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1.
J Clin Med ; 12(23)2023 Nov 27.
Article in English | MEDLINE | ID: mdl-38068399

ABSTRACT

Pain is one of the most important areas to focus on in the assessment and treatment of psoriatic arthritis (PsA), and treatment should be individualized and based on the needs of the patient. Therefore, our aim was to explore and describe the management of pain among patients with PsA. We conducted semi-structured interviews with 11 participants with PsA (3 men and 8 women) and used qualitative content analysis to analyze the text. The results showed a main overarching theme of meaning and three subthemes. They were 'Taking charge of life despite the constant murmur of pain' through 'Sorting out vulnerability', 'Reaching acceptance and engagement', and 'Directing focus to change'. Nine categories further described the components of pain management: 'face uncertainty for the future, 'consider restrictions', 'illuminate the invisible', 'increase awareness', 'find a permissive environment and social support', 'enhance inner endurance', 'reformulate emotions and thoughts', 'use distracting activities', and 'adjust activities'. The action components of pain management interpreted from a theoretical perspective highlight the importance for the patients of attaining the satisfaction of three basic psychological needs, i.e., competence, autonomy, and relatedness. Health professionals therefore need to increase the skills required for needs-supportive behaviors as well as facilitating spouse and peer support in the management of pain in PsA.

2.
Arthritis Care Res (Hoboken) ; 75(4): 793-800, 2023 04.
Article in English | MEDLINE | ID: mdl-35412031

ABSTRACT

OBJECTIVE: Normal age-related decline and temporary restrictions in mobility complicate the understanding of spinal mobility deterioration over time in patients with ankylosing spondylitis (AS). In this study, we aimed to determine whether spinal mobility deterioration occurred linearly in patients with AS. We also aimed to compare patterns of change with corresponding age-related normal values and analyze variations in temporary fluctuations in mobility measurements over time. METHODS: We included 111 men and 30 women (median age 20.9 years at symptom onset), who were followed for a median of 34 years since symptom onset. This inclusion resulted in 9,697 spinal mobility measurements for analysis. Individual linear regression models for development of lateral spinal flexion (LSF), the 10-cm Schober test (ST10), chest expansion (CE), and cervical rotation (CR) were analyzed and compared with normal age-related decline over time. RESULTS: The median values for the constants of all measurements were significantly lower than the norm data. However, LSF, ST10, and CE followed a yearly linear decline comparable to the norm data, whereas CR declined approximately twice as fast as expected from the norm data (beta median -0.62° [25th-75th percentile -1.16, -0.22] and -0.35° [25th-75th percentile -0.35, -0.35], respectively). Temporary fluctuations in LSF and CE were significantly higher during the early phase of the disease, with decreasing residuals over time. CONCLUSION: Based on median constants of our data, mobility restrictions related to AS seem to mainly occur during the first years of disease, indicating a narrow window of opportunity for prevention.


Subject(s)
Spondylitis, Ankylosing , Male , Humans , Female , Young Adult , Adult , Spondylitis, Ankylosing/diagnosis , Spine , Range of Motion, Articular , Physical Examination , Time
3.
Am J Gastroenterol ; 118(4): 702-711, 2023 04 01.
Article in English | MEDLINE | ID: mdl-36227801

ABSTRACT

INTRODUCTION: We investigated the impact of changes in lifestyle habits on colorectal cancer (CRC) risk in a multicountry European cohort. METHODS: We used baseline and follow-up questionnaire data from the European Prospective Investigation into Cancer cohort to assess changes in lifestyle habits and their associations with CRC development. We calculated a healthy lifestyle index (HLI) score based on smoking status, alcohol consumption, body mass index, and physical activity collected at the 2 time points. HLI ranged from 0 (most unfavorable) to 16 (most favorable). We estimated the association between HLI changes and CRC risk using Cox regression models and reported hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Among 295,865 participants, 2,799 CRC cases were observed over a median of 7.8 years. The median time between questionnaires was 5.7 years. Each unit increase in HLI from the baseline to the follow-up assessment was associated with a statistically significant 3% lower CRC risk. Among participants in the top tertile at baseline (HLI > 11), those in the bottom tertile at follow-up (HLI ≤ 9) had a higher CRC risk (HR 1.34; 95% CI 1.02-1.75) than those remaining in the top tertile. Among individuals in the bottom tertile at baseline, those in the top tertile at follow-up had a lower risk (HR 0.77; 95% CI 0.59-1.00) than those remaining in the bottom tertile. DISCUSSION: Improving adherence to a healthy lifestyle was inversely associated with CRC risk, while worsening adherence was positively associated with CRC risk. These results justify and support recommendations for healthy lifestyle changes and healthy lifestyle maintenance for CRC prevention.


