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1.
Med Sci Sports Exerc ; 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31977641

RESUMO

PURPOSE: Cardiopulmonary exercise testing of peak oxygen uptake (VO2peak) is the gold standard to measure cardiorespiratory fitness (CRF). For resource-intensive evaluation, equations estimating CRF (eCRF) may be used. The purpose was to investigate if an eCRF equation from a healthy population is useful in persons with rheumatoid arthritis (RA), and if necessary, develop new equations for eCRF in this group. METHODS: VO2peak results from 93 persons with RA were compared to eCRF calculated by an established equation for healthy individuals including age, sex, physical activity (PA index), resting heart rate (RHR) and waist circumference. Because of deviation from the observed VO2peak, new equations for eCRF in persons with RA were developed from regression analysis of variables associated with observed VO2peak. RESULTS: The established equation over-estimated CRF (R=0.48, RMSE=7.07). The new RA equation more accurately estimated CRF (R=0.81, RMSE=4.44) (female=0, male=1; never smoked=0, ever smoked=1): eCRF = 77.961 + (sex × 28.791) - (age × 0.358) - (age × sex interaction × 0.326) - (body mass index (BMI) × 0.700) - (RHR ×0.125) - (smoking × 1.854) + (PA index × 0.211) - (patient global RA assessment × 0.071). Alternative new RA equation (R=0.79, RMSE=4.63): eCRF = 77.851 + (sex × 25.460) - (age × 0.381) - (age × sex interaction × 0.254) - (BMI × 0.743) - (RHR × 0.115) - (smoking × 2.154) + (PA index × 0.209). CONCLUSIONS: The new RA equations better predicted CRF in individuals with RA, preventing overestimation in low-fit persons. The new equation should be preferred when estimating CRF in individuals with RA. The alternative equation, without patient global assessment, is useful for individuals with RA in population-based studies.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31811695

RESUMO

OBJECTIVE: Adiposity is prevalent among patients with psoriatic arthritis (PsA). However, the temporal relation is unclear. We investigated whether adiposity and body fat distribution may be related to the risk of developing PsA, and whether physical activity could modify the possible risk. METHODS: We included 36,626 women and men from the Norwegian HUNT Study without diagnosed PsA at baseline in 1995-97. Cox regression was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of incident PsA at follow-up in 2006-08. RESULTS: During follow-up, 185 new cases of PsA were reported. One standard deviation increases in BMI (4.2 and 3.5 kg/m2 for women and men) and waist circumference (10.8 and 8.6 cm) were associated with HRs of 1.40 (95% CI 1.24-1.58) and 1.48 (1.31-1.68), respectively. Obese individuals had a HR of 2.46 (1.65-3.68) and overweight 1.41 (1.00-1.99) compared to normal weight individuals. Comparing extreme quartiles of waist circumference gave a HR of 2.63 (1.73-3.99). In analyzes of combined effects using BMI<25 kg/m2 and high physical activity as reference, BMI≥25 kg/m2 was associated with HRs of 2.06 (1.18-3.58) and 1.53 (0.80-2.91) among those with low and high physical activity levels, respectively. Corresponding HRs for high waist circumference and physical activity were 2.25 (1.40-1.63) and 1.85 (0.95-3.50). CONCLUSION: The results suggest that adiposity, and particularly central obesity, is associated with increased risk of incident PsA. Although there was no clear modifying effect of physical activity, high levels of physical activity reduced the risk of PsA, regardless of BMI.

