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Forsblad-D'Elia, Helena
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Publications (10 of 55) Show all publications
Feldthusen, C., Dean, E., Forsblad-d'Elia, H. & Mannerkorpi, K. (2016). Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 97(1), 26-36.
Open this publication in new window or tab >>Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial
2016 (English)In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 1, 26-36 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis (RA).

DESIGN: Randomized controlled trial.

SETTING: Hospital outpatient rheumatology clinic.

PARTICIPANTS: Persons with RA aged 20-65y (n=70); intervention-group (n=36) and reference-group (n=34).

INTERVENTION: The 12-week intervention, with 6-month follow-up, focused on partnership between participant and physical therapist, and tailored health-enhancing physical activity and balancing life activities. The reference-group continued with regular activities; both groups received usual healthcare.

MAIN OUTCOME MEASURES: Primary outcome was general fatigue (Visual Analogue Scale, VAS). Secondary outcomes included multidimensional fatigue (Bristol Rheumatoid Arthritis Fatigue - Multi-Dimensional Questionnaire, BRAF-MDQ), and fatigue-related variables, i.e., disease, health and function.

RESULTS: At posttest, general fatigue improved more in the intervention-group than reference-group (p=0.042). Improvement in median general fatigue reached minimal clinically important difference between and within groups at posttest and follow-up. Improvement was also observed for anxiety (p=0.0099) and trends toward improvements was observed for most multidimensional aspects of fatigue (p=0.023-p=0.048), leg strength/endurance (p=0.024) and physical activity (p=0.023). Compared with the reference-group at follow-up, intervention-group improvement was observed for leg strength/endurance (p=0.001) and the trends toward improvements persisted for physical (p=0.041) and living-related (p=0.031) aspects of fatigue, physical activity (p=0.019) and anxiety (p=0.015) and self-rated health (p=0.010) and self-efficacy (p=0.046).

CONCLUSIONS: Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities, showed significant benefits on fatigue in persons with RA.

Keyword
Arthritis, Rheumatoid, Fatigue, Randomized controlled trial at topic, Rehabilitation
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-111318 (URN)10.1016/j.apmr.2015.09.022 (DOI)000367963500004 ()26482574 (PubMedID)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2017-12-01Bibliographically approved
Feldthusen, C., Grimby-Ekman, A., Forsblad-d'Elia, H., Jacobsson, L. & Mannerkorpi, K. (2016). Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: a longitudinal study. Journal of Rehabilitation Medicine, 48(5), 469-476.
Open this publication in new window or tab >>Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: a longitudinal study
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2016 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 5, 469-476 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the impact of disease-related aspects on long-term variations in fatigue in persons with rheumatoid arthritis.

DESIGN: Observational longitudinal study.

METHODS: Sixty-five persons with rheumatoid arthritis, age range 20-65 years, were invited to a clinical examination at 4 time-points during the 4 seasons. Outcome measures were: general fatigue rated on visual analogue scale (0-100) and aspects of fatigue assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire. Disease-related variables were: disease activity (erythrocyte sedimentation rate), pain threshold (pressure algometer), physical capacity (six-minute walk test), pain (visual analogue scale (0-100)), depressive mood (Hospital Anxiety and Depression scale, depression subscale), personal factors (age, sex, body mass index) and season. Multivariable regression analysis, linear mixed effects models were applied.

RESULTS: The strongest explanatory factors for all fatigue outcomes, when recorded at the same time-point as fatigue, were pain threshold and depressive mood. Self-reported pain was an explanatory factor for physical aspects of fatigue and body mass index contributed to explaining the consequences of fatigue on everyday living. For predicting later fatigue pain threshold and depressive mood were the strongest predictors.

CONCLUSION: Pain threshold and depressive mood were the most important factors for fatigue in persons with rheumatoid arthritis.