Subject(s)
Colorectal Neoplasms , Life Style , Humans , Risk Factors , Prospective Studies , Nutritional Status , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/prevention & control
4.
ACR Open Rheumatol ; 3(3): 138-146, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33570840

ABSTRACT

OBJECTIVE: We aimed to determine relationships between objectively measured nightly sleep, sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) with risk factors for cardiovascular disease (CVD) in patients with early rheumatoid arthritis (RA). Furthermore, we aimed to estimate consequences for these risk factors of theoretical displacements of 30 minutes per day in one behavior with the same duration of time in another. METHODS: This cross-sectional study included 78 patients with early RA. Nightly sleep, SB, LPA, and MVPA were assessed by a combined heart rate and accelerometer monitor. Associations with risk factors for CVD were analyzed using linear regression models and consequences of reallocating time between the behaviors by isotemporal substitution modeling. RESULTS: Median (Q1-Q3) nightly sleep duration was 4.6 (3.6-5.8) hours. Adjusted for monitor wear time, age, and sex, 30-minutes-longer sleep duration was associated with favorable changes in the values ß (95% confidence interval [CI]) for waist circumference by -2.2 (-3.5, -0.9) cm, body mass index (BMI) by -0.9 (-1.4, -0.4) kg/m2 , body fat by -1.5 (-2.3, -0.8)%, fat-free mass by 1.6 (0.8, 2.3)%, sleeping heart rate by -0.8 (-1.5, -0.1) beats per minute, and systolic blood pressure by -2.5 (-4.0, -1.0) mm Hg. Thirty-minute decreases in SB, LPA, or MVPA replaced with increased sleep was associated with decreased android fat and lower systolic blood pressure levels. Replacement of SB or LPA with MVPA yielded lower BMIs. CONCLUSION: Shorter sleep during the night is common among patients with early RA and is associated with adverse risk factors for CVD.

5.
J Rheumatol ; 48(3): 352-360, 2021 03.
Article in English | MEDLINE | ID: mdl-32611672

ABSTRACT

OBJECTIVE: Ankylosing spondylitis (AS) is associated with an elevated risk of cardiovascular disease (CVD) related to atherosclerosis, preceded by arterial stiffness. We aimed to examine common carotid artery (CCA) biomechanical properties using ultrasound to calculate ß stiffness index (indicating arterial stiffness) and, a more recently developed technique, 2-dimensional (2D) speckle tracking strain (indicating arterial motion and deformation, strain) to (1) compare with age- and sex-matched controls, and (2) analyze relationships between strain and stiffness with disease characteristics and traditional risk factors for CVD in patients with AS. METHODS: In this cross-sectional study, a cohort of 149 patients with AS, mean age 55.3 ± 11.2 years, 102 (68.5%) men, and 146 (98%) HLA-B27-positive, were examined. Bilateral CCA were examined for circumferential 2D strain and ß stiffness index. A subgroup of 46 patients was compared with 46 age- and sex-matched controls, both groups without hypertensive disease, diabetes, myocardial infarction, or stroke. RESULTS: Mean bilateral circumferential 2D strain was lower in AS patients compared with controls (7.9 ± 2.6% vs 10.3 ± 1.9%, P < 0.001), whereas mean bilateral ß stiffness index was higher (13.1 ± 1.7 mmHg/mm vs 12.3 ± 1.3 mmHg/mm, P = 0.02). In multivariable linear regression analyses, strain was associated with age, erythrocyte sedimentation rate, history of anterior uveitis, and treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARD) and/or biological DMARD (R2 0.33), while stiffness was associated with age (R2 0.19). CONCLUSION: Both CCA circumferential 2D strain and ß stiffness index differed between patients with AS and controls. Strain was associated with AS-related factors and age, whereas only age was associated with stiffness, suggesting that the obtained results reflect different pathogenic vascular processes.


