Periodontitis in patients with systemic lupus erythematosus: A nation-wide study of 1990 patients

Background The aim of this study was to examine the association between systemic lupus erythematosus (SLE) and periodontitis in Norway during a 10-year period from 2008 through 2017. Methods In this population-based study, 1,990 patients were included in the SLE-cohort based on diagnostic codes registered in the Norwegian Patient Registry. The control group (n = 170,332) comprised patients registered with diagnostic codes for non-osteoporotic fractures or hip or knee replacement because of osteoarthritis. The outcome was periodontitis, defined by procedure codes registered in the Control and Payment of Health Refunds database. Logistic regression analyses were performed to estimate odds ratio for periodontitis in patients versus controls adjusted for potential covariates. Results Periodontitis was significantly more common in SLE patients compared to controls (OR 1.78, 95% CI 1.47-2.14) and the difference was highest in SLE-patients 20 to 30 years of age (OR 3.24, 95% CI 1.23 – 8.52). The periodontitis rate in SLE patients was in the same range as for patients with diabetes mellitus type 2. Conclusions Patients with SLE had an almost doubled risk of periodontitis compared with the control population, and the difference was most accentuated in the young patients. These findings warrant an increased focus on dental health in SLE-patients.publishedVersio

Periodontitis in patients with primary Sjögren's syndrome: A nation-wide register study

The aim of this study was to compare the occurrence of periodontitis in patients with primary Sjögren's syndrome (pSS) and a non-Sjögren's patient group during a 7-year period from 2011 through 2017. In this population-based study, the patients were identified based on the International Classification of Diseases-10 (ICD-10) codes registered in the Norwegian Patient Registry (NPR), which contains information on diagnosis and time of admission for all hospitalized patients in Norway. The pSS group comprised patients with ≥4 registrations with ICD-10 code M35.0 (Sjögren's syndrome) as the main diagnosis. The dependent variable was periodontitis, defined by procedure codes registered in the Norwegian Control and Payment of Health Reimbursement (KUHR). Logistic regression analyses estimated the odds ratio for periodontitis in pSS patients relative to non-pSS patients, adjusted for relevant covariates. Lastly, regression analyses were performed separately for each of the 6 age categories. In total, 760 (7.5%) patients in the pSS group and 22,178 (7.1%) in the non-pSS group had periodontitis. When adjusting for covariates, the presence of pSS had no association with periodontitis (OR = 1.06, 95% CI: 0.98–1.14).publishedVersio

Survival and death causes of patients with giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study

Background: Our objective was to determine the survival and causes of death in a large and well-characterized cohort of patients with giant cell arteritis (GCA). Methods: This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in Western Norway during 1972–2012. Patients were identified through computerized hospital records using the International Classification of Diseases (ICD)-coding system. Medical records were reviewed. Patients were randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway (CPRN). Date and cause of death were obtained from the Norwegian Cause of Death Registry (NCoDR). The survival was analyzed using Kaplan-Meier methods with the Gehan-Breslow test and the causes of death using cumulative incidence and Cox models for competing risks. Results: We identified 881 cases with a clinical diagnosis of GCA of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria. Among those fulfilling the ACR criteria, 528 were also biopsy-verified. Cases were matched with 2577 population controls. A total of 490 (56%) GCA patients and 1517 (59%) controls died during the study period. We found no difference in the overall survival of GCA patients compared to controls, p = 0.413. The most frequent underlying causes of death in both groups were diseases of the circulatory system followed by cancer. GCA patients had increased risk of dying of circulatory disease (HR 1.31, 95% CI 1.13–1.51, p < 0.001) but lower risk of dying of cancer (HR 0.56, 95% CI 0.42–0.73, p < 0.001) compared to population controls. Conclusions: We found no difference in the overall survival of GCA patients compared to matched controls, but there were differences in the distribution of underlying death causes.publishedVersio

Giant cell arteritis: incidence and phenotypic distribution in Western Norway 2013–2020

