Milloin selkäkivun taustalla on tulehduksellinen sairaus?

Noin 40 % suomalaista on kärsinyt selkäkivusta edellisen kuukauden aikana. Pienellä osalla heistä on ¬tulehduksellinen rankasairaus, aksiaalinen spondylartriitti. Jos sairaus diagnosoidaan, potilasta voidaan auttaa omaehtoiseen harjoitteluun ohjaavalla fysioterapialla ja modernilla ¬antireumaattisella lääkehoidolla. Reumatologin arviosta hyötyvät potilaat on kuitenkin haastavaa löytää, koska oirekuva on moninainen. Kansainväliset suositukset pyrkivät nopeuttamaan diagnoosiin pääsyä ja hoidon aloitusta. Hoitamaton aksiaalinen spondylartriitti voi johtaa nikamia luuduttavaan selkärankareumaan ja perifeeristen nivelten muutoksiin

One-Year Treatment Outcomes of Secukinumab Versus Tumor Necrosis Factor Inhibitors in Spondyloarthritis : Results From Five Nordic Biologic Registries Including More Than 10,000 Treatment Courses

Objective To describe baseline characteristics and to compare treatment effectiveness of secukinumab versus tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA) using adalimumab as the main comparator. Methods This was an observational, prospective cohort study. Patients with SpA (clinical ankylosing spondylitis, nonradiographic axial SpA, or undifferentiated SpA) starting secukinumab or a TNFi during 2015-2018 were identified from 5 Nordic clinical rheumatology registries. Data on comorbidities and extraarticular manifestations (psoriasis, uveitis, and inflammatory bowel disease) were captured from national registries (data available in 94% of patients) and included in multivariable analyses. We assessed 1-year treatment retention (crude survival curves, adjusted hazard ratios [HRadj] for treatment discontinuation) and 6-month response rates (Ankylosing Spondylitis Disease Activity Score [ASDAS] scorePeer reviewe

Is the risk of infection higher during treatment with secukinumab than with TNF inhibitors? An observational study from the Nordic countries

Objectives The positioning of secukinumab in the treatment of axial SpA (axSpA) and PsA is debated, partly due to a limited understanding of the comparative safety of the available treatments. We aimed to assess the risk of the key safety outcome infections during treatment with secukinumab and TNF inhibitors (TNFi). Methods Patients with SpA and PsA starting secukinumab or TNFi year 2015 through 2018 were identified in four Nordic rheumatology registers. The first hospitalized infection during the first year of treatment was identified through linkage to national registers. Incidence rates (IRs) with 95% CIs per 100 patient-years were calculated. Adjusted hazard ratios were estimated through Cox regression, with secukinumab as the reference. Several sensitivity analyses were performed to investigate confounding by indication. Results Among 7708 patients with SpA and 5760 patients with PsA, we identified 16 229 treatment courses of TNFi (53% bionaive) and 1948 with secukinumab (11% bionaive). For secukinumab, the first-year risk of hospitalized infection was 3.5% (IR 5.0; 3.9-6.3), compared with 1.7% (IR 2.3; 1.7-3.0) during 3201 courses with adalimumab, with the IRs for other TNFi lying in between these values. The adjusted HR for adalimumab, compared with secukinumab, was 0.58 (0.39-0.85). In sensitivity analyses, the difference from secukinumab was somewhat attenuated and in some analyses no longer statistically significant. Conclusion When used according to clinical practice in the Nordic countries, the observed first-year absolute risk of hospitalized infection was doubled for secukinumab compared with adalimumab. This excess risk seemed largely explained by confounding by indication.Peer reviewe

Baseline findings and safety of infrequent vs. frequent screening of human papillomavirus vaccinated women