Subject(s)
Spondylitis, Ankylosing , Vascular Stiffness , Carotid Arteries , Carotid Artery, Common/diagnostic imaging , Cross-Sectional Studies , Humans , Male , Middle Aged , Spondylitis, Ankylosing/diagnostic imaging , Spondylitis, Ankylosing/drug therapy
6.
BMJ ; 370: m3173, 2020 09 16.
Article in English | MEDLINE | ID: mdl-32938660

ABSTRACT

OBJECTIVE: To determine if the Food Standards Agency nutrient profiling system (FSAm-NPS), which grades the nutritional quality of food products and is used to derive the Nutri-Score front-of-packet label to guide consumers towards healthier food choices, is associated with mortality. DESIGN: Population based cohort study. SETTING: European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries. PARTICIPANTS: 521 324 adults; at recruitment, country specific and validated dietary questionnaires were used to assess their usual dietary intakes. A FSAm-NPS score was calculated for each food item per 100 g content of energy, sugars, saturated fatty acids, sodium, fibre, and protein, and of fruit, vegetables, legumes, and nuts. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed. The higher the score the lower the overall nutritional quality of the diet. MAIN OUTCOME MEASURE: Associations between the FSAm-NPS dietary index score and mortality, assessed using multivariable adjusted Cox proportional hazards regression models. RESULTS: After exclusions, 501 594 adults (median follow-up 17.2 years, 8 162 730 person years) were included in the analyses. Those with a higher FSAm-NPS dietary index score (highest versus lowest fifth) showed an increased risk of all cause mortality (n=53 112 events from non-external causes; hazard ratio 1.07, 95% confidence interval 1.03 to 1.10, P<0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, P<0.001 for trend) and diseases of the circulatory (1.04, 0.98 to 1.11, P=0.06 for trend), respiratory (1.39, 1.22 to 1.59, P<0.001), and digestive (1.22, 1.02 to 1.45, P=0.03 for trend) systems. The age standardised absolute rates for all cause mortality per 10 000 persons over 10 years were 760 (men=1237; women=563) for those in the highest fifth of the FSAm-NPS dietary index score and 661 (men=1008; women=518) for those in the lowest fifth. CONCLUSIONS: In this large multinational European cohort, consuming foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher mortality for all causes and for cancer and diseases of the circulatory, respiratory, and digestive systems, supporting the relevance of FSAm-NPS to characterise healthier food choices in the context of public health policies (eg, the Nutri-Score) for European populations. This is important considering ongoing discussions about the potential implementation of a unique nutrition labelling system at the European Union level.


Subject(s)
Food Labeling , Mortality , Nutritive Value , Adult , Cohort Studies , Europe , Female , Food Preferences , Humans , Male , Middle Aged , Nutrition Assessment , Proportional Hazards Models , Surveys and Questionnaires
7.
Physiother Res Int ; 25(3): e1833, 2020 Jul.
Article in English | MEDLINE | ID: mdl-31913553