Keyword
fatigue, rheumatoid arthritis, longitudinal study, outcome assessment
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-122028 (URN)10.2340/16501977-2090 (DOI)000375753300009 ()27097684 (PubMedID)
Available from: 2016-06-14 Created: 2016-06-14 Last updated: 2017-11-28Bibliographically approved
Exarchou, S., Lie, E., Lindström, U., Askling, J., Forsblad-d'Elia, H., Turesson, C., . . . Jacobsson, L. T. (2016). Mortality in ankylosing spondylitis: results from a nationwide population-based study. Annals of the Rheumatic Diseases, 75(8), 1466-1472.
Open this publication in new window or tab >>Mortality in ankylosing spondylitis: results from a nationwide population-based study
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2016 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no 8, 1466-1472 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Information on mortality in ankylosing spondylitis (AS) is scarce. Our study therefore aimed to assess: (1) mortality in AS versus the general population, and (2) predictors of death in the AS population. Methods: Nationwide cohorts of patients with AS diagnosed at rheumatology or internal medicine outpatient clinics (n=8600) and age-matched, sex-matched and county-matched general population comparators (n=40 460) were identified from the National Patient Register and the census register, respectively. The follow-up period began on 1 January 2006 or at the first date of registered diagnosis thereafter and extended until death, emigration or 31 December 2012, whichever occurred first. Socioeconomic variables, AS-related clinical manifestations, joint surgery, comorbidities and medication were identified from other national registers. Cox regression models were used to determine mortality and predictors for death in the AS cohort. Results: There were 496 deaths in the AS cohort and 1533 deaths in the control cohort resulting in an age-adjusted and sex-adjusted HR of 1.60 (95% CI 1.44 to 1.77), with increased mortality for men (age-adjusted HR=1.53, 95% CI 1.36 to 1.72) and women (ageadjusted HR=1.83, 95% CI 1.50 to 2.22). Within the AS cohort, statistically significant predictors for death were a lower level of education, general comorbidities (diabetes, infections, cardiovascular, pulmonary and malignant diseases) and previous hip replacement surgery. Conclusions: Mortality was increased for male and female patients with AS. Predictors of death within the AS cohort included socioeconomic status, general comorbidities and hip replacement surgery.

National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-111323 (URN)10.1136/annrheumdis-2015-207688 (DOI)000379741100018 ()26338036 (PubMedID)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2017-12-01Bibliographically approved
Lindstrom, U., Forsblad-d'Elia, H., Askling, J., Kristensen, L. E., Lie, E., Exarchou, S. & Jacobsson, L. (2016). Perinatal characteristics, older siblings, and risk of ankylosing spondylitis: a case-control study based on national registers. Arthritis Research & Therapy, 18, Article ID 16.
Open this publication in new window or tab >>Perinatal characteristics, older siblings, and risk of ankylosing spondylitis: a case-control study based on national registers
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2016 (English)In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 18, 16Article in journal (Refereed) Published
Abstract [en]

Background: The effect of circumstances and exposures early in life on the risk of developing ankylosing spondylitis (AS) is largely unknown. The purpose of this study was to determine whether perinatal characteristics predict development of AS. Methods: AS cases (n = 1960; 59 % men) were defined as listed with a diagnosis of AS at least once in the Swedish National Patient Register and registered in the Swedish Medical Birth Register (born = 1973). Population controls were retrieved from the Swedish Population Register (n = 8378; mean 4.3 controls/case), matched on birth year, sex and county. Odds ratios (OR) for developing AS were determined through conditional logistic regression, with regard to: birth weight, birth order, season of birth, maternal age, gestational length, size for gestational age, type of birth, mode of delivery, congenital malformations, mothers' country of birth, mothers' civil status and size of delivery unit. Results: In the univariate analyses statistically significant increases in risk for developing AS were observed for having older siblings (OR 1.18; 95 % Cl 1.06-1.30). No association was observed for the remainder of analysed exposures, although there was a weak association with birth weight below 3000 g (OR 1.19; 95 % CI 1.04-1.37), though not for "low birth weight" <2500 g (OR 0.90; 95 % CI 0.70-1.16). The increase in risk associated with having older siblings was consistent in a multivariate analysis adjusting for possible confounders (OR 1.23; 95 % Cl 1.09-1.39). The direction and magnitude of the point estimates were also consistent in several sensitivity analyses and when stratifying by sex. Conclusions: Having older siblings was associated with an increased risk for developing AS. These results need to be repeated and confirmed in other cohorts.