Less frequent cervical cancer screening in human papillomavirus (HPV) vaccinated birth cohorts could produce considerable savings without increasing cervical cancer incidence and loss of life-years. We report here the baseline findings and interim results of safety and accuracy of infrequent screening among HPV16/18 vaccinated females. The entire 1992-1994 birth-cohorts (30,139 females) were invited to a community-randomized HPV16/18-vaccination trial. A total of 9,482 female trial participants received HPV16/18-vaccination in 2007-2009 at age of 13-15. At age 22, 4,273 (45%) of these females consented to attend a randomized trial on frequent (ages 22/25/28; Arm 1: 2,073 females) vs. infrequent screening (age 28; Arm 2: 2,200 females) in 2014-2017. Females (1,329), who had got HPV16/18 vaccination at age 18 comprised the safety Arm 3. Baseline prevalence and incidence of HPV16/18 and other high-risk HPV types were: 0.5% (53/1,000 follow-up years, 10(4)) and 25% (2,530/10(4)) in the frequently screened Arm 1; 0.2% (23/10(4)) and 24% (2,413/10(4)) in the infrequently screened Arm 2; and 3.1% (304/10(4)) and 23% (2,284/10(4)) in the safety Arm 3. Corresponding prevalence of HSIL/ASC-H and of any abnormal cytological findings were: 0.3 and 4.2% (Arm 1), 0.4 and 5.3% (Arm 2) and 0.3 and 4.7% (Arm 3). Equally rare HSIL/CIN3 findings in the infrequently screened safety Arm A3 (0.4%) and in the frequently screened Arm 1 (0.4%) indicate no safety concerns on infrequent screening despite the up to 10 times higher HPV16/18 baseline prevalence and incidence in the former.Peer reviewe

Human papillomavirus vaccine efficacy against invasive, HPV-positive cancers : population-based follow-up of a cluster-randomised trial

Background Human papillomavirus (HPV) vaccination protects against HPV, a necessary risk factor for cervical cancer. We now report results from population-based follow-up of randomised cohorts that vaccination provides HPV-type-specific protection against invasive cancer. Methods Individually and/or cluster randomised cohorts of HPV-vaccinated and non-vaccinated women were enrolled in 2002-2005. HPV vaccine cohorts comprised originally 16-17 year-old HPV 16/18-vaccinated PATRICIA (NCT00122681) and 012 trial (NCT00169494) participants (2465) and HPV6/11/16/18-vaccinated FUTURE II (NCT00092534) participants (866). Altogether, 3341 vaccines were followed by the Finnish Cancer Registry in the same way as 16 526 non-HPV-vaccinated controls. The control cohort stemmed from 15 665 originally 18-19 years-old women enrolled in 2003 (6499) or 2005 (9166) and 861 placebo recipients of the FUTURE II trial. The follow-up started 6 months after the clinical trials in 2007 and 2009 and ended in 2019. It was age aligned for the cohorts. Findings During a follow-up time of up to 11 years, we identified 17 HPV-positive invasive cancer cases (14 cervical cancers, 1 vaginal cancer, 1 vulvar cancer and 1 tongue cancer) in the non-HPV-vaccinated cohorts and no cases in the HPV-vaccinated cohorts. HPV typing of diagnostic tumour blocks found HPV16 in nine cervical cancer cases, HPV18, HPV33 and HPV52 each in two cases and HPV45 in one cervical cancer case. The vaginal, vulvar and tongue cancer cases were, respectively, positive for HPV16, HPV52/66 and HPV213. Intention-to-treat vaccine efficacy against all HPV-positive cancers was 100% (95% CI 2 to 100, p Interpretation Vaccination is effective against invasive HPV-positive cancer.Peer reviewe

Differences and similarities between the EULAR/ASAS-EULAR and national recommendations for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe

This is the first report comparing EULAR and national treatment recommendations for PsA patients across Europe, and the first this decade to compare ASAS-EULAR and national treatment recommendations in axSpA patients. An electronic survey was completed from October 2021-April 2022 by rheumatologists in 15 European countries. One and four countries followed all EULAR and ASAS-EULAR recommendations, respectively. Five countries had no national treatment recommendations for PsA and/or axSpA, but followed other regulations. In several countries, national treatment recommendations predated the most recent EULAR/ASAS-EULAR recommendations. Entry criteria for starting biologic/targeted synthetic disease-modifying anti-rheumatic drugs varied considerably. In several countries, for PsA patients with significant skin involvement, interleukin-17 inhibitors were not given preference. The positioning of Janus Kinase inhibitors differed and Phosphodiesterase-4 inhibitors were not in use/reimbursed in most countries. This study may motivate European countries to update their national treatment recommendations, to align them better with the latest international recommendations