ABSTRACT

OBJECTIVES: The aim of this study was to investigate aerobic capacity and its associations with disease activity and risk factors for cardiovascular disease (CVD) in early rheumatoid arthritis (RA). METHODS: This cross-sectional study included 67 patients with early RA. Aerobic capacity was estimated with the Åstrand submaximal test adjusted according to the Nord-Tröndelag Health Study formula. The following were also assessed: subclinical atherosclerosis by carotid intima-media thickness and pulse wave analysis; body composition by dual X-ray absorptiometry; estimated CVD mortality risk by the Systematic Coronary Risk Evaluation; disease activity by the Disease Activity Score 28, C-reactive protein and erythrocyte sedimentation rate; blood lipids by total cholesterol, low-density lipoproteins, high-density lipoproteins, and triglycerides; and functional ability by the Stanford health assessment questionnaire. Univariate and multiple linear regression analyses were performed to explore the associations between variables. RESULTS: The mean (SD) aerobic capacity was 31.6 (8.7) ml O2 -1 kg min-1 . Disease activity and risk factors for CVD were more favourable for patients with aerobic capacity above the median value. Aerobic capacity was associated with ESR and several CVD risk factors, independent of age and sex. In a multiple regression model that was adjusted for age and sex, aerobic capacity was significantly associated with per cent body fat (ß = -0.502, 95% CI [-0.671, -0.333]) and triglycerides (ß = -2.365, 95% CI [-4.252, -0.479]). CONCLUSIONS: Disease activity and risk factors for CVD were in favour for patients with a higher aerobic capacity. Aerobic capacity was associated with disease activity and several risk factors for CVD, independent of age and sex. In RA, these findings may provide insights into the benefits of using aerobic capacity as a marker to prevent CVD.


Subject(s)
Arthritis, Rheumatoid/complications , Atherosclerosis/complications , Exercise Tolerance , Heart Disease Risk Factors , Adult , Arthritis, Rheumatoid/blood , Atherosclerosis/blood , Biomarkers/blood , Carotid Intima-Media Thickness , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Risk Factors
8.
Arthritis Care Res (Hoboken) ; 72(7): 1022-1028, 2020 07.
Article in English | MEDLINE | ID: mdl-31099987

ABSTRACT

OBJECTIVE: To evaluate the course of impaired spinal mobility in patients with long-standing well-defined ankylosing spondylitis (AS). METHODS: Data from 232 patients with AS (186 men, 46 women) and 3,849 clinical measurements performed between February 1980 and June 2016 were analyzed. Lateral spinal flexion (LSF), the 10-cm Schober test, chest expansion (CE), and cervical rotation measurements were stratified by disease duration at 10-year intervals and compared with published age- and height-adjusted spinal mobility reference intervals as well as with fixed reference values commonly used in clinical practice. RESULTS: After 10 years of AS, most patients exhibited at least 1 measurement, most commonly LSF, that was under the 2.5th percentile of the adjusted reference interval (53% of men, 65% of women). In all measurements except CE, there were significant linear increases in the proportion of patients during 40 years of disease duration who exhibited impaired mobility. Measured LSF values <2.5th percentile (mean 14.8 cm) after 10 years were associated with further spinal mobility impairments later in the disease course. Fixed reference values yielded higher proportions of patients with impaired mobility compared with adjusted reference intervals. CONCLUSION: Impaired spinal mobility in AS is common after a 10-year disease duration. LSF below the 2.5th percentile at 10 years appeared to be associated with a worse prognosis. Fixed reference values overestimated spinal mobility impairments in AS and should be avoided.


Subject(s)
Range of Motion, Articular , Spondylitis, Ankylosing/pathology , Adolescent , Adult , Aged , Child , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Time , Young Adult
9.
Nutrients ; 11(11)2019 Nov 19.
Article in English | MEDLINE | ID: mdl-31752273

ABSTRACT

Diet has gained attention as a risk factor for the development of rheumatoid arthritis (RA), especially with regards to food of animal origin, such as meat and dairy products. By using data from national patient registers and dietary data from a large prospective population cohort, the Swedish Mammography Cohort, we aimed to investigate whether the consumption of meat and dairy products had any impact on the risk of subsequent development of RA. During 12 years of follow-up (January 2003-December 2014; 381, 456 person-years), 368 patients with a new diagnosis of RA were identified. No associations between the development of RA and the consumption of meat and meat products (hazard ratio [HR] for the fully adjusted model: 1.08 [95% CI: 0.77-1.53]) or the total consumption of milk and dairy products (HR for the fully adjusted model: 1.09 [95% CI: 0.76-1.55]) were observed. In conclusion, in this large prospective cohort of women, no associations were observed between dietary intake of meat and dairy products and the risk of RA development.