3.
RMD Open ; 5(1): e000912, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31168415

RESUMO

Objective: Patients with rheumatoid arthritis (RA) suffer from more cardiovascular disease (CVD), and develop cardiovascular risk factors at an earlier age than the general population. Cardiorespiratory fitness (CRF) is an important predictor of cardiovascular health. There are few data regarding CRF of RA patients, measured as peak oxygen uptake (VO2peak) by the gold standard method; cardiopulmonary exercise testing. We compared CRF in RA patients to those from a healthy population, and investigated if risk factors for CVD and RA-specific variables including subjective and objective disease activity measures were associated with CRF in RA patients. Methods: VO2peak tests of RA patients (n=93) were compared to those of an age-matched and gender-matched healthy population (n=4631) from the Nord-Trøndelag Health Study. Predictors of VO2peak were found using Lasso (least absolute shrinkage and selection operator) regression, followed by standardised multiple linear regression. Results: Women with RA ≥40 years and men with RA aged 40-49 years or 60-69 years had up to 20% lower CRF than the healthy population in the same age groups. By relative importance, body mass index (standardised coefficient=-0.25, p<0.001), physical activity level (coefficient=0.21, p<0.001), patient global assessment (PGA; coefficient=-0.14, p=0.006), systolic blood pressure (coefficient=-0.12, p=0.016), resting heart rate (coefficient=-0.11, p=0.032) and smoking (coefficient=-0.10, p=0.046) were significant predictors of CRF (R2=0.82, gender-adjusted and age-adjusted). Conclusion: CRF in RA patients was lower than in a healthy population. CRF was associated with common risk factors for CVD and the PGA score. Focusing on fitness in RA patients may improve cardiovascular health.

4.
J Rheumatol ; 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30936278

RESUMO

OBJECTIVE: The genetic component of ankylosing spondylitis (AS) development is ~90%. Of the known heritability, ~20% is explained by HLA-B27, and 113 identified AS-associated single-nucleotide polymorphisms (SNP) account for ~7.4%. The objectives were to construct a weighted genetic risk score (wGRS) using currently known genome-wide susceptibility SNP, and to evaluate its predictive ability for AS in the Norwegian population-based Nord-Trøndelag Health Study (HUNT). METHODS: AS cases (n = 164) and controls (n = 49,032) were from the second (1995-1997) and third (2006-2008) waves of the HUNT study, to which the entire adult population of the northern region of Trøndelag was invited. A wGRS based on 110 SNP weighted by published OR for AS was constructed, representing each person's carriage of all risk variants. Logistic regression models including the wGRS alone or in combination with HLA-B27 carrier state and other adjustment variables (sex, age, smoking, body mass index, and hypertension) were developed. Discrimination among models was compared using area under the curve (AUC). RESULTS: The wGRS was associated with AS (OR 1.7, 95% CI 1.4-2.1), but showed low discrimination (AUC 0.62, 95% CI 0.58-0.67). HLA-B27 was significantly associated with AS (OR 50, 95% CI 32-81), showing high discrimination (AUC 0.88, 95% CI 0.85-0.90). Combining the wGRS and HLA-B27 improved prediction (AUC 0.90, 95% CI 0.87-0.92; p < 0.001 vs wGRS alone, p < 0.01 vs HLA-B27 alone). Further inclusion of adjustment variables gave a small improvement (AUC 0.91, 95% CI 0.89-0.94; p = 0.03). CONCLUSION: Prediction in a population-based setting based on all currently known AS susceptibility SNP was better than HLA-B27 carrier state alone, although the improvement was small and of uncertain clinical value.

5.
Arthritis Care Res (Hoboken) ; 71(4): 530-537, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29882634

RESUMO

OBJECTIVE: To evaluate the impact of high-intensity interval training (HIIT) on disease activity and disease perception in patients with psoriatic arthritis (PsA) and to evaluate whether a potential effect could be sustained for a longer period of time. METHODS: We randomly assigned 67 patients with PsA (43 women and 24 men) to an intervention group in which patients performed HIIT for 11 weeks or a control group of patients who were instructed not to change their physical exercise habits. Outcomes were assessed at 3 months and 9 months with the patient's global assessment (PGA), fatigue, and pain scores measured on a 100-mm visual analog scale (VAS), and the composite Disease Activity Score in 44 joints (DAS44) was calculated. We used linear mixed models to calculate the mean difference (95% confidence interval [95% CI]) between groups according to the intent-to-treat principle. RESULTS: At 3 months, there was no clear difference in the PGA score (-0.49 [95% CI -10.91, 9.94]), DAS44 (-0.08 [95% CI -0.36, 0.20]), or pain intensity (5.45 [95% CI -4.36, 15.26]) between the groups. However, patients in the intervention group reported less fatigue (-12.83 [95% CI -25.88, 0.23]) than those in the control group. There was no evidence of long-term effects of HIIT on outcomes measured at 9 months. CONCLUSION: HIIT showed no clear effects on disease activity markers in patients with PsA, but the intervention (exercise) group reported meaningfully less fatigue after the intervention period. The results of this study suggest that patients with PsA tolerate HIIT without deterioration of disease activity and with improvement in fatigue.