Digitaalisen markkinointiviestinnän kehittäminen : case: Imagokoulu Milla Rynty

Opinnäytetyön aiheena oli digitaalisen markkinointiviestinnän kehittäminen kohdeyrityksessä. Toimeksiantajana opinnäytetyöllä oli hyvinvointialan yritys Imagokoulu Milla Rynty. Opinnäytetyön tarkoituksena oli kehittää yrityksen digitaalisen markkinointiviestinnän työkaluja laajemman verkkonäkyvyyden saavuttamiseksi. Tarkoituksena oli myös, että yritys pystyisi vaivattomasti hyödyntämään keräämäämme tietoa aiheesta. Tutkimuksen ja opinnäytetyön tavoitteena oli etsiä yrittäjän käyttöön työkaluja, joiden avulla yrityksen verkkonäkyvyys parantuisi. Tutkimus suoritettiin kvalitatiivisena eli laadullisena tutkimuksena. Laadullisen tutkimuksen aineistonkeruumenetelminä käytettiin yksilöhaastattelua, teemahaastattelua sekä havainnointia. Teemahaastattelussa keskityttiin valittuihin teemoihin, jotka olivat toimitusjohtaja Milla Rynty, yrittäjän ydinosaaminen ja yrityksen SWOT-analyysi, asiakaspalaute, merkittävimmät saavutukset sekä yrityksen tulevaisuus. Aineiston analyysimenetelmänä käytettiin SWOT-analyysiä. Tutkimuksen teoreettinen viitekehys muotoutui digitaalisen markkinointiviestinnän suunnittelusta, viestintäkanavien kartoittamisesta sekä niiden kehittämisestä. Työssä käytettiin laajasti kirjallisuus- ja verkkolähteitä monipuolisen teoriaosuuden luomiseksi. Tutkimuksessa pyrittiin perustelemaan väittämiä ja tutkimustuloksia teorialla. Tutkimuksen tuloksista ilmeni, että yrityksen digitaalisessa markkinointiviestinnässä on kehittämistä vaativia osa-alueita. Teemahaastattelun sekä havainnoinnin perusteella tehdystä SWOT-analyysistä selvisi yrityksen heikkoudet ja se mihin kaikkeen yrityksellä olisi mahdollisuuksia. Valitut markkinointiviestinnän kanavat ja apuvälineet niiden käyttöön valikoituivat teemahaastattelussa ilmenneiden puutteiden pohjalta. Samankaltaisten ongelmien kanssa kamppailevat pienyritykset voivat hyödyntää tutkimustamme omassa markkinointiviestinnän suunnittelussaan.The purpose of this thesis was to create and develop marketing communications at enterprise. The primary subject of the thesis was to develop the digital marketing communication for the target company. Our client, for whom this thesis was written for, is welfare company Imagokoulu Milla Rynty. Successful digital marketing communication broadens the online visibility of a company and our aim was that our client would be able to benefit from the information collected for the thesis. Improving old and finding new tools for the company to use in process to improve their online visibility was the main intention of the research and is included in the thesis. The research was carried out as qualitative and the various methods for collecting the information included interviews and observation. All of the interviews focused on selected themes, some examples of the topics being; CEO (Chief executive officer) Milla Rynty, the core skills of a the CEO, the SWOT-analysis of the company, customer feedback, significant accomplishments and the future of the company. SWOT-analysis was the primary analytic method for the research. In order to guarantee versatile theoretical groundwork for the thesis, multiple literal and online references were widely used. Our aim was that every claim and research result within the thesis could be rationalized trough theory. As a result of the research we found out that the digital marketing communication of Imagokoulu Rynty has areas that could be improved. Through the SWOT-analysis results that were formed using the interviews and observation, the weaknesses of the company could be exposed. Finding and accepting its flaws enables the company to deal with the problems it has and as a result reach its true potential. The recommended channels and tools to increase the company's marketing communication were selected using the research results of the interviews. Small businesses enduring similar problems as Image School Milla Rynty are free to use the research results of our thesis in order to improve their marketing communication planning

Impact of TNF inhibitor medication on working ability in axial spondyloarthritis : an observational national registry-based cohort study

Lay Summary What does this mean for patients? Maintaining the ability of patients to work is a complex and challenging task that deserves special attention when treating people with chronic inflammatory diseases, such as ankylosing spondylitis and non-radiographic SpA (nr-axSpA). Work disability remains a problem among these patients despite the evolving treatment options. We investigated how a type of drug called a tumour necrosis factor inhibitor (TNFi) affects working ability in people with nr-axSpA in a real-life setting in Finland. We used data on patients and their treatment from a database called the National Register for Antirheumatic and Biologic Treatment in Finland. We compared data on sick leave, in- and outpatient days and rehabilitation 1 year before and after starting TNFi medication. Our results show that TNFi medication substantially reduces the amount of sick leave that patients need to take, especially for people with nr-axSpA. However, we found that the amount of disability pension claimed rises steadily despite patients starting TNFi medication. Taking these results together, we conclude that starting TNFi medication might interrupt the decline in the ability to work in nr-axSpA patients. However, effective ways of maintaining patients' ability to work are still needed.Objective The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.Peer reviewe