without a training*group interaction, was observed in Loadpeak and peak oxygen consumption (VO2peak). Pre-training supine LF/HF ratio, an estimate of sympathovagal balance, correlated with training outcome in Loadpeak (Spearman's rho [rs]=-0.74, p=0.006) and VO2peak (rs=- 0.59, p=0.042) in the HIT but not the AET group. Also, the mean change in the standing LF/HF ratio in the morning after an acute HIT exercise during the 1(st) week of intervention correlated with training response in Loadpeak (rs=- 0.68, p=0.014) and VO2peak (rs=-0.60, p=0.039) with HIT but not with AET. In conclusion, pre-training cardiac sympathovagal balance and its initial alterations in response to acute HIT exercise were related to fitness responses to short-term HIT.

Bruxism and sleep efficiency measured at home with wireless devices.

The present study comprised 101 (48 men) employees of the Finnish Broadcasting Company with or without irregular shift work, but all with a work week of five shifts in a row followed by 2 days off. The mean age of the subjects was 41.0 years (SD = 9.9). The BiteStrip, a single-use disposable EMG device was used for one night during the work week to detect sleep bruxism. The Actiwatch Plus actigraph was worn on the non-dominant wrist for the entire week to evaluate sleep. Total sleep time and fragmentation index, the latter as a measure of sleep efficiency was calculated for the present study. The BiteStrip scores among the participants were: 0- no bruxism: 52.2% (according to the manufacturer, comparable to a sleep laboratory bruxism count of up to 39 over 5 h), 1- mild: 29.3% (40-74 counts), 2- moderate: 12.0%: (75-124 counts) and 3- severe: 6.5% (>125 counts). Severe bruxers slept less during the work week than non-bruxers (P = 0.009), but severe bruxers slept slightly more than non-bruxers during days off. The group means of the sleep fragmentation index decreased from start towards the middle of the work week and increased during days off (P = 0.016). The levels of the fragmentation indices were consistently higher in accordance with bruxism severity (P = 0.013). It was concluded that bruxism has a coherent relationship with sleep efficiency and it can be detected at home with a low cost device.

Finnish case-control and family studies support PTPN22 R620W polymorphism as a risk factor in rheumatoid arthritis, but suggest only minimal or no effect in juvenile idiopathic arthritis.

Several studies have identified the PTPN22 allelic variant 1858 C/T that encodes the R620W amino-acid change as a putative susceptibility factor in autoimmune diseases. The current study was undertaken to examine a large cohort of Finnish rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) subjects using both population control and, importantly, family-based association methods. The latter is particularly important when, as is the case for the 1858 C/T polymorphism, the frequency of the variant allele (T) differs in both major ancestral populations and in subpopulations. The analysis of rheumatoid factor-positive 1030 RA probands from Finland provides strong support for association of this variant in both population studies (allele specific odds ratio (OR)=1.47, 95% confidence interval (CI)=1.27-1.70, P=3 x 10(-7)) and in family studies (P<10(-6)). In contrast, no allelic association was seen with JIA (230 probands) and only weak evidence for a genotypic effect of 1858T homozygotes was observed in this population.

Stapling of knees with valgus deformity in children with juvenile chronic arthritis.

OBJECTIVE: Leg length discrepancy and excessive knee valgus are potential complications of juvenile chronic arthritis of the knee. The aim of the present study was to evaluate retrospectively the safety and efficacy of temporary stapling of the knee epiphyses in management of valgus deformities of the knee in children with JCA. METHODS: Medical data of the patients with temporary epiphyseodesis due to knee valgus deformity (KVD) were studied. 177 knees in 112 patients were found with sufficient data for evaluation. Patient documents and radiographs of these patients were evaluated. RESULTS: Mean age at the time of operation was 8 years (range: 2 - 17) in 19 males and 93 females. The patients are predominantly affected by aggressive polyarticular disease. Preoperative mean valgus angle was 11 degrees (IQR: 9, 14) and at staple removal 4 degrees (IQR: 2, 5). In 120 of 177 knees (68% [95% CI: 61 - 74], p < 0.001) the physiological angle (3-8 degrees) was reached. Median time of stapling was 10 months (IQR: 8, 13). Five reversible and one irreversible (3% [95% CI: 2 to 7]) major complications were documented among the 177 stapled knees. CONCLUSION: Temporary epiphyseal stapling enables flexible correction of KVD in children with JCA. Low complication rate encourages the use of the method. Prompt follow-up is, however, important in avoing excess over-correction to varus.

