Education, employment, absenteeism, and work disability in women with systemic lupus erythematosus.

OBJECTIVES: To study education, employment, absenteeism, and work disability (WD) in women with systemic lupus erythematosus (SLE) compared to population controls. METHOD: The study included 181 women of working age with SLE (mean age 44.0 years, disease duration 12.7 years) and 549 female population controls matched for age living in the same metropolitan area of Helsinki. Data regarding education, employment, absenteeism, and WD in patients and controls were obtained by questionnaire and personal interview. RESULTS: Basic education, vocational, or academic degrees and occupational categories in patients with SLE were similar to those in controls. In total, 62% of the patients were employed, compared to 77% of the controls (p < 0.001). During the preceding 12 months, employed SLE patients had been on sick leave for 25.4 days vs. 10.2 days in controls (p < 0.001). Subjective work ability regarding physical and mental demands of the job were lower in SLE patients than in controls (p < 0.001 and p = 0.036, respectively). The rate of permanent WD, defined as receiving disability benefits, was 34.3% in SLE patients vs. 10.3% in controls (p < 0.001). Cumulative WD due to SLE 5, 10, and 20 years after the clinical diagnosis was 13, 22, and 47%, respectively. CONCLUSIONS: SLE does not seem to affect educational achievements and the employment rate for SLE patients is reasonably high. Absenteeism and work disability are, however, 2-3 times more common than in controls. Less than half of the patients were on permanent disability pension due to SLE 20 years after diagnosis of the disease.

The return of unexpected research results in a biobank study and referral to health care for heritable long QT syndrome.

BACKGROUND: In this study, we examined how biobank study participants, who were found to have long QT syndrome (LQTS), a potentially life-threatening but treatable cardiac arrhythmia condition, experienced the process of disclosure of unexpected results and referral to health care. METHODS: All 27 subjects with a LQTS mutation finding were asked to complete a questionnaire. Four participants did not uptake the re-testing and 5 others did not respond to the questionnaire. We received 17 questionnaires from 6 males and 11 females, aged 46-82; 5 of them were also willing to participate in qualitative interviews. RESULTS: Of the respondents, 16/17 had experienced the process of receiving the results as positive and useful, especially if they had had symptoms. One respondent experienced the process negatively due to concerns related to informing her children. All respondents felt that genetic results should be reported back to the participants, while 2 indicated that this should occur only in the case of treatable conditions. Respondents had informed all of their children about the genetic condition, except 2 minors. CONCLUSIONS: The respondents from a population biobank study who were informed about an unexpected genetic finding evaluated this process as mainly positive. They considered that delivering genetic information about a life-threatening but actionable condition has more beneficial than adverse consequences. The feedback policy for biobanks should include how and who is informed, advise treatment or care pathways for actionable findings, and it should also include suitable options for those who do not want to know about such findings.

Frequency of and risk factors for symptomatic bone fractures in patients with systemic lupus erythematosus.

OBJECTIVES: To study risk factors for symptomatic bone fractures in patients with systemic lupus erythematosus (SLE) and to compare the frequency of fractures between SLE patients and population controls. METHOD: The study included 222 SLE patients [mean age 47.0 years, disease duration 13.1 years, 204 (92%) women] and 720 population controls living in the metropolitan area of Helsinki. The history of symptomatic bone fractures in SLE patients and controls was recorded by interview, and demographic and clinical data of SLE patients were obtained by interview, clinical examination, and chart review. RESULTS: A history of at least one symptomatic bone fracture was recorded in 93 (42%) of all 222 patients with SLE. The risk of any fracture in 204 women with SLE compared to controls was 1.8 [95% confidence interval (CI) 1.3-2.4] and fractures in the ankle, hip, and vertebral column were more common than in female controls, with odds ratios (ORs) of 2.0 (95% CI 1.1-3.7), 5.1 (95% CI 1.2-21.5), and 4.0 (95% CI 1.8-8.6), respectively. In 18 men with SLE, compared to male controls, no difference in the frequency of fractures was observed (OR 0.7, 95% CI 0.3-2.0). Risk factors for bone fractures in women with SLE were age (p = 0.008), comorbidity (p = 0.050), and the duration of corticosteroid use (p = 0.025). CONCLUSIONS: Symptomatic bone fractures, especially in the ankle, hip, and vertebral column, are common in women with SLE. Special attention should be paid to preventing fractures in elderly female patients with comorbidities and a long duration of corticosteroid use.

Reproductive health in women with systemic lupus erythematosus compared to population controls.