Subject(s)
Arthritis, Rheumatoid/epidemiology , Dairy Products , Diet , Meat , Aged , Aged, 80 and over , Arthritis, Rheumatoid/diagnosis , Dairy Products/adverse effects , Diet/adverse effects , Feeding Behavior , Female , Follow-Up Studies , Humans , Incidence , Meat/adverse effects , Middle Aged , Prospective Studies , Recommended Dietary Allowances , Registries , Risk Assessment , Risk Factors , Serving Size , Sex Factors , Sweden , Time Factors
10.
COPD ; 16(3-4): 272-277, 2019 08.
Article in English | MEDLINE | ID: mdl-31405301

ABSTRACT

A diet rich in nutrients has been suggested to have protective effects against the development of chronic obstructive pulmonary disease (COPD). Since the traditional Mediterranean diet is high in nutrients, including antioxidants, vitamins, and minerals, it is of interest to study as a protective factor against COPD. Our aim was therefore to study its associations with development of COPD using population-based prospective data from the Västerbotten Intervention Programme (VIP) cohort. Data on diet from 370 individuals, who later visited the Department of Medicine at the University Hospital, Umeå, Sweden, with a diagnosis of COPD, were compared to 1432 controls. Adherence to a Mediterranean diet was assessed by a modified version of the Mediterranean diet score (MDS). Cases were diagnosed with COPD 11.1 years (mean) (standard deviation [SD] 4.5 years) after first stating their dietary habits in the VIP at a mean age of 55.5 years (SD 6.6 years). Higher MDS was associated with a higher level of education and not living alone. After adjustment for co-habiting and education level, individuals with an intermediate MDS and those with the highest MDS had a lower odds of developing COPD (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.56-0.95; OR 0.56, 95% CI 0.37-0.86, respectively). These results remained also after adjustment for smoking intensity, i.e., numbers of cigarettes smoked per day (OR 0.73, 95% CI 0.53-0.99; OR 0.59, 95% CI 0.35-0.97), respectively). To conclude, adherence to a Mediterranean-like diet seems to be inversely associated with the development of COPD.


Subject(s)
Diet, Mediterranean , Patient Compliance , Pulmonary Disease, Chronic Obstructive/prevention & control , Pulmonary Disease, Chronic Obstructive/psychology , Adult , Case-Control Studies , Cohort Studies , Female , Health Behavior , Humans , Male , Middle Aged , Sweden
11.
Clin Rheumatol ; 37(10): 2881-2885, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30022369

ABSTRACT

To assess predictors for spinal immobility in a long-term clinical study of patients with AS, data from annual clinical measurements of spinal mobility in 54 patients (41 men, mean of age at end of follow-up 54.7 years) with ankylosing spondylitis were co-analysed with data regarding lifestyle factors as well as laboratory measurements from a previous cross-sectional study. Spinal immobility was graded on the basis of recently published age-, sex- and length-specific reference intervals. Exercise habits and high-sensitivity C-reactive protein (hsCRP) were independently associated with the development of subnormal spinal immobility (p = 0.019 and p = 0.021). In multiple regression models, approximately 25% of the spinal immobility could be attributed to disease duration (p ≤ 0.011), levels of hsCRP (p ≤ 0.004) and exercise in leisure time (p ≤ 0.019). The mean concentration of hsCRP was 4.2 mg/L (range 0.2-8.4 mg/L) in the study cohort. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR) and physical activity at work were not associated with spinal immobility. The results indicate that exercise habits may have an impact in preventing the development of spinal immobility in AS independently of disease duration and inflammation. This corresponds well with the accumulated knowledge from long-term clinical experience among rheumatologists, health professionals and patients. Consequently, exercise should remain an important part of the non-pharmacological treatment and self-care for patients with AS. Furthermore, modest inflammatory activity, measured as a slightly elevated hsCRP concentration, appears to affect subsequent spinal immobility in AS.