Assuntos
Artrite Psoriásica/psicologia , Treinamento Intervalado de Alta Intensidade , Adulto , Artrite Psoriásica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /estatística & dados numéricos
6.
RMD Open ; 4(2): e000729, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30402265

RESUMO

Background: Psoriatic arthritis (PsA) is associated with an accumulation of cardiovascular disease (CVD) risk factors. The aim of this study was to evaluate the effect of high-intensity interval training (HIIT) on CVD risk factors in patients with PsA. Methods: We randomly assigned 61 patients with PsA (41 women and 20 men) to an intervention group performing HIIT for 11 weeks or a control group who were instructed to not change their physical exercise habits. Outcomes were assessed at 3 and 9 months with measures on maximal oxygen uptake (VO2max), fat percentage and Body Mass Index (BMI). We used linear mixed models to calculate mean difference with 95% CI between the groups according to the intention-to-treat principle. Results: At 3 months, the HIIT group had a 3.72 mL/kg/min (95% CI 2.38 to 5.06) higher VO2max and a 1.28 (95% CI -2.51 to -0.05) lower truncal fat percentage than controls. There was also some evidence that the HIIT group had lower total fat percentage (-0.80; 95% CI -1.71 to 0.10) and slightly lower BMI (-0.31; 95% CI -0.78 to 0.17) than the control group. At 9 months, the HIIT group had still a higher VO2max (3.08; 95% CI 1.63 to 4.53) than the control group, whereas the difference in other factors were small. Conclusion: In patients with PsA, 3 months with HIIT was associated with a substantial increase in VO2max and a reduction in truncal fat percentage compared with controls. The beneficial effect on VO2max was also sustained through 9 months. Trial registration number: NCT02995460.

7.
RMD Open ; 4(1): e000631, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30018797

RESUMO

Background: The risk of osteoporosis in patients with psoriatic arthritis (PsA) still remains unclear. The aim of this study was to investigate bone mineral density (BMD) at the hip and lumbar spine measured by dual-energy X-ray absorptiometry in patients with PsA. Methods: From an outpatient clinic in southern Norway, 140 patients with PsA were consecutively recruited and assessed for osteoporosis as part of a prospective study from January 2013 to May 2014. An extensive data collection was performed including demographic data and measures reflecting disease activity and health status. Results: Mean age was 52.4 years and 71 (50.7%) were women. Median disease duration was 7.8 years. The proportion of patients with low BMD (defined as Z score≤-1.0 SD) was comparable to the expected value of 16%, according to the normal distribution of the Z score in the population. Osteoporosis was only found in 6.4% (95% CI3% to 11%) of the patients. No significant associations were found between BMD and disease activity measures. Conclusion: The prevalence of PsA patients with osteoporosis or low BMD was low and in the range seen in the reference population. This supports that patients with PsA are not at high risk for osteoporosis compared with the general population. Therefore, clinicians may follow the general population guidelines for monitoring of osteoporosis for patients with PsA.

8.
RMD Open ; 4(1): e000630, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29556420

RESUMO

Objectives: The aim of this population-based study was to compare changes in cardiovascular (CV) risk factors over a decade-long period in patients who developed psoriatic arthritis (PsA) and the background population. Methods: Patients diagnosed with PsA (n=151) between 1998 and 2008 and matched controls (n=755) who participated in both the Nord-Trøndelag Health Study (HUNT) 2 (1995-1997) and HUNT3 (2006-2008) were included. Mixed linear and logistic models were used to analyse the difference in mean change between HUNT2 and HUNT3 in patients and controls for body mass index (BMI), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and blood pressure (BP). Results: At baseline (HUNT2), the patients who developed PsA compared with controls had higher BMI (27.2 vs 25.9 kg/m2, p<0.001) and lower HDL-c (1.32 vs 1.40 mmol/L, p<0.03) and more were smokers (41.1 vs 28.5%, p<0.01). Seventy-eight per cent had skin psoriasis. The mean PsA disease duration at HUNT3 was 4.8 (+/-3.0) years. The patients who developed PsA gained less weight from HUNT2 to HUNT3 compared with the control group (2.1 vs 3.9 kg, difference in mean change -1.8 kg, 95% CI -3.9 to -0.5, p<0.01). TC, triglycerides, LDL-c or HDL-c values and BP declined in both groups, with no significant differences between groups. Conclusion: Longitudinal 10-year data did not show an increase in CV risk factors in patients who developed PsA compared with controls. This study implies that unfavourable CV risk factors in PsA were present before the diagnosis was established.

