Disease-Modifying Antirheumatic Drugs and Risk of Parkinson Disease Nested Case-Control Study of People With Rheumatoid Arthritis

Background and Objectives Epidemiologic studies have suggested a link between rheumatoid arthritis and Parkinson disease (PD). Disease-modifying antirheumatic drugs (DMARDs) might explain this association. The aim of this work was to evaluate the association between DMARDs and risk of PD in persons with rheumatoid arthritis. Methods This nested nationwide case-control study was conducted within the Finnish Parkinson's Disease (FINPARK) cohort, which includes 22,189 Finnish persons with clinically verified PD diagnosed in 1996 to 2015. The cases had recorded diagnosis of PD in the Special Reimbursement Register and had no exclusion diagnoses with symptoms that may be confused with PD within 2 years of PD diagnosis. This study included cases with PD diagnosed during 1999 to 2015 and rheumatoid arthritis diagnosed >3 years before PD. Rheumatoid arthritis was identified from the Finnish Care Register for Health Care and Special Reimbursement Register. Cases were matched with up to 7 controls by age, sex, duration of rheumatoid arthritis, and region. DMARDs were categorized into 5 classes, and data on purchased prescriptions were identified from the Prescription Register since 1995. Associations were studied with conditional logistic regression adjusted for confounders. Results Altogether, 315 cases with PD and 1,571 matched controls were included. The majority (>60%) were women, and the median duration of rheumatoid arthritis on matching date was 11.6 years for controls and 12.6 years for cases. Use of DMARDs was not associated with risk of PD with a 3-year lag period applied between exposure and outcome except chloroquine/hydroxychloroquine, which associated with decreased risk (adjusted odds ratio [OR] 0.74, 95% confidence interval [CI] 0.56-0.97). Other DMARDs, including sulfasalazine, methotrexate, gold preparations, and immunosuppressants, were not associated with PD. Discussion Our results suggest that the lower risk of PD in people with rheumatoid arthritis is not explained by DMARD use because these drugs in general did not modify the risk of PD among persons with rheumatoid arthritis. Association between chloroquine/hydroxychloroquine and lower risk of PD and the possible underlying mechanisms should be further investigated. Classification of Evidence This study provides Class II evidence that in individuals with rheumatoid arthritis using DMARDs, only chloroquine/ hydroxychloroquine was associated with a potentially decreased risk of developing PD (adjusted OR 0.74, 95% CI 0.56-0.97).Peer reviewe

Comparison of EQ-5D and 15D instruments for assessing the health-related quality of life in cardiac surgery patients

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Pelvic organ prolapse surgery and quality of life-a nationwide cohort study : Nationwide cohort study

BACKGROUND: Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE: To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN: This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS: In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of ImprovementI. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58-2.70) and vaginal bulge (1.90, 1.30-2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02-2.81). CONCLUSION: Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.Peer reviewe

Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease : a nationwide matched cohort study

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Parkinsonin taudin lääkkeiden erityiskorvausoikeuden saajien määrän muutos vuosina 1996–2015

Lähtökohdat Tutkimme Parkinsonin taudin lääkkeiden erityiskorvausoikeuden saajien määrän muutosta vuosien 1996–2015 aikana. Selvitimme myös, kuinka suurella osalla heistä oli taudin erotus- ja poissulkudiagnoosien mukaisia sairauksia, ja muuttuiko tämä osuus seurannan aikana.Menetelmät Tutkimus oli osa rekisteripohjaista FINPARK-tutkimusta, ja siihen kuuluivat 35 vuotta täyttäneet, vuosina 1996–2015 Parkinsonin taudin lääkkeiden erityiskorvausoikeuden saaneet henkilöt (n = 29 847). Tiedot erotus- ja poissulkudiagnooseista kerättiin hoitoilmoitusrekisteristä kahden vuoden ajalta ennen ja jälkeen korvausoikeuden saannin.Tulokset Korvausoikeuden saaneiden määrä kasvoi tutkimusaikana 0,012 prosenttiyksikköä suhteessa koko Suomen 35 vuotta täyttäneeseen väestöön. Korvausoikeuden saajista 20–30 %:lla oli Parkinsonin taudin lisäksi poissulkudiagnooseja, joista yleisimpiä olivat ekstrapyramidaali- ja liikehäiriöt sekä etenevät neurodegeneratiiviset muistisairaudet.Päätelmät Parkinsonin tautia sairastavien henkilöiden väestöön suhteutettu määrä kasvoi seuranta-aikana. Noin joka neljännellä lääkkeiden erityiskorvausoikeuden saaneista oli kirjaus poissulkudiagnoosista kahden vuoden ajalta ennen tai jälkeen korvausoikeuden saannin. Tämä kertoo kliinisen diagnostiikan epävarmuudesta Parkinsonin taudin varhaisvaiheessa.</p

Increased Risk of Parkinson's Disease in Patients With Schizophrenia Spectrum Disorders

Background PD comorbid with schizophrenia has been considered rare because these diseases associate with opposite alterations in the brain dopamine system. The objective of this study was to investigate the risk of PD after a diagnosis of a schizophrenia spectrum disorder. Methods Regionally, this was a retrospective record-based case-control study. The cohort included 3045 PD patients treated 2004-2019 in southwestern Finland. Nationally this was a nested case-control study using registers to examine Finnish patients who received a clinically confirmed PD diagnosis 1996-2015 (n = 22,189). PD patients with previously diagnosed schizophrenia spectrum disorder (separate analysis for schizophrenia) were included. Comparable non-PD control groups were derived from both data sets. All PD diagnoses were based on individual clinical examinations by certified neurologists. Results In PD patients, the prevalence of earlier schizophrenia spectrum disorder was 0.76% in regional data and 1.50% in nationwide data. In age-matched controls, the prevalence in the regional and national data was 0.16% and 1.31%, respectively. The odds ratio for PD after schizophrenia spectrum disorder diagnosis was 4.63 (95% CI, 1.76-12.19; P <0.01) in the regional data and 1.17 (95% CI, 1.04-1.31; P <0.01) in the national data. Conclusions Schizophrenia spectrum disorder increases the risk of PD later in life. This association was observed in both individual patient data and nationwide register data. Therefore, despite the opposite dopaminergic disease mechanisms, schizophrenia spectrum disorder increases rather than decreases the risk of PD. The increased PD risk could be related to risk-altering effects of dopamine receptor antagonists or to the increased vulnerability of the dopamine system induced by illness phase-dependent dopamine dysregulation in schizophrenia/schizophrenia spectrum disorder. (c) 2021 International Parkinson and Movement Disorder SocietyPeer reviewe