Parity in patients with chronic inflammatory arthritides childless at time of diagnosis.

OBJECTIVE: To assess parity in women with chronic inflammatory arthritides (CIA) childless at time of diagnosis. METHODS: Patients were selected from the Norwegian Disease-Modifying Anti-Rheumatic Drug (NOR-DMARD) registry. Each patient was matched by year of birth with 100 reference women from the Norwegian Population Registry. Data linkage for patients and references with the Medical Birth Registry of Norway (MBRN) identified all offspring until time of linkage (October 2007). Patients and corresponding references childless at the time of diagnosis were included in the analyses. Kaplan-Meier curves visualized the proportion of childless women and were compared by a log rank test. RESULTS: In all, 156 rheumatoid arthritis (RA), 107 other chronic arthritides (OCA), and 75 juvenile idiopathic arthritis (JIA) patients were childless at time of diagnosis. At the time of data linkage, the proportions (%) of childless RA/OCA/JIA patients versus references were 61.5/62.6/57.3 versus 46.9/42.9/41.0, respectively, all differences statistically significant. The log rank test showed lower parity in all diagnostic groups compared with references (p < 0.001 for RA and OCA and p = 0.002 for JIA). No difference in parity was observed between RA and OCA patients, but both diagnostic groups had lower parity than JIA patients (p = 0.001). Disease characteristics were similar between childless and fertile patients. CONCLUSIONS: Reduced parity was observed in all diagnostic groups compared with references. RA and OCA patients had lower parity than JIA patients, indicating that having the disease as a young adult may influence parity more than having the disease in childhood.

Postpartum onset of rheumatoid arthritis and other chronic arthritides: results from a patient register linked to a medical birth registry.

BACKGROUND: It is known that onset of rheumatoid arthritis (RA) is increased post partum. OBJECTIVE: To compare incidence rates between RA and other chronic arthritides (OCA) 0-24 months after delivery, and to compare the incidence rates within each group 0-24 versus 25-48 months post partum. METHODS: Premenopausal women from a Norwegian patient register were linked with the Medical Birth Registry of Norway to study the interval between delivery and time of diagnosis. Cox regression analysis with adjustments for age at delivery and birth order was applied to compare proportions of incident cases of RA and OCA with onset 0-24 months post partum. Poisson regression analysis with adjustment for the population at risk was applied to estimate the incidence rate ratio (IRR) 0-24 versus 25-48 months post partum. RESULTS: Of 183 RA and 110 patients with OCA diagnosed after delivery, 69 (37.7%) had RA and 31 (28.2%) OCA during the first 24 months post partum (p = 0.09). The IRR (95% CI) for diagnosis during 0-24 months versus 25-48 months was 1.73 (1.11 to 2.70) (p = 0.01) for RA, 1.05 (0.59 to 1.84) (p = 0.86) for OCA. The IRR was 2.23 (1.06 to 4.70) and 1.87 (0.67 to 5.21), respectively, when only considering diagnoses after the first pregnancy. Clinical characteristics were similar within each diagnostic group. CONCLUSION: The proportions of incident cases with onset 0-24 months after delivery were not different between RA and OCA. A peak in incidence during 0-24 months was seen in the RA group, both when considering all pregnancies and only the first pregnancy.

Comparison of work disability and health-related quality of life between males and females with rheumatoid arthritis below the age of 45 years.

OBJECTIVES: To compare work disability (WD) and health status between males and females with rheumatoid arthritis (RA) in the age group 18-45 years, and to compare health status between patients with and without WD within each gender, and finally to identify factors independently associated with WD in this age group. METHODS: A cross-sectional study of RA patients at the time starting with disease-modifying antirheumatic drug (DMARD) therapy and/or biological treatment. Patients receiving a permanent, national WD pension corresponding to >or= 50% were defined as work disabled. We examined gender differences with regard to disease characteristics, health status and WD. The Mann-Whitney U-test and Pearson's chi(2)-test were applied for group comparisons. Multiple logistic regression analyses with adjustments for duration of education, disease duration, age, erosive disease, disability score [using the Modified Health Assessment Questionnaire (MHAQ)], Disease Activity Score-28 (DAS-28), the Short Form Health Survey (SF-36) mental health score and gender were used to identify variables associated with WD. RESULTS: Out of 474 (372 females) patients, the number (%) of work-disabled females/males was 91 (24.7)/8 (8.1) (p<0.001). WD was associated with worse health status in both genders. The odds ratio (95% confidence interval) [OR (95% CI)] for WD in females vs. males was 4.84 (1.85-12.65) in the multivariate analyses. Other factors independently associated with WD were worse mental health, disease duration and low level of education. CONCLUSION: Females with RA had a fourfold increased risk of WD compared to men. Low level of education, disease duration and worse mental health were also independently associated with WD.