9.
BMC Musculoskelet Disord ; 18(1): 497, 2017 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-29179748

RESUMO

BACKGROUND: Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis that develops in patients with psoriasis. Inflammatory edema in the spine may reflect subclinical disease activity and be a predictor of radiographic progression. A semi-quantitative method established by the spondyloarthritis research consortium of Canada (SPARCC) is commonly used to assess the disease activity in MR images of the spine. This study aims to evaluate thresholding for quantification of subtle bone marrow inflammation in the spine and the sacroiliac (SI) joints of patients with PsA and compare it with the SPARCC scoring system. METHODS: Short tau inversion recovery (STIR) MR images of the spine (N = 85) and the SI joints (N = 95) of patients with PsA (N = 41) were analyzed. A threshold was applied to visible bone marrow in order to mask areas with higher signal intensity, which are consistent with inflammation. These areas were considered as inflammatory lesions. The volume and relative signal intensity of the lesions were calculated. Results from thresholding were compared to SPARCC scores using linear mixed-effects models. The specificity and sensitivity of thresholding were also calculated. RESULTS: A significant positive correlation between the volumes and mean relative signal intensities, which were calculated by thresholding analysis, and the SPARCC scores was detected for both spine (p < 0.001) and SI joints (p < 0.001). For the spine, thresholding had sensitivity and specificity of 83% and 76% respectively, while for the SI joints the values were 51% and 88% respectively. CONCLUSIONS: Thresholding allows quantification of subtle bone marrow inflammatory edema in patients with psoriatic arthritis, and could support SPARCC scoring of the spine. Improved image processing and inclusion of automatic segmentation are required for thresholding of STIR images to become a rapid and reliable method for quantitative measures of inflammation. TRIAL REGISTRATION: NCT02995460 (December 14, 2016) - Retrospectively registered.


Assuntos
Artrite Psoriásica/diagnóstico por imagem , Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Articulação Sacroilíaca/diagnóstico por imagem , Índice de Gravidade de Doença , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Artrite Psoriásica/complicações , Edema/complicações , Feminino , Humanos , Inflamação/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
RMD Open ; 3(1): e000413, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28955483

RESUMO

BACKGROUND: The risk of osteoporosis in patients with psoriatic arthritis (PsA) remains unclear. The aim of this study was to compare bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) in patients with PsA and controls. PATIENTS AND METHODS: Patients with PsA and controls were recruited from the Nord-Trøndelag Health Study (HUNT) 3. RESULTS: Patients with PsA (n=69) and controls (n=11 703) were comparable in terms of age (56.8 vs 55.3 years, p=0.32), gender distribution (females 65.2% vs 64.3%, p=0.87) and postmenopausal status (75.6% vs 62.8%, p=0.08). Body mass index (BMI) was higher in patients with PsA compared with controls (28.5 vs 27.2 kg/m2, p=0.01). After adjusting for potential confounding factors (including BMI), BMD was higher in patients with PsA compared with controls at lumbar spine 1-4 (1.213 vs 1.147 g/cm2, p=0.003) and femoral neck (0.960 vs 0.926 g/cm2, p=0.02), but not at total hip (1.013 vs 0.982 g/cm2, p=0.11). Controls had significantly higher odds of having osteopenia or osteoporosis based on measurements of BMD in both the femoral neck (p=0.001), total hip (p=0.033) and lumbar spine (p=0.033). CONCLUSION: Our population-based data showed comparable BMD in patients with PsA and controls. This supports that the PsA population is not at increased risk of osteoporosis.

