The prevalence and severity of rheumatoid arthritis in Oslo. Results from a county register and a population survey.

The objective was (1) to examine the prevalence of rheumatoid arthritis (RA) by a county patient register, (2) to cross-validate the register findings by a postal population survey, and (3) to estimate prevalences of disease subsets according to age, sex, and levels of physical disability. The study was performed within a county setting in the city of Oslo with 356,486 inhabitants between 20 and 79 years of age. Prevalence estimates were calculated from a county patient register comprising 1333 patients with RA and a population survey of 10,000 inhabitants. The overall prevalence of RA between 20 and 79 years was 0.437 (95% CI 0.413, 0.461) after adjusting for the incompleteness of the register by a factor of 1.17. Prevalences exceeding 1.0% was only found among females over 60 years. The prevalence of RA with MHAQ scores > or = 1.5 and > or = 2.0 (range 1-4) was 0.225 (95% CI 0.209, 0.243) and 0.099 (0.088, 0.111) respectively. We conclude that RA is less frequent in the city of Oslo than stated in most of the literature. The prevalence of RA with physical disability levels assumed to be associated with increased mortality is less than half of the overall prevalence of 0.4-0.5%.

The validity of self-reported diagnosis of rheumatoid arthritis: results from a population survey followed by clinical examinations.

OBJECTIVE: Self-reported diagnoses of rheumatic conditions are frequently used in epidemiological and clinical research. Our objectives were to examine the validity of patient self-reported rheumatoid arthritis (RA); and to assess the predictive value of symptoms, health status measures, and demographic variables with respect to the actual diagnosis. METHODS: A postal survey was performed in Oslo of 10,000 randomly selected individuals between 20 and 79 years of age. Respondents reported musculoskeletal pain, stiffness, rheumatic diagnoses, disability, and mental distress. The patients reporting RA (either according to patient or doctor) were selected for further examination. RESULTS: Of 5886 respondents (3670 with musculoskeletal pain or stiffness) 158 patients (2.7%) reported having RA diagnosed by doctor (n = 107) and/or according to their own opinion (n = 142). RA was confirmed by clinical examination in 35 of these 158 individuals (22%, CI 16,29). Patients with perceived and actual RA differed regarding self-reported presence of swollen joints and disability score. Multivariate analyses failed to identify a set of useful predictors for the correct diagnosis. CONCLUSION: Patient self-reported diagnosis of RA is unreliable for research or clinical purposes.

[Splenectomy and pneumococcal vaccine. How to follow-up?]. / Miltekstirpasjon og pneumokokkvaksine. Hvordan bør oppfølgingen foregå?

The authors describe the case of an otherwise healthy man who died from pneumococcal septicemia 18 years after having undergone splenectomy. It is widely accepted that splenectomized patients run increased risk of serious bacterial infections. Meningitis and septicemia caused by encapsulated organisms, especially Streptococcus pneumoniae, are most important in this respect, with a reported mortality of 30-60%. Since 1977, splenectomized patients have been offered pneumococcal vaccine as a routine, but persons who was splenectomized before 1977 are not identified, and run an unknown risk of serious infectious disease. Possible approaches to this problem of identification are discussed.