Work disability and health-related quality of life in males and females with psoriatic arthritis.

OBJECTIVES: To compare health status, demographic variables and work disability (WD) between males and females with psoriatic arthritis (PsA) in the 18-45 age group, and further to compare health status between those with and without WD for each gender and to identify variables associated with WD. METHODS: A cross-sectional study was carried out of patients with PsA with peripheral arthritis at the time at which they started disease-modifying antirheumatic drug therapy (DMARD) and/or biological treatment. Patients receiving a permanent national WD pension corresponding to >or=50% were defined as work disabled. Gender differences were examined with regard to health status, demographic variables and WD. Mann-Whitney U test and Pearson chi(2) were applied for group comparisons between males and females and work disabled versus not work disabled for each gender. Multiple logistic regression analyses with adjustments for duration of education, disease duration, age, erosive disease, disability score (Modified Health Assessment Questionnaire; MHAQ), the short form-36 (SF-36) mental health score, and gender were used to identify variables associated with WD. RESULTS: Out of 271 (102 females) patients, the number (%) of work-disabled females/males was 33 (32.7%)/29 (17.4%) (p = 0.004). Work-disabled patients had generally worse health status than non-work-disabled patients, and these differences were generally more pronounced in males than in females. In the multiple logistic regression model, low educational level, increasing disability score (MHAQ), presence of erosive disease, female gender and disease duration were independently associated with WD. CONCLUSIONS: WD in patients with PsA below 45 years of age was independently associated with educational level, disability score, erosive disease, female gender and disease duration.

Inflammatory aortic aneurysm is associated with increased incidence of autoimmune disease.

OBJECTIVE: It has been suggested that certain genetic risk factors indicative of an autoimmune mechanism can be identified in patients with inflammatory aortic aneurysm (IAA). We therefore investigated whether there was a higher incidence of autoimmune diseases in patients with IAA. Further, we explored risk factors, need for in-hospital resources, and early results of treatment, in a case-control study in a university hospital setting. Material and methods From 1983 to 1994, 520 patients were operated because of abdominal aortic aneurysm (AAA). Thirty-one patients had IAA. Control subjects were matched for aneurysm rupture, emergency or elective hospital admission, and date of operation. Two noninflammatory AAA were included for every IAA. RESULTS: Of the 31 patients with IAA, 6 patients (19%) had autoimmune disease, compared with none of the control subjects (P =.0017). Two patients had rheumatoid arthritis, 2 patients had systemic lupus erythematosus, 1 had giant cell arteritis, and 1 patient had an undifferentiated seronegative polyarthritis diagnosed as rheumatoid arthritis. Nineteen patients (61%) with IAA had involvement of the duodenum, and 8 patients (26%) had hydronephrosis with ureteral involvement. Operating time was longer in the IAA group, which also had a higher need for blood transfusion. Hospital stay, intensive care unit stay, and 30-day mortality were similar in the two groups. CONCLUSION: Except for longer operating time and more need for blood transfusions in the IAA group, use of hospital resources was similar after operations to treat IAA or noninflammatory AAA. The study findings indicate an association between IAA and autoimmune disease. This is in accordance with other reports that showed a genetic risk determinant mapped to the human leukocyte antigen (HLA) molecule in these patients. Further research is necessary to explore whether IAA might be a separate entity with a role of antigen binding in the origin of the disease.

Number of births, interpregnancy interval, and subsequent pregnancy rate after a diagnosis of inflammatory rheumatic disease in Norwegian women.

OBJECTIVE: To study female reproduction, i.e., number of births, subsequent pregnancy rate, and interpregnancy interval after diagnosis of inflammatory rheumatic disease. METHODS: In a national population based cohort study, reproduction in mothers with rheumatic disease, registered with the Medical Birth Registry of Norway 1967-1995, were compared to mothers without such diagnoses. RESULTS: After diagnosis, women with rheumatic disease had a statistically significant lower mean number of births, a shorter time span of reproduction, longer interpregnancy intervals, and a reduced subsequent pregnancy rate. CONCLUSION: Altered reproduction observed in women with a rheumatic disease might reflect various mechanisms not accounted for in this study, but possibly related to the disease process, functional impairment, or medical treatment.

