Behandlingsopphold i varmt klima for barn med juvenil idiopatisk artritt : En prospektiv oppfølgingsstudie

Behandlingsopphold i varmt klima for barn med juvenil idiopatisk artritt (JIA). En prospektiv oppfølgingsstudie. Hensikt: Barn med revmatisk sykdom har siden 1985 hatt tilbud om behandlingsopphold i varmt klima i regi av Seksjon for Behandlingsreiser til utlandet, Rikshospitalet. Det er utført lite forskning på effekten av dette behandlingstilbudet for denne pasientgruppen. Hensikten med studien var å undersøke i hvilken grad fysisk funksjon, deltakelse i fysisk aktivitet og helserelatert livskvalitet endres hos barn med JIA etter et 3 ukers behandlingsopphold i varmt klima umiddelbart etter behandlingsoppholdet og etter 3 og 6 måneder. Teoretisk forankring: Studien ble teoretisk forankret i litteratur som omhandlet barn med juvenil idiopatisk artritt samt litteratur om behandlingsopphold i varmt klima for ulike pasientgrupper og treningsstudier for barn med JIA. I tillegg ble litteratur om ulike måleinstrumenter innhentet. Metode: 60 barn med JIA i alderen 7-15 år deltok i studien. Både fysiske tester og spørreskjemaer ble benyttet som evalueringsverktøy. De fysiske testene bestod av 6 minutter gangtest (6 mwt), Timed up an Go (TuG), håndkraft, hopp og løp. Fysisk funksjon, helserelatert livskvalitet og deltakelse i fysisk aktivitet ble målt med henholdsvis Childhood Health Assessment Questionnaire (CHAQ), the Pediatric quality of Life Inventory 4.0 (PedsQL) og Spørreskjema for barn for måling av fysisk aktivitet. De fysiske testene ble kun utført ved ankomst og avreise, mens spørreskjemaene ble benyttet ved ankomst og avreise samt etter 3 og 6 måneder. Behandlingsopplegget bestod av trening i grupper to ganger daglig på hverdagene (45 min i basseng og 45 min landtrening). Resultater: Det var en statistisk signifikant bedring på 6 mwt, TuG, hopp og håndkraft samt i helserelatert livskvalitet målt med PedsQL umiddelbart etter behandlingsoppholdet i varmt klima. Det var ikke statistisk signifikant bedring av løpsfunksjon eller av fysisk funksjon og deltakelse i fysisk aktivitet målt med henholdsvis CHAQ og Spørreskjema for barn for måling av fysisk aktivitet. Endringene vedvarte ikke 3 og 6 måneder etter avsluttet behandling. Subgruppeanalyser av barn med lav og høy CHAQ funksjonsskår viste kun statistisk signifikant forskjell mellom gruppene i endringen av CHAQ funksjonsskår fra ankomst til avreise, hvor barn med CHAQ funksjonsskår >0.25 hadde statistisk signifikant bedring. Konklusjon: Denne studien viste statistisk signifikant bedring i helserelatert livskvalitet samt på alle de fysiske testene bortsett fra løpsfunksjon umiddelbart etter behandlingsoppholdet for barn med JIA. For barn med CHAQ funksjonsskår >0.25 ved ankomst, var det også signifikant bedring i fysisk funksjon målt med CHAQ. Bedringen i helserelatert livskvalitet ble vurdert til å være av klinisk betydning. Bedringene i helserelatert livskvalitet og fysisk funksjon vedvarte ikke 3 og 6 måneder etter hjemkomst. Nøkkelord: JIA, varmt klima, behandling, fysisk funksjon, helserelatert livskvalitet, fysisk aktivite