Keyword
Ankylosing spondylitis, Epidemiology, Pathogenesis, Spondyloarthritis
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-116074 (URN)10.1186/s13075-016-0917-1 (DOI)000368223300001 ()26785608 (PubMedID)
Available from: 2016-02-10 Created: 2016-02-08 Last updated: 2017-11-30Bibliographically approved
Feldthusen, C., Grimby-Ekman, A., Forsblad-d'Elia, H., Jacobsson, L. & Mannerkorpi, K. (2016). Seasonal variations in fatigue in persons with rheumatoid arthritis: a longitudinal study. BMC Musculoskeletal Disorders, 17, Article ID 59.
Open this publication in new window or tab >>Seasonal variations in fatigue in persons with rheumatoid arthritis: a longitudinal study
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2016 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, 59Article in journal (Refereed) Published
Abstract [en]

Background: Fatigue is a prominent symptom in persons with rheumatoid arthritis (RA). Although this symptom has been described to vary in duration and frequency little is known about fluctuations in fatigue over time and season. The aim of this study was to describe monthly and seasonal variations in fatigue, in persons with RA of working age.

Methods: Sixty-five participants diagnosed with RA and aged 20-65 years were recruited from a rheumatology clinic in Sweden. The participants provided self-assessments of their fatigue at seven time points during the four seasons using a 0-100 mm visual analogue scale (VAS) and the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Multiple regression analysis using mixed models was used to analyze changes in fatigue over time.

Results: The mean +/- SD of fatigue rated on the VAS was 51 +/- 13, indicating substantial fatigue. Analysis of monthly variation showed statistically significant variation in fatigue ratings concerning VAS fatigue score (p < 0.01) as well as the BRAF-MDQ total score and Living, Cognition (p < 0.001), and Physical (p < 0.05) sub-scores, but not the BRAF-MDQ Emotional sub-score. The greatest variations were seen from January to September, with higher fatigue ratings in January. The changes in VAS fatigue scores over time were considered to be of clinical importance. Analysis of seasonal variation revealed a statistically significant seasonal variation in fatigue levels, with higher fatigue values during the winter as measured by VAS fatigue score (p < 0.01) as well as BRAF-MDQ total score (p < 0.01) and Physical and Living sub-scores (both p < 0.01). The greatest variation was seen between winter and autumn for VAS fatigue and between winter and summer for BRAF-MDQ total score and Physical and Living sub-scores. There were no statistical differences in fatigue levels, monthly or seasonal, between sexes or age groups.

Conclusions: The majority of rating scales used in this study showed fluctuations in fatigue, general and physical fatigue being significantly greater during the winter. As fatigue is a substantial symptom in many persons with RA, this information is important for rheumatology professionals when dealing with persons with RA in routine care.

Keyword
Fatigue, Rheumatoid arthritis, Longitudinal study, Seasons, Outcome measures
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-117382 (URN)10.1186/s12891-016-0911-4 (DOI)000369227700002 ()26846791 (PubMedID)
Available from: 2016-03-29 Created: 2016-02-29 Last updated: 2017-11-30Bibliographically approved
Klingberg, E., Oleröd, G., Hammarsten, O. & Forsblad-d'Elia, H. (2016). The vitamin D status in ankylosing spondylitis in relation to intestinal inflammation, disease activity, and bone health: a cross-sectional study. Osteoporosis International, 27(6), 2027-2033.
Open this publication in new window or tab >>The vitamin D status in ankylosing spondylitis in relation to intestinal inflammation, disease activity, and bone health: a cross-sectional study
2016 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, no 6, 2027-2033 p.Article in journal (Refereed) Published
Abstract [en]

Summary: We assessed the vitamin D status in ankylosing spondylitis (AS) patients and healthy controls in the late winter when no vitamin D is produced by the sunlight. The vitamin D status was often poor, but not lower in AS and not associated with disease activity or signs of gut inflammation.