Subject(s)
C-Reactive Protein/analysis , Exercise , Spondylitis, Ankylosing/blood , Spondylitis, Ankylosing/complications , Blood Sedimentation , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Severity of Illness Index , Spondylitis, Ankylosing/prevention & control , Sweden
12.
Clin Rheumatol ; 37(3): 647-653, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29119482

ABSTRACT

The knowledge of the development of comorbidities in patients with ankylosing spondylitis (AS) is limited. The aim of this study was to analyse associations between AS disease characteristics and comorbidity and to evaluate patterns of comorbidities in patients with AS. Patients with AS, fulfilling the modified New York Criteria, were identified (n = 346, mean age 56 ± 15 years, 75% men, 99% HLA B27 positive). Through a review of the patient records, data on disease activity parameters, laboratory results, disease manifestations, and diagnoses of any clinically significant comorbidity was obtained. Four categories of comorbidities of interest were identified: A. arrhythmias, conduction disorders, and valvular heart disease; B. atherosclerosis and atherosclerotic CVD; C. spinal and non-spinal fractures; and D. obstructive sleep apnoea syndrome. Associations between AS disease characteristics and comorbidities in categories were assessed in logistic regression models. Differences in proportions of comorbidities was analysed using two-sided chi-square. Age was associated with all four categories of comorbidities, and male sex with arrhythmias, conduction disorders, valvular heart disease, and obstructive sleep apnoea syndrome. Early disease onset and long disease duration, respectively, were associated with arrhythmias, conduction disorders, and valvular heart disease. Obstructive sleep apnoea syndrome was associated with features of the metabolic syndrome. Patients with atherosclerotic cardiovascular disease had an increased risk of most other comorbidities, similar to, but more pronounced than patients with arrhythmias, conduction disorders and valvular heart disease. Comorbid conditions motivate clinical awareness among patients with AS. Longitudinal studies are needed to establish preventive measures.


Subject(s)
Heart Diseases/epidemiology , Metabolic Syndrome/epidemiology , Sleep Apnea Syndromes/epidemiology , Spondylitis, Ankylosing/epidemiology , Adult , Age Factors , Aged , Comorbidity , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Sex Factors
13.
PLoS One ; 12(12): e0190211, 2017.
Article in English | MEDLINE | ID: mdl-29272303

ABSTRACT

The aim of this study was to analyse the change in aerobic capacity from disease onset of rheumatoid arthritis (RA) over 16.2 years, and its associations with disease activity and cardiovascular risk factors. Twenty-five patients (20 f/5 m), diagnosed with RA 1995-2002 were tested at disease onset and after mean 16.2 years. Parameters measured were: sub-maximal ergometer test for aerobic capacity, functional ability, self-efficacy, ESR, CRP and DAS28. At follow-up, cardiovascular risk factors were assessed as blood lipids, glucose concentrations, waist circumference, body mass index (BMI), body composition, pulse wave analysis and carotid intima-media thickness. Aerobic capacity [median (IQR)] was 32.3 (27.9-42.1) ml O2/kg x min at disease onset, and 33.2 (28.4-38.9) at follow-up (p>0.05). Baseline aerobic capacity was associated with follow-up values of: BMI (rs = -.401, p = .047), waist circumference (rs = -.498, p = .011), peripheral pulse pressure (rs = -.415, p = .039) self-efficacy (rs = .420, p = .037) and aerobic capacity (rs = .557, p = .004). In multiple regression models adjusted for baseline aerobic capacity, disease activity at baseline and over time predicted aerobic capacity at follow-up (AUC DAS28, 0-24 months; ß = -.14, p = .004). At follow-up, aerobic capacity was inversely associated with blood glucose levels (rs = -.508, p = .016), BMI (rs = -.434, p = .030), body fat% (rs = -.419, p = .037), aortic pulse pressure (rs = -.405, p = .044), resting heart rate (rs = -.424, p = .034) and self-efficacy (rs = .464, p = .020) at follow-up. We conclude that the aerobic capacity was maintained over 16 years. High baseline aerobic capacity associated with favourable measures of cardiovascular risk factors at follow-up. Higher disease activity in early stages of RA predicted lower aerobic capacity after 16.2 years.