Physical activity and physical fitness in juvenile idiopathic arthritis

The aims of this study were to compare physical activity (PA) behavior and physical fitness in patients with JIA who were diagnosed in the era of biologics with controls from the general population, and to examine if disease variables were associated with PA behavior and physical fitness. Further, to investigate the measurement properties of a submaximal treadmill test for use in both clinical practice and research settings. The thesis has a comparative cross-sectional design, including a test-retest design to evaluate the reliability of the submaximal treadmill test. PA behavior was examined by objective and subjective measurements. Physical fitness was assessed with state-of-the-art methods. Additionally, the participants performed a submaximal treadmill test for the evaluation of criterion validity and reliability. The overall PA levels were comparable between patients and controls, but patients had lower levels of vigorous PA. Patients participated in similar types and amounts of both organized and unorganized PA as controls. Both patients and controls reported enjoyment as the most important PA facilitator. Patients and controls had comparable cardiorespiratory fitness and body composition, while patients had lower muscle strength and endurance and bone mineral density. The use of biologic medication was a correlate for higher overall PA levels and lower sedentary time. No other disease variables were identified as correlates for PA or physical fitness. Higher vigorous PA was a correlate for higher cardiorespiratory fitness and muscle strength in patients. The submaximal treadmill test was valid and reliable for research purposes on group level in patients, but not optimal for estimation of VO2peak in individual patients. Our findings are encouraging regarding PA behavior and physical fitness in patients with JIA. The results suggest that patients also should perform vigorous PA and bone- and muscle-strengthening activities at least three times per week according to PA recommendations for children in general, preferably through enjoyable activities

Measurement properties and performance of an eight-minute submaximal treadmill test in patients with juvenile idiopathic arthritis: a controlled study

Background Poor cardiorespiratory fitness is previously reported in patients with juvenile idiopathic arthritis (JIA) measured both by maximal and submaximal exercise tests, but a submaximal exercise test with acceptable measurement properties is currently lacking for both clinical and research purposes in this patient population. The objectives of this study were to evaluate the measurement properties and performance of a submaximal treadmill test in patients with JIA, and to compare the results with those obtained in controls. Methods Fifty-nine patients (50 girls), aged 10–16 years, with oligo- (n = 30) and polyarticular (n = 29) JIA, and 59 age- and sex-matched controls performed an eight-minute submaximal treadmill test for estimating peak oxygen uptake (VO2peak) followed by a maximal treadmill test measuring VO2peak directly. During the submaximal treadmill test, the study participants walked with no inclination at a speed between 3.2–7.2 km/h for four minutes, and then continued to walk at the same speed for four minutes with five % inclination. VO2peak was directly measured during a continuous graded exercise test on treadmill until exhaustion. Thirty-seven patients participated in the evaluation of the reliability. Criterion validity and reliability were evaluated with interclass correlation coefficient (ICC); measurement errors by Bland-Altman plot, standard error of measurement and smallest detectable change. Results In patients with JIA, the ICC (95% CI) for criterion validity was acceptable at group level 0.71 (0.51, 0.82), but not at individual level. The test-retest reliability and inter-rater reliability were acceptable at individual (0.84 (0.71, 0.91) and 0.92 (0.83, 0.96), respectively) and group levels (0.91 (0.83, 0.96) and 0.96 (0.91, 0.98), respectively). The measurement errors (for test-retest reliability/inter-rater reliability) were large. Bland-Altman plots showed no systematic differences, but a large variability for both the validity and reliability. The performance of and estimated VO2peak from the submaximal test were not associated with disease variables and were comparable between patients and controls. Conclusion The submaximal treadmill test is valid for use in patients with JIA on group level, but not on individual level. The reliability is acceptable. Due to large measurement errors, the submaximal treadmill test is not optimal for use in daily clinical practice to estimate VO2peak in individual patients

Physical activity in patients with oligo- and polyarticular juvenile idiopathic arthritis diagnosed in the era of biologics: a controlled cross-sectional study