INTRODUCTION: The aims of the study were to investigate the vitamin D levels attained mainly by dietary intake in ankylosing spondylitis (AS) in comparison with healthy controls and in relation to gut inflammation, measured indirectly by fecal calprotectin, disease activity, osteoproliferation, bone mineral density (BMD), and vertebral fractures.

METHODS: Serum 25-hydroxy vitamin D (25(OH)D) was measured in 203 AS patients and 120 healthy controls at the end of "the vitamin D winter," when the out-door UVB irradiation is too low to allow synthesis of vitamin D3 in the skin at the latitude of Gothenburg, Sweden. Fecal calprotectin was measured in stool samples. Disease activity was assessed with CRP, ESR, ASDASCRP, BASDAI, BAS-G, BASFI, and BASMI. Lateral spine radiographs were scored for osteoproliferation and vertebral fractures using the mSASSS and Genant scores. BMD was measured in the lumbar spine and femoral neck.

RESULTS: Vitamin D insufficiency (a serum 25(OH)D <50 nmol/L) was found in approximately 50 % of the AS patients, but serum 25(OH)D was not different from healthy controls and not significantly correlated with fecal calprotectin, gastrointestinal symptoms, disease activity parameters, mSASSS, BMD, or vertebral fractures.

CONCLUSIONS: The vitamin D status was often poor in the late winter in AS but not different from the healthy controls. No evidence for a connection between subclinical gut inflammation, malabsorption, and hypovitaminosis D was found. Serum 25(OH)D was not associated with disease activity, osteoproliferation, BMD, or vertebral fractures. We suggest that the lower vitamin D levels in AS, previously found by others, may be caused by reduced out-door UVB exposure.

Keyword
Ankylosing spondylitis, Fecal calprotectin, Gut inflammation, Spondylarthritis, Vitamin D, Vitamin D deficiency
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-122029 (URN)10.1007/s00198-016-3489-7 (DOI)000376100700009 ()26809190 (PubMedID)
Available from: 2016-06-14 Created: 2016-06-14 Last updated: 2017-11-28Bibliographically approved
Klingberg, E., Sveälv, B. G., Täng, M. S., Bech-Hanssen, O., Forsblad-d'Elia, H. & Bergfeldt, L. (2015). Aortic Regurgitation Is Common in Ankylosing Spondylitis: Time for Routine Echocardiography Evaluation?. American Journal of Medicine, 128(11), 1244-1250.
Open this publication in new window or tab >>Aortic Regurgitation Is Common in Ankylosing Spondylitis: Time for Routine Echocardiography Evaluation?
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2015 (English)In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 128, no 11, 1244-1250 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to assess the prevalence of aortic regurgitation and any relation to disease activity and specific human leukocyte antigen (HLA)-B27 subtypes in patients with ankylosing spondylitis.

METHODS: Transthoracic echocardiography was performed in 187 patients (105 men), mean age (SD) 50 (13) years, and mean disease duration 24 (13) years, and was related to demographic, clinical, radiographic, electrocardiographic, and laboratory data.

RESULTS: Aortic regurgitation was found in 34 patients (18%; 95% confidence interval [CI], 12%-24%): mild in 24, moderate in 9, and severe in one. The prevalence was significantly higher than expected from population data. Conduction system abnormalities were documented in 25 patients (13%; 95% CI, 8%-18%), and significantly more likely in the presence of aortic regurgitation (P = .005), which was related to increasing age and longstanding disease, and increased from ∼20% in the 50s to 55% in the 70s. It was also independently associated with disease duration, with higher modified Stoke Ankylosing Spondylitis Spine Score, and with a history of anterior uveitis. HLA-B27 was present in similar proportions in the presence vs absence of aortic regurgitation. For comparison, clinically significant coronary artery disease was present in 9 patients (5%; 95% CI, 2%-8%).