11.
J Clin Endocrinol Metab ; 102(8): 2719-2728, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28482002

RESUMO

Context: Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower thyroid-stimulating hormone (TSH) and higher free thyroxine (FT4) in euthyroid individuals are associated with fracture risk. Objective: To evaluate the association of TSH and FT4 with incident fractures in euthyroid individuals. Design: Individual participant data analysis. Setting: Thirteen prospective cohort studies with baseline examinations between 1981 and 2002. Participants: Adults with baseline TSH 0.45 to 4.49 mIU/L. Main Outcome Measures: Primary outcome was incident hip fracture. Secondary outcomes were any, nonvertebral, and vertebral fractures. Results were presented as hazard ratios (HRs) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45 to 0.99 mIU/L; 1.00 to 1.49 mIU/L; 1.50 to 2.49 mIU/L; 2.50 to 3.49 mIU/L; and 3.50 to 4.49 mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts. Results: During 659,059 person-years, 2,565 out of 56,835 participants had hip fracture (4.5%; 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05 to 1.49) for TSH 0.45 to 0.99 mIU/L, 1.19 (1.01 to 1.41) for TSH 1.00 to 1.49 mIU/L, 1.09 (0.93 to 1.28) for TSH 1.50 to 2.49 mIU/L, and 1.12 (0.94 to 1.33) for TSH 2.50 to 3.49 mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 [HR (95% CI) 1.22 (1.11 to 1.35) per one standard deviation increase in FT4]. FT4 only was associated with any and nonvertebral fractures. Results remained similar in sensitivity analyses. Conclusions: Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.


Assuntos
Fraturas do Quadril/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Tireotropina/sangue , Tiroxina/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
12.
J Rheumatol ; 44(8): 1134-1141, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28412703

RESUMO

OBJECTIVE: Self-reported diagnoses of inflammatory arthritis are not accurate. The primary study aim was to ascertain self-reported diagnoses of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the Norwegian population-based Nord-Trøndelag Health Study (HUNT) using hospital case files. The secondary aim was to provide updated estimates of the prevalence and incidence of RA and AS. METHODS: All inhabitants ≥ 20 years old from the county of Nord-Trøndelag were invited. Data from 70,805 unique participants from HUNT2 (1995-1997) and HUNT3 (2006-2008) were included. For participants who self-reported RA or AS, case files from all 3 hospitals in the catchment area were evaluated using standardized diagnostic criteria. RESULTS: Of 2703 self-reported cases of RA, 19.1% were verified in hospital files. Of 1064 self-reported cases of AS, 15.8% were verified. Of 259 cases self-reporting both RA and AS, 8.1% had RA and 5.4% had AS. Overall, a self-report of 1 or both diagnoses could not be verified in 82.1%, including 22.8% with insufficient information or no case file. The prevalence of RA was 768 (95% CI 705-835) per 100,000. The incidence of RA from HUNT2 to HUNT3 was 0.48 (0.41-0.56) per 1000 per year. The prevalence of AS was 264 (228-305) per 100,000. The incidence of AS from HUNT2 to HUNT3 was 0.19 (0.15-0.24) per 1000 per year. CONCLUSION: Self-reported diagnoses of RA and AS are often false-positive. The prevalence and incidence of RA were comparable to reports from similar populations. The incidence of AS was higher than previously reported in a mixed population from Norway.


Assuntos
Artrite Reumatoide/diagnóstico , Autorrelato , Espondilite Anquilosante/diagnóstico , Adulto , Idoso , Artrite Reumatoide/epidemiologia , Autoavaliação Diagnóstica , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prevalência , Espondilite Anquilosante/epidemiologia
13.
Eur J Rheumatol ; 3(2): 56-60, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27708972

RESUMO

OBJECTIVE: To compare clinical outcomes following microdecompression surgery or laminectomy for central lumbar spinal stenosis (LSS) between patients with rheumatoid arthritis (RA) and patients without rheumatic disease. MATERIAL AND METHODS: Data were collected from the Norwegian Registry for Spine Surgery. The primary outcome was change in the Oswestry Disability Index (ODI) score at 1 year. The secondary endpoints were health-related quality of life that was measured using the Euro-Qol-5D (EQ-5D), back pain numerical rating scale (NRS), leg pain NRS, and complications. RESULTS: A total of 1433 patients were included (1396 controls and 37 patients with RA). For all the patients, there was an improvement in ODI score 16.7 points; 95% confidence interval (CI), 15.7, 17.7; p<0.001). There were no differences between controls and patients with RA with respect to the mean changes of ODI scores (-2.5 points; 95% CI, -9.0 to 4.1; p=0.462), EQ-5D (p=0.295), back pain NRS (p=0.194), leg pain NRS (p=0.927), and complications within 3 months of surgery (12.8% vs. 13.5%, p=0.806). At 1 year, 68.6% (n=775) of controls had achieved a minimal clinically important difference (≥8 points ODI score improvement) compared with 65.5% (n=19) of patients with RA (p=0.726). CONCLUSION: Patients with RA experienced similar and large improvements in patient-reported outcomes following surgical decompression for LSS compared with patients without rheumatic disease. There was no increased risk of complications in patients with RA.