[Takayasu's arteritis]. / Takayasus arteritt.

BACKGROUND: Takayasu's arteritis is a chronic, idiopathic, inflammatory disease that affects aorta and its main branches. The disease is rare; its etiology is unknown and shows race differences. The inflammation of the arteries may lead to stenosis, occlusions, dilatations or aneurysms. The clinical picture and angiographic findings are not previously reported in a Norwegian cohort. MATERIAL AND METHODS: We report a retrospective, hospital-based study describing the clinical picture, diagnostic findings, treatment and prognosis in a cohort of six patients in Central Norway with Takayasu's arteritis. The data was extracted through chart review. RESULTS: In the period 1988-2000, six patients with Takayasu's arteritis, five women and one man, were identified. All the patients were of Norwegian origin. Median age at diagnosis was 39 years, range 24-63 years, and median time from first symptoms to definite diagnosis was six months, range 1-36 months. The estimated minimum annual incidence was 0.8 per million. All patients had elevated erythrocyte sedimentation rate; five out of six patients had unilateral or bilateral subclavian stenosis; one patient had a thoracoabdominal aneurysm. All patients were treated with prednisolone. There were no deaths in the observation period of median 7.5 years, range 0-26 years. INTERPRETATION: Takayasu's arteritis is a rare disease in our region, with lower incidence than reported in the literature. The prognosis is excellent, but the morbidity was substantial. The clinical findings are similar to those reported in other studies. The location and appearance of the angiographic findings were characteristic for the disease.

Pregnancy complications and delivery practice in women with connective tissue disease and inflammatory rheumatic disease in Norway.

OBJECTIVE: To assess possible associations between inflammatory rheumatic disease and pregnancy complications/delivery practice. METHODS: In a population based study proportions were compared of obstetrical complications and interventions at delivery notified to the Medical Birth Registry of Norway during the years 1967-95 in women with (3,403) and without (671,221) rheumatic disease. RESULTS: Women with rheumatic disease had significantly higher rates of preeclampsia and cesarean section. The relative risk of preeclampsia was particularly high in women with connective tissue disease in the years 1977-86. In women with inflammatory arthritides, the relative risk of preeclampsia was particularly high during 1987-95. The relative risk of cesarean section was high in all patient groups throughout the observation period and particularly in women with connective tissue disease. CONCLUSION: High rates of preeclampsia and cesarean section in connective tissue disease pregnancies documented in a population based study emphasize the importance of monitoring and obstetrical interventions.

Reproduction in women reporting chronic musculoskeletal disorders.

UNLABELLED: The present population based study assessed aspects of female health as a part of a national cardiovascular screening program in 40-42 year old women in the Sor-Trondelag county. Fertility, events related to the menstrual cycle, reproduction, and the use of contraceptive methods in women reporting musculoskeletal diseases (MSD) were compared to women without these disorders (references). A higher proportion of women with MSD reported subfertility. No significant difference in mean age of menarche or menstrual cycling pattern was found, however women reporting MSD had significantly more often metrorrhagia than references. Mother's age at birth of the first and last child differed from references only in two of the patient groups, and interval between pregnancies was longer in women with MSD. Women with MSD more often chose sterilisation as a contraceptive method. CONCLUSION: Reproduction was altered in women with MSD. It remains to elucidate the interrelationship between rheumatic disorders and gynecological dysfunction.

[Polychondritis--a rare and difficult diagnosis]. / Polykondritt--en vanskelig og sjelden diagnose.

We present two patients with polychondritis. Polychondritis is a rare inflammatory disease of unknown origin, but immunological mechanisms are essential in the pathogenesis. Histological features are inflammation and destruction of cartilage. The disease is systemic, may have a remitting course, and it can be primary or associated with several other diseases. We also review the literature with emphasis on symptoms, clinical presentation, diagnostic procedures and treatment. The literature consists mainly of case reports, summary of case reports, no epidemiological and only few clinical studies. Two sets of diagnostic criteria with great similarities have been proposed. Non-steroidal antiinflammatory drugs or immunosuppressive drugs like glucocorticoids and cyclophosphamide are the drugs of choice, depending on the stage and severity of the disease.

Perinatal outcome in pregnancies of women with connective tissue disease and inflammatory rheumatic disease in Norway.