CONCLUSION: Patients with ankylosing spondylitis frequently have cardiac abnormalities, but they more often consist of disease-related aortic regurgitation or conduction system abnormalities than manifestations of atherosclerotic heart disease. Because aortic regurgitation or conduction abnormalities might cause insidious symptoms not easily interpreted as of cardiac origin, we suggest that both electrocardiography and echocardiography evaluation should be part of the routine management of patients with ankylosing spondylitis.

Place, publisher, year, edition, pages
Elsevier, 2015
Keyword
Ankylosing spondylitis, Aortic regurgitation, Disease activity, Echocardiography, Electrocardiography
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-111327 (URN)10.1016/j.amjmed.2015.04.032 (DOI)000363453500040 ()26052024 (PubMedID)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2017-12-01Bibliographically approved
Bengtsson, K., Forsblad-d'Elia, H., Lie, E., Klingberg, E., Dehlin, M., Exarchou, S., . . . Jacobsson, L. T. H. (2015). Are Ankylosing Spondylitis, Psoriatic Arthritis and Undifferentiated Spondylarthritis Associated with an Increased Risk of Cardiovascular Disease?. Arthritis & Rheumatology, 67, Article ID 1057.
Open this publication in new window or tab >>Are Ankylosing Spondylitis, Psoriatic Arthritis and Undifferentiated Spondylarthritis Associated with an Increased Risk of Cardiovascular Disease?
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2015 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, 1057Article in journal, Meeting abstract (Other academic) Published
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-118427 (URN)10.1002/art.39448 (DOI)000370860202321 ()
Available from: 2016-04-06 Created: 2016-03-18 Last updated: 2017-11-30Bibliographically approved
Bengtsson, K., Forsblad-d'Elia, H., Lie, E., Klingberg, E., Dehlin, M., Exarchou, S., . . . Jacobsson, L. T. H. (2015). Increased Risk of Atrioventricular Block, Atrial Fibrillation and Pacemaker Implantation in Ankylosing Spondylitis, Undifferentiated Spondylarthritis and Psoriatic Arthritis Compared to the General Population. Arthritis & Rheumatology, 67(10), Article ID 1059.
Open this publication in new window or tab >>Increased Risk of Atrioventricular Block, Atrial Fibrillation and Pacemaker Implantation in Ankylosing Spondylitis, Undifferentiated Spondylarthritis and Psoriatic Arthritis Compared to the General Population
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2015 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no 10, 1059Article in journal, Meeting abstract (Other academic) Published
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-118435 (URN)10.1002/art.39448 (DOI)000370860202323 ()
Available from: 2016-04-01 Created: 2016-03-18 Last updated: 2017-11-30Bibliographically approved
Sveälv, B. G., Täng, M. S., Klingberg, E., Forsblad-d'Elia, H. & Bergfeldt, L. (2015). Prevalence of diastolic dysfunction in patients with ankylosing spondylitis: a cross-sectional study. Scandinavian Journal of Rheumatology, 44(2), 111-117.
Open this publication in new window or tab >>Prevalence of diastolic dysfunction in patients with ankylosing spondylitis: a cross-sectional study
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, 111-117 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To determine the prevalence of diastolic dysfunction (DD) in patients with ankylosing spondylitis (AS) by following recommended criteria from the American Society of Echocardiography (ASE) and using single variables reflecting DD.

METHOD: A total of 187 patients with AS (105 men; mean age 51 ± 13 years; mean duration of disease 15 ± 11 years) fulfilled the inclusion criteria and underwent pulsed-wave and tissue Doppler imaging.

RESULTS: By following ASE recommended criteria, we observed that 12% of patients with AS had mild DD. We also compared single standard Doppler values with normal age-stratified reference values and showed a wide variation in the number of patients with AS outside the 95% confidence interval (CI) of normal values depending on the variable chosen (ranging from 1.1% to 30.5%).

CONCLUSIONS: By following recommended criteria, our cross-sectional study shows that DD was infrequent and mild in patients with AS.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-102958 (URN)10.3109/03009742.2014.953201 (DOI)000351182100005 ()25421143 (PubMedID)
Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2017-12-04Bibliographically approved
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