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Ljung, Lotta
Publications (10 of 44) Show all publications
Sundström, B., Ljung, L. & Di Giuseppe, D. (2019). Consumption of dairy products and risk of rheumatoid arthritis among women: a population-based prospective cohort study. Paper presented at Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019. Annals of the Rheumatic Diseases, 78, 1047-1048
Open this publication in new window or tab >>Consumption of dairy products and risk of rheumatoid arthritis among women: a population-based prospective cohort study
2019 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1047-1048Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Conflicting results have been reported regarding the association between consumption of milk and dairy products and the risk for development of rheumatoid arthritis (RA).

Objectives: The aim of this study was to investigate the association between consumption of milk and dairy products and the development of RA in a large population-based cohort of women.

Methods: In a prospective cohort study 35,600 women aged 48-83 years, from the Swedish Mammography Cohort (SMC), were followed between 2003 and 2015. Consumption of dairy products was assessed in 1997 at a mean age of mean age of 61.5 years (SD 9.1 years) with a 96-item self-administered questionnaire. The risk (hazard ratio; HR) of RA development associated with consumption of dairy products was estimated using Cox proportional hazard regression models with adjustment for age, alcohol intake, smoking, energy intake, meat and fish consumption.

Results: During the follow-up of 12 years, 368 individuals were identified with a new diagnosis of RA. Comparing high consumption with low consumption of dairy products, no association between consumption of dairy products and the development of RA was observed: HR for the fully adjusted model=1.12 (95% CI: 0.78-1.59 (Table 1). Also when evaluating milk and cheese consumption separately, no association with the risk of RA was observed: HR for the highest milk consumption=1.10 (95% CI: 0.82-1.44) and highest cheese consumption HR=1.20 (95% CI: 0.81-1.79), compared with low consumption (fully adjusted models, table 1).

Conclusion: In this large population-based cohort study, consumption of dairy products was not associated with risk to develop RA.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-161725 (URN)10.1136/annrheumdis-2019-eular.1187 (DOI)000472207103153 ()
Conference
Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019
Note

Supplement: 2

Meeting Abstract: FRI0697-HP

Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Ljung, L., Wiberg, K., Ärlestig, L. & Rantapää-Dahlqvist, S. (2019). Low-energy fractures in rheumatoid arthritis - associations with genes and clinical characteristics. Paper presented at Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019. Annals of the Rheumatic Diseases, 78, 344-345
Open this publication in new window or tab >>Low-energy fractures in rheumatoid arthritis - associations with genes and clinical characteristics
2019 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 344-345Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Patients with rheumatoid arthritis (RA) have increased risk of osteoporosis and low-energy fractures. Several genes associated with bone mineralization, osteoporosis or risk of fracture in the general population have been identified.

Objectives: To analyse the association between nine selected SNPs and the risk of low-energy fracture, taking clinical patient characteristics into account.

Methods: We identified a cohort of patients (n=896, 70% women, age at inclusion 60.0±14.8 years) with RA according to ACR criteria from the catchment area of the register of Umeå injury database, Umeå, Sweden, which enabled identification of low-energy fractures (n=254). The follow-up (mean 8.8±6.1 years, total 7928 person-years) started two years after RA diagnosis but not earlier than January 1, 1993 and ended at the first of December 31, 2011, death or the first low-energy fracture. Nine SNPs were analysed in all patients with available DNA-samples (n=667) using KASPTM genotyping assays (LGC genomics Ltd, Hoddesdon, UK): rs3801387 (WNT16), rs6666455 (SOAT), rs3736228 (LRP5), rs4796995 (FAM210A), rs4792909 (SOST), rs2062377 (TNFRSF11B/OPG), rs884205 (TNFRSF11A/RANK), rs9533090 (TNFSF11/RANKL), and rs1373004 (DKK1). Anti-CCP was analysed and clinical patient characteristics (duration of RA, ever smoking, disease activity the first two years after RA diagnosis, and joint erosions) were extracted from patient files. Associations between the risk of fracture and risk alleles in the cohort were evaluated using Kaplan-Meier curves (K-M) and Cox proportional hazards models: crude, adjusted for age and sex, and for clinical patient characteristics.

