Analgesic purchases among older adults - a population-based study

Background: Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults' prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods: One thousand four hundred twenty community-dwelling citizens aged 62-86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results: Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion: Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults' pain management.Peer reviewe

Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis

Objectives To validate cut-offs of the Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) and to compare them with other patient cohorts. Methods In a national multicentre study, cross-sectional data on recent visits of 337 non-systemic patients with juvenile idiopathic arthritis (JIA) were collected from nine paediatric outpatient units. The cut-offs were tested with receiver operating characteristic curve-based methods, and too high, too low and correct classification rates (CCRs) were calculated. Results Our earlier presented JADAS10 cut-offs seemed feasible based on the CCRs, but the cut-off values between low disease activity (LDA) and moderate disease activity (MDA) were adjusted. When JADAS10 cut-offs for clinically inactive disease (CID) were increased to 1.5 for patients with oligoarticular disease and 2.7 for patients with polyarticular disease, as recently suggested in a large multinational register study, altogether 11 patients classified as CID by the cut-off had one active joint. We suggest JADAS10 cut-off values for oligoarticular/polyarticular disease to be in CID: 0.0-0.5/0.0-0.7, LDA: 0.6-3.8/0.8-5.1 and MDA: >3.8/5.1. Suitable cJADAS10 cut-offs are the same as JADAS10 cut-offs in oligoarticular disease. In polyarticular disease, cJADAS10 cut-offs are 0-0.7 for CID, 0.8-5.0 for LDA and > 5.0 for MDA. Conclusion I nternational consensus on JADAS cutoff values is needed, and such a cut-off for CID should preferably exclude patients with active joints in the CID group.Peer reviewe

Pain-coping scale for children and their parents : a cross-sectional study in children with musculoskeletal pain

BackgroundIn a chronic pain-causing disease such as juvenile idiopathic arthritis, the quality of coping with pain is crucial. Parents have a substantial influence on their children's pain-coping strategies. This study aimed to develop scales for assessing parents' strategies for coping with their children's pain and a shorter improved scale for children usable in clinical practice.MethodsThe number of items in the Finnish version of the pain-coping questionnaire for children was reduced from 39 to 20. A corresponding reduced scale was created for parental use. We recruited consecutive patients from nine hospitals evenly distributed throughout Finland, aged 8-16 years who visited a paediatric rheumatology outpatient clinic and reported musculoskeletal pain during the past week. The patients and parents rated the child's pain on a visual analogue scale from 0 to 100 and completed pain-coping questionnaires and depression inventories. The selection process of pain questionnaire items was performed using factor analyses.ResultsThe average (standard deviation) age of the 130 patients was 13.0 (2.3) years; 91 (70%) were girls. Four factors were retained in the new, improved Pain-Coping Scales for children and parents. Both scales had 15 items with 2-5 items/factor. The goodness-of-fit statistics and Cronbach's alpha reliability coefficients were satisfactory to good in both scaled. The criterion validity was acceptable as the demographic, disease related, and the depression and stress questionnaires correlated with the subscales.ConclusionsWe created a shorter, feasible pain-coping scale for children and a novel scale for caregivers. In clinical work, the pain coping scales may serve as a visualisation of different types of coping strategies for paediatric patients with pain and their parents and facilitate the identification of families in need of psychological support.Peer reviewe

Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis

Objectives To validate cut-offs of the Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) and to compare them with other patient cohorts.Methods In a national multicentre study, cross-sectional data on recent visits of 337 non-systemic patients with juvenile idiopathic arthritis (JIA) were collected from nine paediatric outpatient units. The cut-offs were tested with receiver operating characteristic curve-based methods, and too high, too low and correct classification rates (CCRs) were calculated.Results Our earlier presented JADAS10 cut-offs seemed feasible based on the CCRs, but the cut-off values between low disease activity (LDA) and moderate disease activity (MDA) were adjusted. When JADAS10 cut-offs for clinically inactive disease (CID) were increased to 1.5 for patients with oligoarticular disease and 2.7 for patients with polyarticular disease, as recently suggested in a large multinational register study, altogether 11 patients classified as CID by the cut-off had one active joint. We suggest JADAS10 cut-off values for oligoarticular/polyarticular disease to be in CID: 0.0–0.5/0.0–0.7, LDA: 0.6–3.8/0.8–5.1 and MDA: >3.8/5.1. Suitable cJADAS10 cut-offs are the same as JADAS10 cut-offs in oligoarticular disease. In polyarticular disease, cJADAS10 cut-offs are 0–0.7 for CID, 0.8–5.0 for LDA and >5.0 for MDA.Conclusion International consensus on JADAS cut-off values is needed, and such a cut-off for CID should preferably exclude patients with active joints in the CID group.</div