14.
Womens Health (Lond) ; 12(2): 209-16, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26900798

RESUMO

Reduced bone mineral density is a strong risk factor for fracture. The WHO's definition of osteoporosis is based on bone mineral density measurements assessed by dual x-ray absorptiometry. Several on other techniques than dual x-ray absorptiometry have been developed for quantitative assessment of bone, for example, quantitative ultrasound and digital x-ray radiogrammetry. Some of these techniques may also capture other bone properties than bone mass that contribute to bone strength, for example, bone porosity and microarchitecture. In this article we give an update on technologies which are available for evaluation primarily of bone mass and bone density, but also describe methods which currently are validated or are under development for quantitative assessment of other bone properties.


Assuntos
Absorciometria de Fóton , Densidade Óssea/fisiologia , Programas de Rastreamento/métodos , Osteoporose/diagnóstico , Intensificação de Imagem Radiográfica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco
15.
Arch Osteoporos ; 11: 7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26781125

RESUMO

UNLABELLED: The incidence of forearm fractures for men and women ≥40 years in Central Norway was high during the period 1999-2012. A decline in fractures was observed only among women over 50 years. A seasonal variation with highest incidence in the winter months was found among women. PURPOSE: The aim of this study was to examine the incidence of forearm fractures in Central Norway in men and women 40 years and older from 1999 to 2012 and assess time trends as well as seasonal variations. METHODS: Data is from the fracture registry in Nord-Trøndelag, including all forearm fractures in persons ≥40 sustained from 1999 to 2012. Annual incidence of forearm fractures were calculated and tested for trends. Variations in the occurrence of fractures were explored by comparing proportion of fractures by month and seasons. RESULTS: The study population consisted of 4003 subjects (77.1% women). The total number of fractures were 4240. There was an increase in fractures for women with increasing age, steepest, a three-fold increase between age group 40-50 and the age group 50-60. Among men, this pattern was not observed as incidences did not change with increasing age. The age-standardized incidence rate for all fractures among women ≥50 ranged from 82 fractures per 1000 (95% CI 71-94) to 100 (88-114) and among men from 19 (14-27) to 31 (24-39). Restricting the analysis to the first fracture sustained during the observed period, women ≥50 years showed a reduction in fractures of 1.30% per year (95% CI 0.01%: 2.56%,) and 12.18% per 10 years (3.61%: 19.98%). For all women, there was a trend towards a decline of 0.73% per year (-2.29%: 0.85%), although not significant. For men, there was a trend towards an increase in fractures of 1.66% per year (-0.11%: 3.45%). The occurrence of fractures among women varied by season of the year, with higher fracture rates in the winter months. CONCLUSIONS: The incidence rate of forearm fractures in Central Norway was high. However, a small decline in the incidence of the first fracture among women older than 50 years was observed. Fractures were more often sustained during winter months among women.


Assuntos
Traumatismos do Antebraço/epidemiologia , Fraturas Ósseas/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Sistema de Registros , Estações do Ano , Distribuição por Sexo , Fatores de Tempo
16.
Ann Rheum Dis ; 75(5): 819-24, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-25814652