Results: The SNPs: rs1373004, rs4792909, and rs2062377 were associated with the risk of fracture in K-M analyses (Figure 1). For the other genes no significant associations were observed. Patients carrying the risk allele of rs1373004 (22.6% of the patients), or who were homozygous for the risk allele of SNP rs4792909 (38.6%), had a >50% higher risk of low-energy fracture compare to other patients, irrespectively of disease characteristics (Table 1). The association between rs2062377 and the risk of fracture was not independent of clinical patient characteristics (Table 1).

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-161726 (URN)10.1136/annrheumdis-2019-eular.4264 (DOI)000472207101052 ()
Conference
Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019
Note

Supplement: 2

Meeting Abstract: THU0143

Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Ljung, L. & Holmqvist, M. (2019). Methotrexate in Our Hearts. Journal of Rheumatology, 46(5), 447-449
Open this publication in new window or tab >>Methotrexate in Our Hearts
2019 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 46, no 5, p. 447-449Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Journal of Rheumatology Publishing Company Limited, 2019
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-159059 (URN)10.3899/jrheum.181269 (DOI)000466402600002 ()31043496 (PubMedID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved
Westerlind, H., Holmqvist, M., Ljung, L., Frisell, T. & Askling, J. (2019). Siblings of patients with rheumatoid arthritis are at increased risk of acute coronary syndrome. Annals of the Rheumatic Diseases, 78(5), 683-687
Open this publication in new window or tab >>Siblings of patients with rheumatoid arthritis are at increased risk of acute coronary syndrome
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2019 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no 5, p. 683-687Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate a potential shared susceptibility between rheumatoid arthritis (RA) and acute coronary syndrome (ACS) by estimation of the risk of ACS among full siblings of patients with RA.

Methods: By linking nation-wide Swedish registers, we identified a cohort of patients with new-onset RA 1996–2016, age- and sex-matched (5:1) general population comparator subjects, full siblings of RA and comparator subjects, and incident ACS events through 31 December 2016. We used Cox regression to estimate the HR of ACS among patients with RA and the siblings of patients with RA versus the general population, overall and stratified by RA serostatus. We explored the impact of traditional cardiovascular (CV) risk factors on the observed associations.

Results: We identified 8109 patients with incident RA, and 11 562 full siblings of these. Compared with the general population, the HR of ACS in RA was 1.46 (95% CI 1.28 to 1.67) and 1.22 (95% CI 1.09 to 1.38) among their siblings. The increased risks seemed confined to seropositive RA (patients: 1.52 [1.30 to 1.79], their siblings: 1.27 [1.10 to 1.46]); no significant risk increase was observed among siblings of patients with seronegative RA (HR 1.13 [95% CI 0.92 to 1.39]). Adjustment for 19 traditional CV risk factors did not appreciably alter these associations.

Conclusion: Siblings of patients with RA are at increased risk of ACS, suggesting shared susceptibility between RA and ACS, indicating the need and potential for additional cardio-preventive measures in RA (and their siblings).

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-161473 (URN)10.1136/annrheumdis-2018-214828 (DOI)000471068200030 ()30787006 (PubMedID)
Funder
Swedish Research CouncilSwedish Foundation for Strategic Research Stockholm County CouncilNordForsk
Available from: 2019-07-09 Created: 2019-07-09 Last updated: 2019-07-09Bibliographically approved
Delcoigne, B., Di Giuseppe, D., Askling, J. & Ljung, L. (2019). The influence of patient demographics on disease activity measurments in theumatoid arthritis. Paper presented at Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019. Annals of the Rheumatic Diseases, 78, 1423-1424
Open this publication in new window or tab >>The influence of patient demographics on disease activity measurments in theumatoid arthritis
2019 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1423-1424Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Several indexes have been constructed for the measurement of disease activity in rheumatoid arthritis (RA) patients, including the Disease Activity Score 28-joint count, which either includes the Erythrocyte Sedimentation Rate (DAS28ESR) or the C-reactive protein concentration (DAS28CRP), and the Clinical Disease Activity Index (CDAI). The categorization of the results of these three indexes into levels of disease activity (Remission, Low, Moderate and High) is used to assess patient outcomes, and to guide medical decisions regarding treatment. However, the different indexes can lead to somewhat different classification, and hence influence treatment decisions.1

Objectives: To investigate how DAS28ESR, DAS28CRP and CDAI indexes are associated to age and sex in RA patients. To investigate the agreement between indexes and between categories of disease activity levels.