Defining new clinically derived criteria for high disease activity in non-systemic juvenile idiopathic arthritis: a Finnish multicentre study

ObjectivesTo redefine criteria for high disease activity (HDA) in JIA, to establish HDA cut-off values for the 10-joint Juvenile Arthritis Disease Activity Score (JADAS10) and clinical JADAS10 (cJADAS10) and to describe the distribution of patients’ disease activity levels based on the JADAS cut-off values in the literature.MethodsData on 305 treatment-naïve JIA patients were collected from nine paediatric units treating JIA. The median parameters of the JADAS were proposed to be the clinical criteria for HDA. The cut-off values were assessed by using two receiver operating characteristics curve–based methods. The patients were divided into disease activity levels based on currently used JADAS cut-off values.ResultsWe proposed new criteria for HDA. At least three of the following criteria must be satisfied in both disease courses: in oligoarthritis, two or more active joints, ESR above normal, physician global assessment (PGA) of disease activity ≥2 and parent/patient global assessment (PtGA) of well-being ≥2; in polyarthritis, six or more active joints, ESR above normal, PGA of overall disease activity ≥4 and PtGA of well-being ≥2. The HDA cut-off values for JADAS10 (cJADAS) were ≥6.7 (6.7) for oligoarticular and ≥15.3 (14.1) for polyarticular disease. The distribution of the disease activity levels based on the JADAS cut-off values in the literature varied markedly based on which cut-offs were used.ConclusionNew clinically derived criteria for HDA in JIA and both JADAS and cJADAS cut-off values for HDA were proposed.</div

Juvenile Idiopathic Arthritis: Studies on associated autoimmune diseases and drug therapy