Subject(s)
Arthritis, Rheumatoid/physiopathology , Cardiovascular Diseases/epidemiology , Exercise , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk Factors
15.
Rheumatology (Oxford) ; 54(3): 487-93, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25209067

ABSTRACT

OBJECTIVE: Recent studies in animal models and on human cells have shown an effect of sodium chloride (NaCl) on Th17 cells promoting inflammation. The aim of this study was to evaluate the impact of NaCl intake on the risk of development of RA. METHODS: A nested case-control study was performed using population-based prospective data from the Västerbotten Intervention Programme. The study included 386 individuals who had stated their dietary habits as part of a community intervention programme a median of 7.7 years before the onset of symptoms of RA. For comparison, 1886 matched controls were identified from the same database and co-analysed. RESULTS: No significant association was found between sodium intake and the development of RA when all of the individuals were included. In analyses stratified for smoking status at the time of the examination, sodium intake more than doubled the risk for RA among smokers [odds ratio (OR) 2.26 (95% CI 1.06, 4.81)]. This was not observed among non-smokers. Additive interaction analysis of smoking and cases with the highest tertile of sodium intake revealed that 54% of the increased risk of developing RA from these exposures was due to interaction between them [attributable proportion 0.54 (95% CI 0.26, 0.82)]. The risk was further increased for the development of anti-CCP-positive and/or HLA shared epitope-positive RA. CONCLUSION: Although we were unable to confirm our stated hypothesis, our results that high sodium consumption among smokers was associated with the risk of RA may provide new insights into the impact of smoking in RA development.


Subject(s)
Arthritis, Rheumatoid/epidemiology , Smoking/adverse effects , Sodium, Dietary/adverse effects , Adult , Case-Control Studies , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Risk Factors , Sweden/epidemiology
16.
Clin Rheumatol ; 33(1): 111-7, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24135890

ABSTRACT

The aim of this study was to evaluate whether modifiable cardiovascular disease (CVD) risk factors, e.g. atherogenic blood lipids, hypertension and lifestyle-related factors such as smoking, diet and physical inactivity, differ among patients with ankylosing spondylitis (AS) in comparison to the general population. Eighty-eight patients diagnosed with AS were identified by analysis of the databases of a previous community intervention programme, the Västerbotten intervention programme. The patients were compared with 351 controls matched for age, sex and study period. These databases include the results of blood samples analysed for cholesterol, triglycerides and plasma glucose, as well as data on hypertension, height, weight, smoking and dietary habits and physical activity. No significant differences were found between patients and controls regarding hypertension, body mass index, physical activity, diet or smoking. Levels of serum triglycerides (p < 0.01) and cholesterol (p < 0.01) were significantly lower in the patient group. Among the patients, the level of triglycerides correlated inversely with the intake of total fat (r s = -0.25, p < 0.05), monounsaturated fats (r s = -0.29, p < 0.05) and positively correlated to the intake of carbohydrates (r s = 0.26, p < 0.05). These associations were not apparent among the controls. In the cohort of AS patients studied, no differences were found regarding the modifiable risk factors for CVD compared with the general population. Hence, the increased presence of CVD in patients with AS may be caused by other factors such as differences in metabolism and medication such as NSAID or the chronic low-grade inflammation present in the disease.


Subject(s)
Cardiovascular Diseases/physiopathology , Spondylitis, Ankylosing/physiopathology , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Blood Glucose/analysis , Body Mass Index , Cardiovascular Diseases/epidemiology , Cholesterol/blood , Diet , Female , Humans , Hypertension/physiopathology , Inflammation , Life Style , Linear Models , Male , Middle Aged , Motor Activity , Risk Factors , Smoking , Spondylitis, Ankylosing/epidemiology , Sweden , Triglycerides/blood
17.
J Rheumatol ; 39(2): 327-33, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22174215