Methods: We identified a cohort of RA patients, registered in the Swedish Rheumatology Quality Register between January 1st2014 and December 31st2017. The indexes were obtained from the first visit at the time point of RA diagnosis, and at the visit registered at the start of a first ever biological treatment prescription. Linear models were used to investigate the correlation between the indexes, age and sex. The agreement between the indexes was explored with Bland-Altman plots. The agreement between disease activity levels was evaluated through kappa statistics.

Results: Data were analyzed for 3855 RA patients (2576 women, mean age ±SD=60±15) at their first diagnosis visit and for 3062 RA patients (2313 women, mean age ±SD=57±14) at the start of their first biologic. Similar results for all subsequently described analyses were obtained at both time points. The correlation coefficient and 95% confidence interval (95%CI) between the indexes and age were 0.093 (0.063-0.124) for DAS28ESR and 0.055 (0.025-0.085) for DAS28CRP at the first visit, while CDAI was not correlated to age. There was no difference between men and women for CDAI and DAS28CRP, while DAS28ESR presented a mean difference of 0.1 unit between men and women. The agreement between categories of disease activity was moderate: at the RA diagnosis visit, the kappa statistics and 95% CI were: 0.63 (0.61-0.65) between DAS28ESR and DAS28CRP, 0.59 (0.57-0.61) between DAS28ESR and CDAI, and 0.55 (0.53-0.57) between DAS28CRP and CDAI. About 25% of the patients were classified differently. The Bland-Altman plot revealed that the difference between DAS28ESR and DAS28CRP depended on sex and slightly increased with age.

Conclusion: Factors related to patient demographics might influence the results of disease activity indexes. This has a potential to affect clinical decisions, as the definition into disease activity categories can differ depending on the score used. This suggests the need to consider sex and age when defining such categories and interpreting results from these indexes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-161728 (URN)10.1136/annrheumdis-2019-eular.4635 (DOI)000472207104243 ()
Conference
Annual European Congress of Rheumatology (EULAR), Madrid, Spain, June 12-15, 2019
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26
Södergren, A., Askling, J., Bengtsson, K., Forsblad-d'Elia, H., Jernberg, T., Lindström, U., . . . Jacobsson, L. T. (2018). Case fatality over 365 days after first acute coronary syndrome in patients with ankylosing spondylitis. Paper presented at Congress of the European-League-Against-Rheumatism (EULAR), JUN 13-16, 2018, Amsterdam, NETHERLANDS. Annals of the Rheumatic Diseases, 77, 341-341
Open this publication in new window or tab >>Case fatality over 365 days after first acute coronary syndrome in patients with ankylosing spondylitis
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2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 341-341Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-152909 (URN)000444351001050 ()
Conference
Congress of the European-League-Against-Rheumatism (EULAR), JUN 13-16, 2018, Amsterdam, NETHERLANDS
Note

Supplement: 2

Meeting Abstract: THU0243

Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2018-10-30Bibliographically approved
Sundström, B., Ljung, L. & Wallberg-Jonsson, S. (2018). Exercise habits and C-reactive protein may predict development of spinal immobility in patients with ankylosing spondylitis. Clinical Rheumatology, 37(10), 2881-2885
Open this publication in new window or tab >>Exercise habits and C-reactive protein may predict development of spinal immobility in patients with ankylosing spondylitis
2018 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 37, no 10, p. 2881-2885Article in journal (Refereed) Published
Abstract [en]

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 ae 0.011), levels of hsCRP (p ae0.004) and exercise in leisure time (p ae 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.