Objectives: There is an increasing awareness of the spectrum of phenotypes in giant cell arteritis (GCA). However, there is sparse evidence concerning the phenotypic distribution which may be influenced by both genetic background and the environment. We established a cohort of all GCA-patients in the Bergen Health Area (Western Norway), to describe the phenotypic distribution and whether phenotypes differ with regards to incidence and clinical features. Methods: This is a retrospective cohort study including all GCA-patients in the Bergen Health Area from 2013–2020. Data were collected by reviewing patient records, and patients considered clinically likely GCA were included if they fulfilled at least one set of classification criteria. Temporal artery biopsy (TAB) and imaging results were used to classify the patients according to phenotype. The phenotype “cranial GCA” was used for patients with a positive TAB or halo sign on temporal artery ultrasound. “Non-cranial GCA” was used for patients with positive findings on FDG-PET/CT, MRI-, or CT angiography, or wall thickening indicative of vasculitis on ultrasound of axillary arteries. Patients with features of both these phenotypes were labeled “mixed.” Patients that could not be classified due to negative or absent examination results were labeled “unclassifiable”. Results: 257 patients were included. The overall incidence of GCA was 20.7 per 100,000 persons aged 50 years or older. Overall, the cranial phenotype was dominant, although more than half of the patients under 60 years of age had the non-cranial phenotype. The diagnostic delay was twice as long for patients of non-cranial and mixed phenotype compared to those of cranial phenotype. Headache was the most common clinical feature (78% of patients). Characteristic clinic features occurred less frequently in patients of non-cranial phenotype compared to cranial phenotype. Conclusion: The overall incidence for GCA was comparable to earlier reports from this region. The cranial phenotype dominated although the non-cranial phenotype was more common in patients under 60 years of age. The diagnostic delay was longer in patients with the non-cranial versus cranial phenotype, indicating a need for examination of non-cranial arteries when suspecting GCA.publishedVersio

Covid-19 hos pasienter med kronisk inflammatorisk leddsykdom

BAKGRUNN Siden pasienter med kronisk inflammatorisk leddsykdom kan være mer utsatt for infeksjoner, ønsket vi å undersøke forekomsten av covid-19 i denne gruppen og se om forhold ved den revmatiske sykdommen, pasienten eller behandlingen hadde betydning. MATERIALE OG METODE 27 907 pasienter registrert i Norsk kvalitetsregister for artrittsykdommer (NorArtritt) ble koblet til Meldingssystem for smittsomme sykdommer og Norsk intensiv- og pandemiregister for å finne forekomsten av covid-19 i 2020 og andel innlagt i sykehus. Standardisert insidensforhold (SIR) ble beregnet ved sammenligning med kjønns- og aldersspesifikk forekomst i den generelle befolkningen. Ved logistisk regresjonsanalyse ble det undersøkt om diagnose, alder, kjønn, sykdomsaktivitet, komorbiditet eller medikamentell behandling hadde betydning for forekomsten. RESULTATER 185 av pasientene i NorArtritt fikk påvist covid-19, hvorav 10 % ble innlagt på sykehus. Forekomsten var lavere enn i den generelle befolkningen (SIR 0,84; 95 %-konfidensintervall (KI): 0,72 til 0,97, P = 0,02). Ung alder og lav sykdomsaktivitet var knyttet til høyere smitteforekomst. De andre faktorene hadde ingen signifikant betydning. FORTOLKNING At forekomsten av covid-19 var lavere enn i normalbefolkningen og innad i gruppen lavere hos dem med moderat/høy sykdomsaktivitet og høyere alder, skyldes trolig at pasienter med kronisk aktiv sykdom og høy alder i større grad har beskyttet seg mot smitte.publishedVersio

Trends in the occurrence of ischaemic heart disease over time in rheumatoid arthritis: 1821 patients from 1972 to 2017