HLA-DRB1, TAP2/TAP1, and HLA-DPB1 haplotypes in Finnish juvenile idiopathic arthritis: more complexity within the MHC.

This study further defines genetic susceptibility to JIA in the region centromeric to HLA-DRB1. DNA from 234 Finnish JIA nuclear families and 639 elderly Finnish control individuals was genotyped for five functional SNPs within the TAP2 and TAP1 loci ( approximately 200 kb centromeric of HLA-DRB1). Subsets of the controls (186) and patients (145) that had been previously typed for HLA-DRB1 were also genotyped by sequence for the HLA-DPB1 locus. Case/control and transmission disequilibrium test (TDT) methods revealed an association with the DPB1(*)030101 allele for JIA (OR 2.3, 95% CI 1.5-3.5). Notably, a detailed haplotypic analysis of the TAP2/TAP1 loci and their interaction with the HLA-DPB1(*)030101 and DRB1(*)08 and (*)11 alleles showed a variety of over-represented and under-represented TAP2/TAP1 haplotypes not evident in the single marker analysis. The strongest effect was observed in the polyarticular RF negative JIA subgroup for the 2-2-1-2-1 TAP2/TAP1 haplotype (TAP2B and TAP1A alleles) which showed an independent effect from both DRB1(*)08 and (*)11 (P<0.000003) and DPB1(*)030101 (P=0.02). We have provided evidence that the extended haplotypes (including HLA-DRB1, TAP2/TAP1, and HLA-DPB1) of pauciarticular and polyarticular RF negative disease are distinct. This observation may have implications for functional etiological differences between the pauciarticular and polyarticular JIA patients.

Reported bruxism and biopsychosocial symptoms: a longitudinal study.

OBJECTIVES AND METHODS: In this follow-up study of 30-50-year-old employees (n = 211) of the Finnish Broadcasting Company (YLE), respondents completed questionnaires in both 1999 and 2000 containing items on demographic data, tobacco use, levels of perceived bruxism, affective disturbance, sleep disturbance, somatic symptoms, pain symptoms and temporomandibular disorder (TMD) symptoms. RESULTS: Bruxism was significantly more prevalent among smokers (P = 0.005). Age, marital status, and gender were not associated with bruxism. Subjects in the frequent bruxism group (n = 74) reported the TMD-related painless symptoms, affective disturbance and early insomnia significantly more often than average. In the multivariate analyses, clustered pain symptoms (P = 0.001), TMD-related painless symptoms (P = 0.004) and smoking (P = 0.012) were significantly positively associated with frequent bruxism, when the independent effects of age and gender were controlled for. CONCLUSIONS: It was concluded that successful management of TMD necessitates smoking cessation, as tobacco use may both amplify the patient's pain response and provoke bruxism. Psychosocial factors and perceived stress should not be ignored, however.

Perceived stress, pain and work performance among non-patient working personnel with clinical signs of temporomandibular or neck pain.

The aim of the present study was to assess the associations between different types of perceived stress, pain and work performance among non-patients with clinical signs of muscle pain in the head/neck region. One-fifth (n = 241) of the 1339 media employees who had participated in a previous survey (Ahlberg J. et al., J Psychosom Res 2002; 53: 1077-1081) were randomly selected for standardized clinical examinations. Altogether 49% (n = 118) of these subjects had clinical signs of temporomandibular and/or neck muscle pain and were enrolled in the present study. The mean age of the study sample was 46.9 years (s.d. 6.6) and the female to male distribution 2:1. Of the 118 employees 46.5% reported that the pain problem interfered with their ability to work. Perceived ability to work was not significantly associated with age, gender or work positions. According to logistic regression, reduced work performance was significantly positively associated with continuous pain [odds ratio (OR) 4.38; 95% CI 1.21-15.7], level of perceived pain severity (OR 1.30; 95% CI 1.04-1.63), and health stress (OR 2.08; 95% CI 1.22-3.54). The results of this study indicated an association between specific self-reported stress regarding health and work issues, pain and work performance. From a preventive perspective this indicates a need for increased awareness about these associations on not only individual level but also at the organizational level and in health care.

Analysis of MHC region genetics in Finnish patients with juvenile idiopathic arthritis: evidence for different locus-specific effects in polyarticular vs pauciarticular subsets and a shared DRB1 epitope.