ABSTRACT

OBJECTIVE: To investigate fatty acid composition in the diet, plasma phospholipids, and adipose tissue in a cohort of patients with ankylosing spondylitis (AS), and to determine their correlations to disease activity and blood lipids in a cross-sectional study. METHODS: Diet was assessed using a food frequency questionnaire in 66 patients with AS. Polyunsaturated fatty acids in plasma phospholipids and gluteal adipose tissue were measured using gas chromatography. Disease status was quantified using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein, and proinflammatory cytokines. RESULTS: Diet did not correlate with disease activity assessed by the BASDAI, but there were negative correlations between the dietary intake of long-chain omega-3 fatty acids and ESR (r(s) = -0.27, p < 0.05). The plasma phospholipid content of arachidonic acid correlated significantly with the BASDAI score (r(s) = 0.39, p < 0.01). There were correlations between the intake of long-chain omega-3 fatty acids and high-density lipoproteins and serum triglycerides (r(s) = 0.26 and r(s) = -0.25, respectively, p < 0.05). CONCLUSION: There was a positive correlation between levels of arachidonic acid in plasma phospholipids and disease activity assessed by BASDAI in patients with AS. A Western diet does not appear to influence this correlation, but seems to affect blood lipids involved in atherogenic processes.


Subject(s)
Fatty Acids/blood , Phospholipids/blood , Spondylitis, Ankylosing/blood , Adipose Tissue , Adult , Blood Sedimentation , C-Reactive Protein/analysis , Cross-Sectional Studies , Diet Surveys , Dietary Fats , Fatty Acids, Omega-3/administration & dosage , Fatty Acids, Unsaturated/blood , Female , Humans , Lipoproteins, HDL/blood , Male , Middle Aged , Muscle, Skeletal/chemistry , Severity of Illness Index , Spondylitis, Ankylosing/etiology , Triglycerides/blood
18.
Clin Rheumatol ; 30(1): 71-6, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21110212

ABSTRACT

The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered postal questionnaire regarding demographic data, diet, medication, and gastrointestinal symptoms in addition to two established disease assessment questionnaires, i.e., the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). No significant correlation between diet and disease activity was found. Overall, 27% of the patients reported aggravating gastrointestinal problems when consuming certain foodstuff(s). The 30% of patients who reported suffering from gastrointestinal pain had significantly greater disease activity and poorer functional status according to their BASDAI and BASFI scores (p < 0.01 and p = 0.01, respectively). Patients who reported gastrointestinal pain had a significantly higher consumption of vegetables (p < 0.01) and lower consumption of milk and soured milk (p = 0.04). No significant correlation was found between the use of non-steroidal anti-inflammatory drugs (NSAID) and gastrointestinal symptoms. In multiple regression models, BASDAI and the consumption of vegetables were independent and statistically significant predictors of gastrointestinal pain. To conclude, in a group of Swedish AS patients, no correlation between diet and disease activity could be detected. There were, however, correlations between diet and gastrointestinal pain. Gastrointestinal problems were also found to be prevalent in AS, independent of NSAID usage.


Subject(s)
Diet , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/diagnosis , Spondylitis, Ankylosing/complications , Spondylitis, Ankylosing/diagnosis , Adolescent , Adult , Aged , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Cross-Sectional Studies , Female , Food , Humans , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/diagnosis , Male , Middle Aged , Milk , Regression Analysis , Severity of Illness Index , Vegetables
19.
Scand J Rheumatol ; 31(3): 163-7, 2002.
Article in English | MEDLINE | ID: mdl-12195631

ABSTRACT

OBJECTIVE: This study aimed at evaluating exercise habits among patients with ankylosing spondylitis, their clinical status and what mainly restrains these patients from exercising. METHODS: In a cross-sectional design study 189 patients completed a self-administrated questionnaire regarding their exercise habits and their clinical status. RESULTS: A majority of the patients reported that they performed exercises. The most popular form of exercise was walking. Pool exercise was perceived to relieve the symptoms more than any other exercise and was also rated as the most enjoyable form of exercise. The main obstacle to exercise was lack of time, followed by fatigue. A small number of patients experienced aggravation of symptoms with exercise. CONCLUSION: A majority of AS patients exercise, although the frequency of the exercise was low for many patients. The main obstacle to exercise was lack of time and fatigue.


Subject(s)
Exercise , Spondylitis, Ankylosing/physiopathology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Sweden
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