RESUMO

OBJECTIVE: To compare the presence of cardiovascular (CV) risk factors and established CV disease in patients with psoriatic arthritis (PsA) and the general population and to compare the 10-year risk of a fatal CV event calculated by the Systematic Coronary Risk Evaluation (SCORE) algorithm. METHODS: Patients with PsA (n=338) and controls (n=50 468) were recruited from the Nord-Trøndelag Health Study 3. Age-adjusted and sex-adjusted prevalence rates of CV risk factors and comorbidity were calculated and the SCORE algorithm was applied. RESULTS: There was an increased prevalence of angina pectoris (5.0% vs 3.6%, p=0.01), history of percutaneous coronary intervention (2.4% vs 1.4%, p=0.04), hypertension (45.3% vs 39.3%, p=0.01), obesity (32.0% vs 22.4%) and tobacco smoking (21.3% vs 16.4%, p=0.02) in patients with PsA compared with controls. Patients with PsA had elevated levels of C reactive protein (CRP; p<0.001), body mass index (BMI; p<0.001) and triglycerides (p=0.01). The median calculated CV risk in patients with PsA was low and comparable with controls (0.87 vs 0.83, p=0.24). The distribution across CV risk classes was similar among patients with PsA and controls. CONCLUSIONS: Patients with PsA have a higher risk of CV disease than the background population, although there was no difference between groups in 10-year risk of a fatal CV event estimated by SCORE. However, patients with PsA had elevated levels of CV risk factors not included in the SCORE algorithm, such as BMI, triglycerides and CRP.


Assuntos
Artrite Psoriásica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artrite Psoriásica/complicações , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prevalência , Medição de Risco/métodos , Fatores de Risco , Triglicerídeos/sangue
17.
Arch Osteoporos ; 10: 235, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26334427

RESUMO

UNLABELLED: Use of anti-osteoporotic drugs (AOD) the first year after a forearm fracture in central Norway was low in the period 2005-2012. Women with fractures used more AOD compared to the general population only in 2006, 2007, and 2011. Female gender, age ≥ 60 years, use of glucocorticosteroids, or ≥ 4 different drugs were associated with AOD use. PURPOSE: The primary aim of this study was to examine time trends in prevalence and incidence of AOD use the first year after a forearm fracture from 2005-2012. Further, secondary aims were to investigate if gender, the number of drugs used before fracture, or use of glucocorticoids influenced the prescription of AOD, and to examine adherence to AOD. METHODS: Data is from the fracture registry in Nord-Trøndelag and the Norwegian Prescription database, including women (N = 1434) and men (N = 513) 40-84 years with their first forearm fracture between 2005 and 2012. AOD were defined as bisphosphonates, teriparatide, denosumab, and raloxifene. Prevalence and incidence were calculated, and prevalent use among women with forearm fracture was compared with the population in Nord-Trøndelag and Norway. Age-adjusted Poisson regression analyses for time trends and odds ratio for treatment with AOD was estimated. Adherence was defined as medication possession ratio ≥ 80 %. RESULTS: The first year after the fracture, 11.2 % of the women and 2.7 % of the men were prevalent users, while 5.1 % and 1.2 %, respectively, were incident users of AOD. Bisphosphonates comprised 98.8 %. AOD use among women with fractures was significantly higher compared to the general population in Nord-Trøndelag only in 2006, 2007, and 2011. There was a trend towards a decline in AOD use among women with fractures from 2005 to 2012 (coefficient -0.05, p = 0.15). Female gender, age ≥ 60 years, use of glucocorticosteroids, or ≥ 4 different drugs the last year before fracture were associated with AOD use. In women, 54.8 % were adherent during 3 years after fracture. CONCLUSIONS: The use of AOD after a forearm fracture was low. An increased focus on osteoporosis in fracture patients is needed for secondary fracture prevention.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Traumatismos do Antebraço/tratamento farmacológico , Fraturas Ósseas/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Feminino , Antebraço , Traumatismos do Antebraço/prevenção & controle , Fraturas Ósseas/prevenção & controle , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Osteoporose/prevenção & controle , Cloridrato de Raloxifeno/uso terapêutico , Prevenção Secundária , Teriparatida/uso terapêutico
18.
JAMA ; 313(20): 2055-65, 2015 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-26010634

RESUMO

IMPORTANCE: Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE: To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures. DATA EXTRACTION: Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH <0.45 mIU/L), and subclinical hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES: The primary outcome was hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS: Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975 participants (4.6%; 12 studies), any fracture in 2528 participants (9.0%; 8 studies), nonspine fracture in 2018 participants (8.4%; 8 studies), and spine fracture in 296 participants (1.3%; 6 studies). In age- and sex-adjusted analyses, the hazard ratio (HR) for subclinical hyperthyroidism vs euthyroidism was 1.36 for hip fracture (95% CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56,471); for any fracture, HR was 1.28 (95% CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25,901); for nonspine fracture, HR was 1.16 (95% CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21,722); and for spine fracture, HR was 1.51 (95% CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20,328). Lower TSH was associated with higher fracture rates: for TSH of less than 0.10 mIU/L, HR was 1.61 for hip fracture (95% CI, 1.21-2.15; 47 events in 510 participants); for any fracture, HR was 1.98 (95% CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HR was 1.61 (95% CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HR was 3.57 (95% CI, 1.88-6.78; 8 events in 162 participants). Risks were similar after adjustment for other fracture risk factors. Endogenous subclinical hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE: Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.