This study used Finnish juvenile idiopathic arthritis (JIA) probands with pauciarticular and rheumatoid factor (RF) negative polyarticular subtypes of JIA to further define the genetic susceptibility to JIA. We examined 16 markers spanning an 18 cM region of chromosome 6 encompassing the MHC and surrounding genomic region in a set of 235 Finnish JIA nuclear families and 639 Finnish control individuals. Analysis by case/control association and transmission disequilibrium test (TDT) methods each demonstrated strong evidence for a susceptibility locus near the D6S2447 microsatellite (P<10(-6) for both methods) that is flanked by DQB1 and DRB1. Analysis of the DRB1 locus suggested that DRB1*0801 and DRB1*1101 rather than DQA1 or other HLA alleles may be responsible for conferring susceptibility to disease. These findings are consistent with the most compelling results of previous reports on HLA associations and suggest a JIA DRB1 shared epitope encompassing critical amino-acid residues in the third hypervariable region of this molecule. Most importantly, in pauciarticular patients, the strong association does not extend to proximal markers as it does in polyarticular patients (P<0.00001). Analysis strongly suggests that the difference is because of additional JIA susceptibility loci within the MHC being present in polyarticular RF negative patients.

Severe childhood uveitis without overt arthritis.

OBJECTIVE: To look for forme fruste (incomplete) forms of juvenile idiopathic arthritis (JIA)-associated uveitis. METHODS: The study involved 6 patients (3 girls and 3 boys) without overt arthritis who had been sent for ophthalmologic and rheumatologic evaluation because of uveitis resembling that seen in JIA. RESULTS: Two patients evinced no evidence of arthritis, 3 had non-specific signs and symptoms such as pains or valgus ankle and one may have had an episode of arthritis. Five patients carried the HLA allele B27 and 4 were positive for antinuclear antibodies. The mean age at diagnosis of uveitis was 8.4 years (range 3.5-14.2 years) and the mean follow-up period was 6.2 years (range 3.8-7.3 years). All patients had obviously had their uveitis for a long period prior to the first contact with an ophthalmologist. In 3 patients uveitis was asymptomatic when diagnosed, 2 had mild conjunctival injection and one had exacerbation of the disease process. Subsequently the uveitis was asymptomatic and bilateral in all patients. Complications of uveitis were common: cataract was found in 4 patients, glaucoma in 1 patient, cystoid macular edema in 4, posterior synechiae in 5 and band keratopathy in 3. The final visual acuity was poor in one eye of 1 patient despite effective treatment of uveitis. Uveitis was still active in all patients at the close of follow-up. CONCLUSION: Asymptomatic uveitis, which is frequently positive for antinuclear antibodies, can occur in children who show no clear evidence of arthritis. Complications occur in consequence of a delay in the diagnosis of insidious uveitis.

Occurrence of chronic inflammatory rheumatic diseases among parents of multiple offspring affected by juvenile idiopathic arthritis.

OBJECTIVE: The rarity of reports on extended multiplex families points out that the genetic component in juvenile idiopathic arthritis (JIA) might not be particularly strong. Our objective was to determine the frequency of chronic inflammatory rheumatic diseases among the parents who had two or more offspring affected by JIA. METHODS: During the last 17 years patients with JIA treated at the Rheumatism Foundation Hospital in Heinola and their parents have been systematically asked about the familial occurrence of rheumatic diseases. A total of 45 families with more than one sibling affected by JIA were found among about 2,300 JIA cases. In these "multicase families", 9 parents from 8 families also had a diagnosis of chronic inflammatory rheumatic disease. Their case histories were studied. RESULTS: Four of the parents had had JIA (one subsequently developed ankylosing spondylitis), and 4 had rheumatoid factor-negative chronic arthritis (one had also had chronic iritis since the age of 10, resembling that seen in JIA). Three of them had features of JIA and only one met the classification criteria for rheumatoid arthritis. One had ankylosing spondylitis. CONCLUSIONS: Since the expected number of JIA cases among the 90 parents was about 0.2, there was drastic increase in JIA frequency among the parents in families with multiple offspring also affected by JIA. These results suggest that JIA susceptibility genes may likely be clustered in these families.

Distinct biopsychosocial profiles emerge among nonpatients.