Perinatal outcome in infants of women with rheumatic disease notified between 1967 95 to the Medical Birth Registry of Norway was compared to women without such disease. Logistic regression provided odds ratios for associations between rheumatic disease and perinatal outcome for 3 time periods: 1967-76, 1977-86, and 1987-95. Women with rheumatic disease had significantly higher rates of preterm birth than references and this was only partly correlated to the increased occurrence of preeclampsia. The risk of small for gestational age (SGA) infants was significantly higher both in women with connective tissue disease (CTD) and inflammatory arthritides. The proportion of infants with Apgar score < = 6 after 1 minute and 5 minutes was significantly increased in the CTD group indicating moderate to severe fetal asfyxia. The rate of perinatal mortality was high in the CTD group and postperinatal mortality was increased in infants born to mothers with rheumatic disease. Thus, rheumatic disease not only comprises pregnancy outcome, but increases the risk of adverse perinatal outcome.

Obstetrical and neonatal outcome in pregnant patients with rheumatic disease.

Possible associations between inflammatory rheumatic and connective tissue disease and adverse pregnancy outcome were assessed by using the Medical Birth Registry of Norway during the years 1967-95. All women with rheumatic disease were compared to women without such disease. Data on pregnancy outcome and deliveries were analyzed after adjustment for possible confounding factors. Women with rheumatic disease had significantly higher rates of preeclampsia, premature delivery and cesarean section as well a significantly increased relative risk of SGA children in all diagnostic groups in 1967-95. These findings emphasize the importance of close monitoring of pregnancy and delivery not only in patients with connective tissue disease, but also in patients with other inflammatory rheumatic disease.

[Systemic sclerosis. A diagnostic and follow-up program]. / Systemisk sklerose. Et utrednings--og kontrollprogram.

Systemic sclerosis (scleroderma) is a rare chronic progressive multiorgan disease characterized by elevated collagen content in affected organs. The condition is classified in the group connective tissue diseases, and appears in both a systemic and a limited form. The rate of progression and the prognosis differ for the two forms. The heterogeneity of the disease makes systematic examination of the patients necessary in order to provide a correct diagnosis and classification as a basis for therapy and prognosis. Based on the low incidence and prevalence of the disease, the care of these patients should be a specialist task. At our department, a programme has been introduced consisting of clinical examination, immunological and biochemical analysis, histological examination and different imaging techniques, and with an interdisciplinary approach. This programme has made the management of these patients more standardized.

The outcome of ankylosing spondylitis: a study of 100 patients.

The outcome was studied in 100 patients with adult-onset primary ankylosing spondylitis (AS). After a mean disease duration of 16 yr, 51.5% of the patients were employed in full-time work. Cessation of work occurred at a mean disease duration of 15.6 yr, and was significantly associated with female sex, low levels of education, acute anterior uveitis, 'bamboo spine' and the co-existence of non-rheumatic diseases. Functional outcome was studied by analysing activities of daily living, and revealed similar findings in males and females. Most of the loss of function occurred during the first 10 yr of disease, and correlated significantly with the occurrence of peripheral arthritis, spinal X-ray changes of AS and development of 'bamboo spine'. After > 20 yr of disease, > 80% of the patients still complained of daily pain and stiffness, and > 60% reported daily use of drugs.

HLA-B27 negative ankylosing spondylitis in a father and a son.

Only 5% of AS patients are B27 negative. We describe two cases of HLA-B27 negative AS in a father and a son who both developed clinical and radiological features characteristic of AS. Tissue typing for HLA-A,-B,-C was performed in all 1.degree family members except for the father who died in 1990. All family members possessed B40. HLA-B40 may contribute to an increased susceptibility for AS not only in B27 positive individuals but also in B27 negative cases.

[Injuries following a hurricane in Nordmøre]. / Helseskader som følge av orkan på Nordmøre.

In this article we describe the efforts of local authorities to detect and treat casualties caused by a hurricane that struck the west coast of Norway January 1st, 1992 and prevent further injuries. Wind velocity exceeded 100 knots (117 mph), the strongest ever recorded in Norway. The damage to buildings, trees and power lines was so devastating that the Nordmøre area, with approximately 50,000 inhabitants, was left without electricity for five days. Altogether 56 casualties were reported by physicians and the local hospital (one death, caused by hypothermia and exhaustion, and six admissions to hospital) in the period 1-5 January. Nine old people suffered injuries by falling in the dark in their houses, and ten men were injured during repair work.