Assuntos
Fraturas Ósseas/etiologia , Fraturas do Quadril/etiologia , Hipertireoidismo/complicações , Hipotireoidismo/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Tireotropina/sangue , Adulto Jovem
19.
Eur J Appl Physiol ; 115(10): 2081-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26013051

RESUMO

PURPOSE: Rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are inflammatory diseases which involve increased risk of cardiovascular disease (CVD). High intensity interval training (HIIT) is known to be effective in improving cardiovascular health. The aim of this study was to investigate whether 10 weeks of HIIT at 85-95% of HRmax would improve important risk factors of CVD in rheumatic patients, and if these patients would tolerate exercise intensities above today's recommendations. METHODS: Seven women with RA and eleven with adult-JIA, 20-50 years, were recruited to this cross-over study. Participants performed HIIT, consisting of 4 × 4 min intervals at 85-95% of HRmax twice a week for 10 weeks on spinning bikes. Maximal oxygen uptake (VO2max), heart rate recovery, blood pressure, body composition, and blood variables were measured before and after the exercise and control period. Disease activity was determined and questionnaire data were collected. RESULTS: HIIT resulted in 12.2% increase in VO2max and 2.9% improvement in heart rate recovery (p < 0.05). BMI, body fat, and waist circumference decreased 1.2, 1.0, and 1.6%, respectively, whereas muscle mass increased 0.6% (p < 0.05). A trend toward decreased CRP was detected after HIIT (p = 0.08). No changes were detected in disease activity or pain. CONCLUSION: Despite rigorous high intensity exercise, no increase was detected in disease activity or pain, indicating that HIIT was well tolerated by these patients. Furthermore, HIIT had positive effects on several CVD risk factors. In light of this pilot study, HIIT seems like a promising non-pharmacological treatment strategy for patients with RA and adult-JIA.


Assuntos
Artrite Juvenil/terapia , Artrite Reumatoide/terapia , Terapia por Exercício/efeitos adversos , Treinamento de Resistência/efeitos adversos , Adulto , Feminino , Frequência Cardíaca , Humanos , Pessoa de Meia-Idade
20.
Ann Rheum Dis ; 74(1): 60-4, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23962458

RESUMO

BACKGROUND: A wide range in the prevalence (<0.01-0.25%) and incidence (0.5-23.1/100 000) of psoriatic arthritis (PsA) is reported. The main objective of this study was to examine the prevalence and incidence of PsA in central Norway. METHOD: The patients were recruited from the Nord-Trøndelag Health Study 3, a population study carried out in 2006-2008. All 94 194 inhabitants aged >20 years were invited and 50 806 (54%) responded. The study consisted of a questionnaire (Q1) and a brief medical examination. Q1 included questions if the persons suffered from psoriasis, rheumatoid arthritis (RA) or ankylosing spondylitis (AS). Patients with self-reported psoriasis further answered a specific questionnaire on psoriasis including a questionnaire concerning PsA. In order to identify patients with PsA we used the following criteria: Persons reporting they had or may have PsA; persons answering that they had psoriasis and RA; and persons answering that they had psoriasis and AS. Using this approach, 1278 patients were identified. Hospital files were evaluated by a rheumatologist according to a predefined protocol to verify the diagnosis of PsA. RESULTS: 338 patients, 144 men and 194 women, were verified to have PsA. The prevalence of PsA was 6.7 (95% CI 5.9 to 7.4) per 1000 inhabitants >20 years with no significant difference between men and women. In the 9-year period of 2000-2008, a total of 188 patients were diagnosed with PsA, which give an incidence rate of 41.3/100 000 (35.8-47.6). CONCLUSIONS: The prevalence of PsA in central Norway appears to be higher than previously reported. The reason for this is unknown and may include environmental factors, life style factors and genetic differences.


Assuntos
Artrite Psoriásica/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prevalência , Adulto Jovem
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