OBJECTIVES: The cross-sectional study comprised 30- to 55-year-old permanent employees (N=1784) of the Finnish Broadcasting Company (YLE). METHODS: The participants (N=1339, response rate 75%) completed standardised questionnaires covering demographic items, physical health, work performance, stress symptoms, pain and musculoskeletal symptoms, and overall biopsychosocial health. RESULTS: Physical symptoms (present often or continually) were reported by 15%, psychosomatic by 19% and psychosocial by 14%. The intercorrelations between 73 biopsychosocial variables revealed nine factors explaining 54.5% of variance for intrapersonal profiles and four factors explaining 59.2% of variance for interpersonal profiles. The Cronbach alphas for reliability ranged from.76 to.83. Three distinct biopsychosocial cluster profiles were found: Cluster 1 (n=290, 27%) loaded positively with the somatic and psychosocial variables, Cluster 2 (n=558, 51%) loaded negatively with the various biopsychosocial symptoms, and Cluster 3 (n=235, 22%) loaded positively with anxiety. CONCLUSION: Discriminant function analysis confirmed that this cluster solution correctly classified 95.2% of the subjects in a nonpatient multiprofessional population, which supports the biopsychosocial approach also in work life issues.

Reported bruxism and stress experience.

The aim of the study was to analyze whether perceived bruxism was associated with stress experience, age, gender, work role, and occupational health care use among a nonpatient multiprofessional population. Altogether, 1784 (age 30-55 years) employees of the Finnish Broadcasting Company were mailed a self-administered questionnaire covering demographics, perceived bruxism, total stress experience and the use of health care services provided by the company. The response rate was 75% (n = 1339, 51% men) and mean age was 46 years (SD = 6) in both genders. There were no significant differences in demographic status by age and gender. Bruxism and stress experiences did not significantly vary with regard to category of work, but both were significantly more frequent among women (P < 0.05). In all work categories frequent bruxers reported more stress, and the perceptions were significantly differently polarized between the groups (P < 0.001). According to logistic regression, frequent bruxism was significantly positively associated with severe stress experience (Odds ratio = 5.00; 95% CI = 2.84-8.82) and female gender (Odds ratio = 2.26; 95% CI = 1.43-3.55). Frequent bruxism was also significantly positively associated with the numbers of occupational health care and dental visits (P < 0.01), and slightly negatively associated with increasing age and work in administration (P < 0.05). It was concluded that bruxism may reveal ongoing stress in normal work life.

Uveitis as a marker of active arthritis in 372 patients with juvenile idiopathic seronegative oligoarthritis or polyarthritis.

OBJECTIVE: To compare the activity of arthritis in children with recently diagnosed seronegative oligoarthritis or polyarthritis with or without uveitis. METHODS: The study covered 372 JIA children with recently diagnosed seronegative oligoarthritis or polyarthritis. The mean prospective follow-up period was 4.5 years. Asymptomatic anterior uveitis was found in 96 cases. The activity of arthritis in all 372 patients was assessed clinically and by laboratory parameters. RESULTS: The erythrocyte sedimentation rate was significantly higher (p = 0.001) at the diagnosis of arthritis and at the end of the follow-up (p = 0.02) in the 96 JIA patients with uveitis than in the 276 JIA patients without uveitis. The hemoglobin value was significantly lower (p = 0.008) at the diagnosis of arthritis in patients with uveitis, but not at the end of the follow-up. The number of inflamed joints was significantly greater at the end of the follow-up in patients with persistent polyarthritis and uveitis (p = 0.01) compared to those polyarthritis patients without uveitis. Patients with uveitis were significantly more often treated with oral prednisolone (p < 0.001), glucocorticoid joint injections (p < 0.001), and with methotrexate (p = 0.003) compared to patients without uveitis. Clinical remission of arthritis was achieved significantly less frequently in patients with uveitis than in patients without uveitis (21% versus 42%, p<0.001). CONCLUSION: The inflammatory activity of arthritis seems to be increased in patients with seronegative oligo- or polyarthritis and uveitis compared to those without uveitis.

The cervical spine in mutilant juvenile chronic arthritis.

OBJECTIVE: To describe inflammatory cervical spine disorders in juvenile chronic arthritis (JCA) patients with arthritis mutilans (AM) hand deformity. METHODS: The series consisted of 18 patients affected by AM hand deformity who fulfilled the European League of Associations for Rheumatology criteria for JCA. The patient records and the most recent cervical spine radiographs were evaluated for subluxations, atlantoaxial impaction (AAI) and apophyseal joint ankylosis. RESULTS: Seventeen (94%) patients had subluxation, AAI or apophyseal joint ankylosis in the cervical spine. Apophyseal joint ankylosis was noted in 12 (67%) patients and AAI in 10 (56%). Anterior atlantoaxial subluxation was detected in five (28%) patients. CONCLUSION: Almost all of the JCA patients with AM hand deformity evinced some inflammatory changes in the cervical spine. Apophyseal joint ankylosis, AAI and multiplicity of changes in cervical spine may be considered characteristic in this subset of JCA patients. Patients with JCA and AM hand deformity tend to have severe changes also in the cervical spine.