Objective To evaluate trends of acute myocardial infarction (AMI) and ischaemic heart disease (IHD) in rheumatoid arthritis (RA) patients compared with the general population over time. Method We performed a retrospective cohort study of 1821 RA patients diagnosed from 1972 to 2013. Aggregated counts of the total population of the same county (Hordaland, Norway) and period were used for comparison. Information on AMI and IHD events was obtained from hospital patient administrative systems or cardiovascular registries. We estimated incidence rates and excess of events [standardized event ratio (SER) with 95% confidence interval (CI)] compared with the general population by Poisson regression. Results There was an average annual decline of 1.6% in age- and gender-adjusted AMI incidence rates from 1972 to 2017 (p < 0.035). The difference in events (excess events) in RA patients compared with the general population declined on average by 1.3% per year for AMI and by 2.3% for IHD from 1972 to 2014. There were no significant excess AMI (SER 1.05, 95% CI 0.82–1.35) or IHD events (SER 1.02, 95% CI 0.89–1.16) for RA patients diagnosed after 1998 compared with the general population. Conclusion Incidence rates and excess events of AMI and IHD in RA patients declined from 1972 to 2017. There were no excess AMI or IHD events in RA patients diagnosed after 1998 compared with the general population.publishedVersio

Results after 562 total elbow replacements: A report from the Norwegian Arthroplasty Register

Background: The aim of this study was to give results of elbow arthroplasty for a relatively large population and compare different prosthesis brands and different patient subgroups. Methods: Between 1994 and 2006, 562 total elbow replacement operations were reported to the Norwegian Arthroplasty Register. Revisions of prostheses were shown using Kaplan-Meier failure curves, and risk of revision was calculated using Cox regression analysis. Results: The overall 5-and 10-year failure rates were 8% and 15%, respectively. There were only minor differences between the different implants. Patients who developed traumatic arthritis after fracture had the worst prognosis compared with inflammatory arthritis (P ¼ .005). Risk of revision was also increased when the ulnar component was inserted without cement (P ¼ .02.) Conclusions: Good results in terms of prosthesis survival were obtained with total elbow arthroplasty, although results were worse than for knee-and hip arthroplasties. The best results were achieved in patients with inflammatory arthritis. Level of evidence: Level 2; prospective cohort study

Risk factors for revision after shoulder arthroplasty: 1,825 shoulder arthroplasties from the Norwegian Arthroplasty Register

Background and purpose Previous studies on shoulder arthroplasty have usually described small patient populations, and few articles have addressed the survival of shoulder implants. We describe the results of shoulder replacement in the Norwegian population (of 4.7 million) during a 12-year period. Trends in the use of shoulder arthroplasty during the study period were also investigated

Factors predicting death and cancer in patients with giant cell arteritis in Western Norway 1972–2012: a retrospective observational cohort study

Objectives: Evidence as to whether or not giant cell arteritis (GCA) confers added risk of cancer or death is conflicting. Our aim was to identify factors predicting death or cancer in a large Norwegian GCA-cohort. Methods: This is a retrospective observational cohort study including patients diagnosed with GCA in Western Norway during 1972–2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding. Medical records were reviewed and data about registered deaths and cancer occurrences were extracted from the Norwegian Cause of Death Registry and the Cancer Registry of Norway. We investigated predicting factors using Cox proportional hazards regression. Results: We identified 881 cases with a validated diagnosis of GCA (60% biopsy-verified). 490 patients (56%) died during the study period. Among 767 patients with no registered cancer prior to GCA diagnosis, 120 (16%) were diagnosed with cancer during the study period. Traditional risk factors were the main predictors of death; age at time of GCA-diagnosis [hazard ratio (HR) 2.81], smoking (HR 1.61), hypertension (HR 1.48) and previous cardiovascular disease (HR 1.26). Hemoglobin (Hb) level was also associated with risk of death with increasing Hb-levels at time of GCA-diagnosis indicating decreased risk of death (HR 0.91). Other GCA-related factors were not predictive of death. We did not identify any predictors of cancer risk. Conclusion: In our cohort of GCA-patients, the risk of death was predominantly predicted by age and traditional risk factors. We found no significant associations with regards to the risk of incident cancer.publishedVersio