Autoimmuunitaudit ovat kroonisia sairauksia, joissa elimistön oma poikkeavasti toimiva puolustusmekanismi kohdistuu yhteen tai useampaan elimeen tai kudokseen. Lastenreuma on autoimmuunitauti, jonka syy on edelleen avoin. Tutkimukset viittaavat sekä perimän että ympäristön vaikutukseen taudin synnyssä. Tutkimukset eri puolilta maailmaa ovat vahvistaneet, että normaaliväestöön verrattuna autoimmuunitauteja on enemmän sekä lastenreumapotilailla että heidän sukulaisillaan. Ensimmäisessä tutkimuksessa halusimme tutkia suomalaisten lastenreumapotilaiden muita autoimmuunitauteja. Tutkimme kaikkien vuosina 1992-2000 Heinolaan, Reumasäätiön Sairaalaan tutkimuksiin ja hoitoon ensi kertaa lähetettyjen lastenreumapotilaiden (417) sairauskertomukset Totesimme, että potilailla oli keskimäärin yli 5-kertainen todennäköisyys, verrattuna muuhun väestöön, saada joko nuoruusiän diabetes, keliakia tai hypothyreoosi. Lisäksi selvitimme lastenreumapotilaiden isän, äidin ja täyssisarusten autoimmuunitaudit. Vuosina 1996-2001 Reumasäätiön sairaalaan lähetettyjen 432 potilaan perheille postitettiin kyselylomake, jossa tiedustelimme perheen autoimmuunitauteja: krooninen reumatauti, keliakia, MS-tauti ja nuoruusiän diabetes. Saimme vastauksen 362:lta potilaalta. Noin viidesosassa (21,4 %) perheistä oli lastenreuman lisäksi joku muu autoimmuunitauti. Lastenreuman ja nuoruusiän diabeteksen esiintyvyys oli selvästi suurempi kuin aikaisemmissa väestötutkimuksissa. Lisäksi kolmannessa väitöskirjatyössä tarkastettiin valtakunnallisesti vuosilta 1976-2005 kaikkien lastenreumaa ja samanaikaista nuoruusiän diabetesta sairastavien potilaiden sairauskertomukset. Tutkimuksessa selvitettiin näiden tapausten ilmaantuvuus ja lastenreuman taudinkuva. Ilmaantuvuus oli noussut yli viisinkertaiseksi kolmen vuosikymmenen aikana. Tutkituista potilaista useampi kuin lastenreumapotilaista yleensä sairasti taudin reumafaktoripositiivista muotoa ja heillä esiintyi vähemmän kroonista reumaattista silmätulehdusta. Lähes neljäsosalla (22 %) oli joku kolmas autoimmuunitauti. Heillä oli myös huomattavasti enemmän (16 %) vaikeita psykiatrisia ongelmia muuhun väestöön verrattuna. Neljänneksi tutkimme sitä, mitä lääkkeitä lastenreuman hoitoon Suomessa valtakunnallisesti käytetään. Kansaeläkelaitoksen (KELA) tiedostoista kerättiin tiedot erityiskorvattavista lääkkeistä, jotka oli myönnetty kroonisen niveltulehduksen hoitoon alle 16-vuotiaille lapsille vuosina 2000-2007 ja samanaikaisista reseptiostoista. Aktiivinen lastenreuman hoito kannattaa, koska havaitsimme, että seurantajakson aikana metotreksaatin käyttö lisääntyi merkittävästi samalla kun kortisonin käyttö väheni. Selvitimme myös, miten samanaikainen nuoruusiän diabeteksen sairastaminen vaikutti lastenreuman lääkitykseen. KELAn tiedostoista löytyi 23 potilasta, joilla oli jo diagnosoitu DM1 ja joille myönnettiin korvattavuus kroonista artriittia hoitaviin lääkkeisiin. Lastenreumapotilaita, joilla on myös nuoruusiän diabetes, hoidettiin aktiivisemmin, koska näistä 19:lle (83 %) aloitettiin metotreksaatti ensimmäisen kolmen kuukauden aikana. Vastaava luku kaikilla lastenreumaa sairastavilla potilailla (1970) valtakunnallisesti oli 59 %. Ero oli tilastollisesti merkitsevä.Autoimmune diseases (AIDs) are chronic conditions that involve an immune attack on one or more organ systems. Juvenile idiopathic arthritis (JIA) belongs to AIDs with an unknown specific aetiology, with some evidence referring to genetic and environmental factors. Over the recent years, several studies have revealed that the prevalence of AIDs is higher among JIA patients than in controls. The occurrence of other AIDs was studied in 417 children referred to the Rheumatism Foundation Hospital (RFH) because of JIA during years 1992-2000. Children with JIA had approximately over 5-fold occurrence of diabetes mellitus type 1 (DM1), celiac disease (CD) or hypothyreosis (HT) compared to the population data available. The occurrence of AIDs was studied by questionnaires addressed to the families of the 362 JIA patients referred to the RFH in years 1996-2001. The questions concerned the AID diagnoses in these families: chronic arthritis (CA), DM1, CD and multiple sclerosis (MS). The families were also asked whether the patients or their first-degree relatives were entitled to a special reimbursement for medicines for diabetes or chronic arthritis by the Social Insurance Institution (SII), and what their exact diagnosis was. The diagnoses ultimately made by a physician and recorded as per the ICD-10 classification were then gathered. Almost a quarter, 21.4%, of the families had a member with another AID. The occurrence of JIA and DM1 among the JIA patients relatives was clearly higher than in the previously published studies. The characteristics of JIA were studied in 82 patients with both JIA and DM1 identified from the SII registers in years 1976-2005. The simultaneous occurrence of JIA and DM1 had increased over 5-fold as the first ten-year period (1976-1985) was compared with the last ten-year period (1996-2005). A quarter of these patients (22%) had a third AI disease. Seropositivity was recorded more often than expected and the proportion of uveitis was low. Almost a fifth of children in this group (16%) had serious psychiatric problems. The data on prescribed medication for JIA, reimbursed by SII for the first time in years 2000-2007, were collected from the SII registers. The number of identified patients younger than 16 years was 1970. The use of methotrexate (mtx) increased significantly whereas the use of prednisolone decreased during the study period. The influence of simultaneous DM1 to the drug treatment for JIA was studied in 1970 JIA patients identified in the SII registers from years 2000-2007. The diagnosis of DM1 was already made in 23 children. Mtx was introduced to 83% of these children during the first 3 disease months, compared to 59% in all Finnish JIA patients

