Impact of early systemic lupus erythematosus on work disability-results from the Finnish nationwide register 2000-2007

Objectives of this study were to examine work disability (WD) and its leading causes in incident SLE patients. Data were derived from the Finnish nationwide registries to identify all non-retired, 18 to 64-year-old incident SLE patients between 2000 and 2007. Sick benefits and WD pensions and the causes for them were monitored until the end of 2008. A total of 446 working-aged, incident SLE patients available for work force (mean age 42 +/- 13 years, 89% females) were found. During the follow-up (median 5.3 years), WD pension was granted to 27 patients. The most common cause was SLE itself (14 patients, 52%), with cumulative incidence of 3.4% (95% CI 1.9 to 5.8) in 5 years and 5.0% (95% CI 3.0 to 8.5) in 8 years, followed by musculoskeletal and psychiatric causes. The age- and sex- adjusted incidence ratio for WD pension in SLE patients due to any cause was 5.4 (95% CI 3.7 to 7.9) compared to the Finnish population. The mean number of WD days was 32 (95% CI 28 to 35) per patient-year among all SLE patients during the follow-up. The study concludes that SLE patients have an increased risk for WD already in early course of the disease.Peer reviewe

Reumalääkityksen laboratorioseuranta - ohjeet päivitetty

Reumalääkkeiden turvallinen käyttö edellyttää laboratorioseurantaa. Se toteutetaan perusterveydenhuollon ja erikoissairaanhoidon yhteistyönä.Seurantaohjeet on päivitetty yliopistosairaaloiden yhteistyönä. Usean perinteisen reumalääkehoidon laboratorioseurantaa on kevennetty ja uusista lääkkeistä on laadittu ohjeet.Suosituksen sisältö perustuu tutkimustietoon sekä aiempiin kansallisiin ja kansainvälisiin ohjeisiin, asiantuntija-arvioihin ja kliiniseen kokemukseen.</p

Association of rheumatoid arthritis disease activity and antibodies to periodontal bacteria with serum lipoprotein profile in drug naive patients

Abstract Objective: We investigated lipid concentrations, particle sizes and antibodies binding to periodontal bacteria Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis and to malondialdehyde-acetaldehyde (MAA) modified low-density lipoprotein in immunoglobulin (Ig) class A, G and M among patients with newly diagnosed rheumatoid arthritis (RA) in a population-based cohort. Methods: Concentrations and sizes of lipoprotein particles analysed by proton nuclear magnetic resonance spectroscopy and antibody levels to MAA modified low-density lipoprotein were studied at baseline and after one-year of follow-up. Serum Ig A and G class antibodies to periodontal bacteria were determined at baseline. Results: Sixty-three patients were divided into tertiles according to disease activity by disease activity score with 28 joint count and erythrocyte sedimentation rate (ESR) (&lt;3.9, 3.9–4.7, &gt;4.7). Small low-density lipoprotein concentration was lowest in the tertile with the highest disease activity. In high-density lipoprotein, the concentrations of total, medium and small particles decreased with disease activity. The particle size in low-density lipoprotein associated with disease activity and the presence of antibodies to P. gingivalis. Ig G and M antibodies to MAA modified low-density lipoprotein correlated with disease activity. Inflammation associated changes faded by one year. Conclusions: Drug naive RA patients had proatherogenic changes in lipid profiles, but they were reversible, when inflammation diminished

YKL-40 was associated with disease activity and inflammation during intensive treatment with DMARDs.

<p>The figure shows quadratic relationships of YKL-40 with the disease activity measured as DAS28 (A) and with the inflammatory cytokine IL-6 (B) during the 26 weeks of treatment. The patients were treated for the first four weeks with a combination of sulphasalazine, methotrexate, hydroxychloroquine and low dose prednisolone, and thereafter randomized to receive either placebo infusions or infliximab infusions added to the treatment for another 22 weeks. Measurements were carried out at weeks 0, 4, 10, 18, and 26 during the treatment and area under the curve analysis over time (AUC_{0-26 weeks}) adjusted for age, gender and RF positivity was used. Gray-shaded areas represent 95% confidence intervals around the mean. YKL-40 AUC_{0-26 weeks} showed a statistically significant correlation to DAS28 AUC_{0-26 weeks} and IL-6 AUC_{0-26 weeks}.</p

YKL-40 levels decreased during the intensive anti-rheumatic treatment with a combination of csDMARDs.

<p>The figure shows the mean change in plasma YKL-40 levels in 88 patients in the NEO-RACo -study treated with a combination of sulphasalazine, methotrexate, hydroxychloroquine and low dose prednisolone for the first four weeks, and thereafter randomized to receive either placebo infusions (Fin-RACo + Pla) or infliximab infusions (Fin-RACo + INFL) added on the csDMARD combination for another 22 weeks. YKL-40 levels decreased significantly (p<0.001) during the first four weeks of treatment with csDMARDs; when infliximab (or placebo) was added to the treatment there was a minor further decrease (groups combined, p = 0.031) but no difference between placebo and infliximab treatment groups was found. The change is presented as ng/ml, mean ± 95% CI, n = 88.</p

Generalized estimating equations models for the effect of YKL40, time and interaction in measures of disease activity from baseline to 26 weeks.

<p>Generalized estimating equations models for the effect of YKL40, time and interaction in measures of disease activity from baseline to 26 weeks.</p

CONSORT flow diagram for the NEO-RACo study.

<p>CONSORT flow diagram for the NEO-RACo study.</p

The baseline characteristics of the patients.

<p>The baseline characteristics of the patients.</p