Background Knowledge about objectively measured levels of physical activity (PA) and PA participation (included facilitators and barriers for PA) in patients with juvenile idiopathic arthritis (JIA) diagnosed in the era of biologics is limited. We aimed to compare objectively measured PA in patients with oligo- and polyarticular JIA diagnosed in the biologic era with controls and to examine associations between PA and disease variables; furthermore, to explore participation in PA, physical education (PE) and facilitators and barriers for PA participation in patients and controls. Methods The study cohort included 60 patients (30 persistent oligo JIA/30 poly-articular disease) and 60 age- and sex-matched controls. Age range was 10–16 years and 83% were female. PA was measured with accelerometry for seven consecutive days. Disease activity, current treatment, disease duration, functional ability, pain and fatigue were assessed. Structured interviews were applied to explore participation in PA and PE, and PA facilitators and barriers. Results Patients spent less time in daily vigorous PA than controls, (mean(SE) 21(2) min vs. 26(2) min, p = 0.02), while counts per minute (cpm), steps daily, sedentary time and light and moderate PA did not differ. No differences were found between JIA subgroups. The use of biologic medication was associated with higher cpm and lower sedentary time. Most patients and controls participated in organized or unorganized PA and PE, and enjoyment was the most reported facilitator for PA participation. More patients than controls reported pain as a PA barrier. Conclusion The PA levels and participation in patients with oligo- and polyarticular JIA are mostly comparable to controls, but patients still need to be encouraged to increase vigorous PA. Enjoyment is the most important facilitator for PA participation in patients with JIA

Physical activity in patients with oligo- and polyarticular juvenile idiopathic arthritis diagnosed in the era of biologics: A controlled cross-sectional study

Background Knowledge about objectively measured levels of physical activity (PA) and PA participation (included facilitators and barriers for PA) in patients with juvenile idiopathic arthritis (JIA) diagnosed in the era of biologics is limited. We aimed to compare objectively measured PA in patients with oligo- and polyarticular JIA diagnosed in the biologic era with controls and to examine associations between PA and disease variables; furthermore, to explore participation in PA, physical education (PE) and facilitators and barriers for PA participation in patients and controls. Methods The study cohort included 60 patients (30 persistent oligo JIA/30 poly-articular disease) and 60 age- and sex-matched controls. Age range was 10–16 years and 83% were female. PA was measured with accelerometry for seven consecutive days. Disease activity, current treatment, disease duration, functional ability, pain and fatigue were assessed. Structured interviews were applied to explore participation in PA and PE, and PA facilitators and barriers. Results Patients spent less time in daily vigorous PA than controls, (mean(SE) 21(2) min vs. 26(2) min, p = 0.02), while counts per minute (cpm), steps daily, sedentary time and light and moderate PA did not differ. No differences were found between JIA subgroups. The use of biologic medication was associated with higher cpm and lower sedentary time. Most patients and controls participated in organized or unorganized PA and PE, and enjoyment was the most reported facilitator for PA participation. More patients than controls reported pain as a PA barrier. Conclusion The PA levels and participation in patients with oligo- and polyarticular JIA are mostly comparable to controls, but patients still need to be encouraged to increase vigorous PA. Enjoyment is the most important facilitator for PA participation in patients with JIA

Droplet digital PCR-based testing for donor-derived cell-free DNA in transplanted patients as noninvasive marker of allograft health: Methodological aspects.

In solid organ transplantation, donor-derived cell-free DNA (dd-cfDNA) is a promising universal noninvasive biomarker for allograft health, where high levels of dd-cfDNA indicate organ damage. Using Droplet Digital PCR (ddPCR), we aimed to develop an assay setup for monitoring organ health. We aimed to identify the least distinguishable percentage-point increase in the fraction of minute amounts of cfDNA in a large cfDNA background by using assays targeting single nucleotide polymorphisms (SNPs). We mimicked a clinical sample from a recipient in a number of spike-in experiments, where cfDNA from healthy volunteers were mixed. A total of 40 assays were tested and approved by qPCR and ddPCR. Limit of detection (LOD) was demonstrated to be approximately 3 copies per reaction, observed at a fraction of 0.002%, and which would equal 6 copies per mL plasma. Limit of quantification (LOQ) was 35 copies per reaction, estimated to 0.038%. The lowest detectable increase in percentage point of dd-cfDNA was approximately 0.04%. Our results demonstrated that ddPCR has great sensitivity, high precision, and exceptional ability to quantify low levels of cfDNA. The ability to distinguish small differences in mimicking dd-cfDNA was far beyond the desired capability. While these methodological data are promising, further prospective studies are needed to determine the clinical utility of the proposed method