Juvenile Idiopathic Arthritis: Studies on associated autoimmune diseases and drug therapy

Autoimmuunitaudit ovat kroonisia sairauksia, joissa elimistön oma poikkeavasti toimiva puolustusmekanismi kohdistuu yhteen tai useampaan elimeen tai kudokseen. Lastenreuma on autoimmuunitauti, jonka syy on edelleen avoin. Tutkimukset viittaavat sekä perimän että ympäristön vaikutukseen taudin synnyssä. Tutkimukset eri puolilta maailmaa ovat vahvistaneet, että normaaliväestöön verrattuna autoimmuunitauteja on enemmän sekä lastenreumapotilailla että heidän sukulaisillaan. Ensimmäisessä tutkimuksessa halusimme tutkia suomalaisten lastenreumapotilaiden muita autoimmuunitauteja. Tutkimme kaikkien vuosina 1992-2000 Heinolaan, Reumasäätiön Sairaalaan tutkimuksiin ja hoitoon ensi kertaa lähetettyjen lastenreumapotilaiden (417) sairauskertomukset Totesimme, että potilailla oli keskimäärin yli 5-kertainen todennäköisyys, verrattuna muuhun väestöön, saada joko nuoruusiän diabetes, keliakia tai hypothyreoosi. Lisäksi selvitimme lastenreumapotilaiden isän, äidin ja täyssisarusten autoimmuunitaudit. Vuosina 1996-2001 Reumasäätiön sairaalaan lähetettyjen 432 potilaan perheille postitettiin kyselylomake, jossa tiedustelimme perheen autoimmuunitauteja: krooninen reumatauti, keliakia, MS-tauti ja nuoruusiän diabetes. Saimme vastauksen 362:lta potilaalta. Noin viidesosassa (21,4 %) perheistä oli lastenreuman lisäksi joku muu autoimmuunitauti. Lastenreuman ja nuoruusiän diabeteksen esiintyvyys oli selvästi suurempi kuin aikaisemmissa väestötutkimuksissa. Lisäksi kolmannessa väitöskirjatyössä tarkastettiin valtakunnallisesti vuosilta 1976-2005 kaikkien lastenreumaa ja samanaikaista nuoruusiän diabetesta sairastavien potilaiden sairauskertomukset. Tutkimuksessa selvitettiin näiden tapausten ilmaantuvuus ja lastenreuman taudinkuva. Ilmaantuvuus oli noussut yli viisinkertaiseksi kolmen vuosikymmenen aikana. Tutkituista potilaista useampi kuin lastenreumapotilaista yleensä sairasti taudin reumafaktoripositiivista muotoa ja heillä esiintyi vähemmän kroonista reumaattista silmätulehdusta. Lähes neljäsosalla (22 %) oli joku kolmas autoimmuunitauti. Heillä oli myös huomattavasti enemmän (16 %) vaikeita psykiatrisia ongelmia muuhun väestöön verrattuna. Neljänneksi tutkimme sitä, mitä lääkkeitä lastenreuman hoitoon Suomessa valtakunnallisesti käytetään. Kansaeläkelaitoksen (KELA) tiedostoista kerättiin tiedot erityiskorvattavista lääkkeistä, jotka oli myönnetty kroonisen niveltulehduksen hoitoon alle 16-vuotiaille lapsille vuosina 2000-2007 ja samanaikaisista reseptiostoista. Aktiivinen lastenreuman hoito kannattaa, koska havaitsimme, että seurantajakson aikana metotreksaatin käyttö lisääntyi merkittävästi samalla kun kortisonin käyttö väheni. Selvitimme myös, miten samanaikainen nuoruusiän diabeteksen sairastaminen vaikutti lastenreuman lääkitykseen. KELAn tiedostoista löytyi 23 potilasta, joilla oli jo diagnosoitu DM1 ja joille myönnettiin korvattavuus kroonista artriittia hoitaviin lääkkeisiin. Lastenreumapotilaita, joilla on myös nuoruusiän diabetes, hoidettiin aktiivisemmin, koska näistä 19:lle (83 %) aloitettiin metotreksaatti ensimmäisen kolmen kuukauden aikana. Vastaava luku kaikilla lastenreumaa sairastavilla potilailla (1970) valtakunnallisesti oli 59 %. Ero oli tilastollisesti merkitsevä.Autoimmune diseases (AIDs) are chronic conditions that involve an immune attack on one or more organ systems. Juvenile idiopathic arthritis (JIA) belongs to AIDs with an unknown specific aetiology, with some evidence referring to genetic and environmental factors. Over the recent years, several studies have revealed that the prevalence of AIDs is higher among JIA patients than in controls. The occurrence of other AIDs was studied in 417 children referred to the Rheumatism Foundation Hospital (RFH) because of JIA during years 1992-2000. Children with JIA had approximately over 5-fold occurrence of diabetes mellitus type 1 (DM1), celiac disease (CD) or hypothyreosis (HT) compared to the population data available. The occurrence of AIDs was studied by questionnaires addressed to the families of the 362 JIA patients referred to the RFH in years 1996-2001. The questions concerned the AID diagnoses in these families: chronic arthritis (CA), DM1, CD and multiple sclerosis (MS). The families were also asked whether the patients or their first-degree relatives were entitled to a special reimbursement for medicines for diabetes or chronic arthritis by the Social Insurance Institution (SII), and what their exact diagnosis was. The diagnoses ultimately made by a physician and recorded as per the ICD-10 classification were then gathered. Almost a quarter, 21.4%, of the families had a member with another AID. The occurrence of JIA and DM1 among the JIA patients relatives was clearly higher than in the previously published studies. The characteristics of JIA were studied in 82 patients with both JIA and DM1 identified from the SII registers in years 1976-2005. The simultaneous occurrence of JIA and DM1 had increased over 5-fold as the first ten-year period (1976-1985) was compared with the last ten-year period (1996-2005). A quarter of these patients (22%) had a third AI disease. Seropositivity was recorded more often than expected and the proportion of uveitis was low. Almost a fifth of children in this group (16%) had serious psychiatric problems. The data on prescribed medication for JIA, reimbursed by SII for the first time in years 2000-2007, were collected from the SII registers. The number of identified patients younger than 16 years was 1970. The use of methotrexate (mtx) increased significantly whereas the use of prednisolone decreased during the study period. The influence of simultaneous DM1 to the drug treatment for JIA was studied in 1970 JIA patients identified in the SII registers from years 2000-2007. The diagnosis of DM1 was already made in 23 children. Mtx was introduced to 83% of these children during the first 3 disease months, compared to 59% in all Finnish JIA patients