Place, publisher, year, edition, pages
Springer London, 2018
Keywords
Ankylosing spondylitis, Biomarkers, Exercise, Physical activity
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-152384 (URN)10.1007/s10067-018-4195-y (DOI)000444749500036 ()30022369 (PubMedID)
Funder
Norrbotten County CouncilVästerbotten County CouncilSwedish Rheumatism Association
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-10-05Bibliographically approved
Di Giuseppe, D., Ljung, L. & Sundström, B. (2018). Meat Consumption and Risk of Rheumatoid Arthritis in Women: A Population-Based Cohort Study. Paper presented at 2018 ACR/ARHP Annual Meeting, October 19–24, 2018, Chicago, IL. Arthritis & Rheumatology, 70(S9), Article ID 203.
Open this publication in new window or tab >>Meat Consumption and Risk of Rheumatoid Arthritis in Women: A Population-Based Cohort Study
2018 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 70, no S9, article id 203Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background/Purpose: Mixed results have been reported for the association between meat consumption and the risk of developing rheumatoid arthritis (RA). The aim of this study was to evaluate the association between red meat, particularly processed meat, and the risk of RA using data from a population-based cohort of women.

Methods: We prospectively followed 35,600 women aged 48-83 years from the Swedish Mammography Cohort (SMC), between 2003 and 2014. Meat consumption was assessed with a 96-item self-administered questionnaire in 1997. A corresponding questionnaire data from 1987 was available, enabling identification of long-term meat consumption. The relative risk (RR) of RA associated with meat consumption and its 95% confidence interval (CI) were estimated using Cox proportional hazard regression models. Multivariable models were adjusted for age, body mass index, educational level, physical activity, use of dietary supplements, energy intake, and smoking.

Results: During the 12 years of follow-up (381 456 person years), 368 new cases of rheumatoid arthritis were identified. Meat consumption was not associated with the development of RA in age-adjusted (RR=0.96 (95% CI: 0.69-1.32)) or multivariable adjusted (RR=1.08 (95%CI: 0.77-1.53)) models (Table 1). No association was observed either for consumption of type-specific meat, such as red meat (RR=1.08 (95% CI: 0.77-1.50)), processed meat (RR=0.84 (95% CI: 0.59-1.22)), or poultry (RR=0.88 (95% CI: 0.60-1.31)). , Women with a consistent long-term consumption of meat of >7 servings/week over a period of 10 years had no increased risk of RA, HR 1.19 (95% CI: 0.78-1.80), compared to women with a consistent consumption of <=4 servings/week.

Conclusion: In this large population-based cohort study, meat consumption, in total, by sub-types, or over time, was not associated with the risk of RA development in women.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-153134 (URN)000447268900204 ()
Conference
2018 ACR/ARHP Annual Meeting, October 19–24, 2018, Chicago, IL
Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2018-11-08Bibliographically approved
Holmqvist, M., Ljung, L. & Askling, J. (2018). Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?. Annals of the Rheumatic Diseases, 77(1), 85-91
Open this publication in new window or tab >>Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?
2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no 1, p. 85-91Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death. Methods: Using an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register. Results: 17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently. Conclusions: Despite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-143711 (URN)10.1136/annrheumdis-2017-212131 (DOI)000417778700017 ()28970218 (PubMedID)
Available from: 2018-01-08 Created: 2018-01-08 Last updated: 2018-06-09Bibliographically approved
Ljung, L., Sundström, B., Smeds, J., Ketonen, M. & Forsblad-d'Elia, H. (2018). Patterns of comorbidity and disease characteristics among patients with ankylosing spondylitis: a cross-sectional study. Clinical Rheumatology, 37(3), 647-653
Open this publication in new window or tab >>Patterns of comorbidity and disease characteristics among patients with ankylosing spondylitis: a cross-sectional study
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2018 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 37, no 3, p. 647-653Article in journal (Refereed) Published
Abstract [en]

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 =3D 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.

Place, publisher, year, edition, pages
Springer London, 2018
Keywords
Ankylosing spondylitis, Comorbidity, Cross-sectional, Epidemiology
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-146158 (URN)10.1007/s10067-017-3894-0 (DOI)000426714500010 ()29119482 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-06-09Bibliographically approved
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