Multiple stress fractures in a young girl with chronic idiopathic arthritis. Extended case report.

The occurrence of stress fractures in patients with long-standing rheumatoid arthritis (RA) is widely known. Osteoporosis, corticosteroid therapy, joint stiffness, contracture, angular deformity of the joint and failed joint reconstruction--all together or separately--predispose to bone loss and stress fractures. In the present report we describe the history of a girl with juvenile idiopathic arthritis (JIA) having multiple stress fractures. The relationship between corticosteroid therapy and immobilisation in the treatment of fractures is discussed.

Changes in the incidence of juvenile rheumatoid arthritis in Finland.

OBJECTIVE: To study trends in the incidence of juvenile rheumatoid arthritis (JRA). METHODS: The study covered subjects who were entitled under the nation-wide sickness insurance scheme to receive specially reimbursed medication for juvenile rheumatic diseases in 11 of 21 central hospital districts in Finland (the base population comprised about 445,000 children <16 yr of age) in 1995. Data from the years 1980, 1985 and 1990 were compared with data from 1995 concerning the central part of the area, which had been included in a previous study by us. RESULTS: A total of 87 incident cases (58 girls and 29 boys) satisfied criteria for JRA in 1995 in the study area. The incidence of JRA was 19.5 per 100 000 [95% confidence interval (CI) 15.6-24.1] of the population <16 yr of age for the whole area. It was 22.7 per 100,000 (95% CI 17.3-29.2) for the area that had been covered by the earlier study (five districts) and 14.9 per 100,000 (95% CI 9.8-21.7) for the new area (six additional districts). The incidence of JRA was significantly higher than in the earlier years (1980, 1985 and 1990) in the same district (trend, P=0.024). The highest incidence, 60.3 per 100,000 (95% CI 35.8-95.4), was noted in 1995 among girls in the age group 10-15 yr in the southernmost part of the study area. CONCLUSIONS: There was both temporal and regional variation in the incidence of JRA. Results of the present study suggest that environmental factors may influence the frequency of JRA.

The Finnish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Finnish language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Finnish CHAQ-CHQ were validated with 3 forward and 1 backward translations. A total of 161 subjects were enrolled: 89 patients with JIA (9% systemic onset, 44% polyarticular onset, 26% extended oligoarticular subtype, and 21% persistent oligoarticular subtype) and 72 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Finnish version of the CHAQ-CHQ is a reliable and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Cervical spine in patients with juvenile chronic arthritis and amyloidosis.

OBJECTIVE: To describe cervical spine abnormalities in a group of adult patients with refractory juvenile chronic arthritis (JCA) complicated by secondary amyloidosis (SA). METHODS: The series consists of 49 patients who fulfilled the diagnostic criteria of the European League Against Rheumatism for JCA, here complicated by secondary amyloidosis (SA). We evaluated their clinical records and most recent cervical spine radiographs taken in adult age (> 18 years) at or after the diagnosis of SA. RESULTS: Forty-two (86%) patients evinced inflammatory changes in the cervical spine. Apophyseal joint ankylosis was seen in 31 (63%) and atlantoaxial impaction (AAI) in 28 (57%) patients; anterior atlantoaxial subluxation (aAAS) was noted in 17 (35%) patients, and 19 (39%) had the combination of AAI and apophyseal joint ankylosis. The size of the 4th vertebral body was small or narrow in 14 (29%) patients with JCA onset at a median of 3 years of age (range 1-12). CONCLUSION: Inflammatory cervical spine disorders are common and may be detected along the entire length of the cervical spine in patients with severe refractory JCA. The disorders tend to ankylose the apophyseal joints and destroy the atlantoaxial joints, resulting in aAAS or impaction. These changes will restrict rotatory and bending movements in the cervical spine. A peculiarly small or narrow cervical vertebral body was seen mainly in patients with early onset disease. The present findings shed light on the characteristics and course of the inflammatory changes in the cervical spine in patients with refractory JCA.