Etanercept for patients with juvenile idiopathic arthritis : drug levels and influence of concomitant methotrexate: observational study

BackgroundEtanercept (ETN) is widely used tumour necrosis factor (TNF) blocker in the treatment of juvenile idiopathic arthritis (JIA) when traditional synthetic disease modifying antirheumatic drug (sDMARD) therapy is not sufficient. There is limited information about the effects of methotrexate (MTX) on serum ETN concentration in children with JIA. We aimed to investigate whether ETN dose and concomitant MTX would effect ETN serum trough levels in JIA patients, and whether concomitant MTX have an influence on the clinical response in patients with JIA receiving ETN.MethodsIn this study, we collected the medical record data of 180 JIA patients from eight Finnish pediatric rheumatological centres. All these patients were treated with ETN monotherapy or combination therapy with DMARD. To evaluate the ETN concentrations, blood samples of the patients were collected between injections right before the subsequent drug. Free ETN level was measured from serum.ResultsNinety-seven (54%) of the patients used concomitant MTX, and 83 (46%) received either ETN monotherapy or used sDMARDs other than MTX. A significant correlation was noted between ETN dose and drug level [r = 0.45 (95% CI: 0.33-0.56)]. The ETN dose and serum drug level were correlated (p = 0.030) in both subgroups - in MTX group [r = 0.35 (95% CI: 0.14-0.52)] and in non-MTX group [r = 0.54 (95% CI: 0.39-0.67)].ConclusionIn the present study, we found that concomitant MTX had no effect on serum ETN concentration or on clinical response. In addition, a significant correlation was detected between ETN dose and ETN concentration.Peer reviewe