OBJECTIVE: To study the reproductive health history in women with systemic lupus erythematosus (SLE) compared to population controls. METHODS: A total of 206 female SLE patients were interviewed regarding demographic and disease data, menstruation, use of contraception and hormone replacement therapy (HRT), infertility, and pregnancies. The control group consisted of 1037 women from the general population of similar age and socioeconomic status living in the same region. RESULTS: In SLE women compared to population controls, mean age at menarche (13.3 vs. 13.2 years) and frequency of infertility (16% vs. 16%) were similar but menopause occurred earlier (44.9 vs. 46.8 years, p = 0.01). Current use of oral contraceptives (OCs) was less common than in controls [18% vs. 28%, odds ratio (OR) 0.55, 95% CI 0.3-1.0] while previous use of progesterone-containing intrauterine devices (IUDs) was more common (13% vs. 5%, OR 3.2, 95% CI 1.9-5.4). Current use of HRT was similar (22% vs. 21%) but SLE patients had started the use earlier (43.2 vs. 47.1 years, p = 0.003). Mean number of pregnancies was lower in SLE patients compared to controls (2.3 vs. 2.5, p = 0.046) and in lupus nephritis patients compared to SLE patients without nephritis (1.9 vs. 2.5, p = 0.01). No difference was found in the occurrence of spontaneous and induced abortions compared to controls, but pregnancy-associated complications were more common in SLE women. CONCLUSION: When compared to population controls women with SLE are normally fertile, use less OCs and more IUDs, have earlier menopause and use HRT as frequently. Family size is reduced, especially in lupus nephritis patients, and pregnancy-associated complications are more common.

Self-reported dental health, treatment need and attendance among older adults in two areas of Finland.

OBJECTIVE: The purpose of the study was to assess differences in dental health, need for care and attendance among older adults in two areas of Finland with contrasting socio-cultural and economic backgrounds. A further aim was to analyse and compare the determinants of oral health and dental visiting patterns. BASIC RESEARCH DESIGN AND PARTICIPANTS: FINRISK senior survey was conducted by the National Public Health Institute in the two areas in 1997. Data were collected through a postal questionnaire, a health examination and an interview, which included questions of number of extracted teeth, dental treatment need and utilisation. The sample consisted of 1,500 persons, 250 women and 500 men aged 65-74 years in both areas; the response rate was 86%. RESULTS: Forty-one per cent of the respondents reported having lost all their teeth and 44% had visited a dentist during the past year. Differences between the areas concerning both dental health and attendance were considerable. Respondents living in North Karelia had lost more teeth and visited a dentist more seldom than respondents in the Helsinki region. Risk indicators for the number of extracted teeth differed between the areas, while determinants for the dental attendance during the previous year were almost identical. The major predictors for a dental visit during the previous year were number of teeth and household income. Self-perceived need for dental care was minor. Functional capacity, medically compromising diagnoses or medication did not play any apparent role in dental attendance. CONCLUSIONS: The number of teeth together with income are the principal determinants for dental visits among older persons in Finland.

Antifilaggrin antibodies within "normal" range predict rheumatoid arthritis in a linear fashion.

OBJECTIVE: Increasing attention has been paid to the significance of antifilaggrin antibodies (AFA) in rheumatoid arthritis (RA). We studied the prediction of RA by AFA in serum specimens from the period prior to the onset of clinical RA. METHODS: A case-control study was nested within a Finnish cohort of 19.072 adults who had neither arthritis nor a history of it at the baseline examination during 1973-77. Pre-illness serum specimens for the assay of AFA by ELISA, using filaggrin purified from human skin as the antigen, were available from 124 of the 126 patients who had developed RA by late 1989. Of the incident cases 89 were positive for rheumatoid factor (RF). Three controls per each incident case were individually matched for sex, age, and municipality. RESULTS: Pre-illness serum AFA level was found to be directly proportional to the risk of RF positive RA. The odds ratio (95% confidence interval) in the highest quintile compared to the lowest quintile was 5.4 (2.2-13.6). In the subgroup of subjects positive for RF at baseline the figure was 24 (4.0-140). AFA did not predict the development of RF negative RA. A close association of the same order of magnitude between RF and AFA was noted in the pre-illness sera and in the control sera. CONCLUSION: AFA still within the "normal" range predicts RA in a linear fashion. AFA and RF are associated markers of the rheumatoid immunological process.

Serum C-reactive protein does not predict rheumatoid arthritis.

OBJECTIVE: Clinical rheumatoid arthritis (RA) is preceded by an immunological process. Our objective was to investigate C-reactive protein (CRP) for its prediction of RA. METHODS: A case-control study was nested within a Finnish cohort of 19,072 adults who had no arthritis and no history of the disease at the baseline examination conducted between 1973 and 1977. By late 1989, 124 had developed RA. Three controls for each incident case were individually matched for sex, age, and municipality. The CRP concentration was measured by a sensitive ELISA. RESULTS: No difference was noted in serum CRP levels between cases and controls. The odds ratios (95% confidence intervals) of RA in the quintiles of CRP were 1.0, 0.89 (0.45-1.76), 1.11 (0.59-2.08), 0.99 (0.51-1.91), and 0.95 (0.49-1.87). Similarly, there was no difference when the data were analyzed in strata of sex, age, rheumatoid factor (RF) status at baseline, and length of time from taking the specimens to the onset of clinical disease. CONCLUSION: Pre-rheumatoid immunological process as reflected in RF production is not associated with any marked inflammation or tissue injury heightening CRP.