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  • 1. Agca, R.
    et al.
    Heslinga, S. C.
    Rollefstad, S.
    Heslinga, M.
    McInnes, B.
    Peters, M. J. L.
    Kvien, T. K.
    Dougados, M.
    Radner, H.
    Atzeni, F.
    Primdahl, J.
    Södergren, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Wållberg Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    van Rompay, J.
    Zabalan, C.
    Pedersen, T. R.
    Jacobsson, L.
    de Vlam, K.
    Gonzalez-Gay, M. A.
    Semb, A. G.
    Kitas, G. D.
    Smulders, Y. M.
    Szekanecz, Z.
    Sattar, N.
    Symmons, D. P. M.
    Nurmohamed, M. T.
    EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no 1, p. 17-28Article, review/survey (Refereed)
    Abstract [en]

    Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

  • 2. Agca, Rabia
    et al.
    Heslinga, Sjoerd C.
    Rollefstad, S.
    Heslinga, S.
    Södergren, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Semb, A. G.
    Kitas, George D.
    Sattar, Naveed
    Nurmohamed, Michael T.
    Response to: "Influence of changes in cholesterol levels and disease activity on the 10-year cardiovascular risk estimated with different algorithms in rheumatoid arthritis patients" by Fornaro et al2020In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 79, no 9, article id e105Article in journal (Refereed)
  • 3. Agmon-Levin, Nancy
    et al.
    Damoiseaux, Jan
    Kallenberg, Cees
    Sack, Ulrich
    Witte, Torsten
    Herold, Manfred
    Bossuyt, Xavier
    Musset, Lucille
    Cervera, Ricard
    Plaza-Lopez, Aresio
    Dias, Carlos
    Sousa, Maria Jose
    Radice, Antonella
    Eriksson, Catharina
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Hultgren, Olof
    Viander, Markku
    Khamashta, Munther
    Regenass, Stephan
    Coelho Andrade, Luis Eduardo
    Wiik, Allan
    Tincani, Angela
    Ronnelid, Johan
    Bloch, Donald B.
    Fritzler, Marvin J.
    Chan, Edward K. L.
    Garcia-De la Torre, I.
    Konstantinov, Konstantin N.
    Lahita, Robert
    Wilson, Merlin
    Vainio, Olli
    Fabien, Nicole
    Sinico, Renato Alberto
    Meroni, Pierluigi
    Shoenfeld, Yehuda
    International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no 1, p. 17-23Article in journal (Refereed)
    Abstract [en]

    Anti-nuclear antibodies (ANA) are fundamental for the diagnosis of autoimmune diseases, and have been determined by indirect immunofluorescence assay (IIFA) for decades. As the demand for ANA testing increased, alternative techniques were developed challenging the classic IIFA. These alternative platforms differ in their antigen profiles, sensitivity and specificity, raising uncertainties regarding standardisation and interpretation of incongruent results. Therefore, an international group of experts has created recommendations for ANA testing by different methods. Two groups of experts participated in this initiative. The European autoimmunity standardization initiative representing 15 European countries and the International Union of Immunologic Societies/World Health Organization/Arthritis Foundation/Centers for Disease Control and Prevention autoantibody standardising committee. A three-step process followed by a Delphi exercise with closed voting was applied. Twenty-five recommendations for determining ANA (1-13), anti-double stranded DNA antibodies (14-18), specific antibodies (19-23) and validation of methods (24-25) were created. Significant differences between experts were observed regarding recommendations 24-25 (p<0.03). Here, we formulated recommendations for the assessment and interpretation of ANA and associated antibodies. Notably, the roles of IIFA as a reference method, and the importance of defining nuclear and cytoplasmic staining, were emphasised, while the need to incorporate alternative automated methods was acknowledged. Various approaches to overcome discrepancies between methods were suggested of which an improved bench-to-bedside communication is of the utmost importance. These recommendations are based on current knowledge and can enable harmonisation of local algorithms for testing and evaluation of ANA and related autoantibodies. Last but not least, new more appropriate terminologies have been suggested.

  • 4. Alenius, G
    et al.
    Bergin, E
    Dahlqvist, Solbritt Rantapää
    Antibodies against cyclic citrullinated peptide (CCP) in patients with psoriasis with or without inflammatory joint manifestations2005In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 64Article in journal (Refereed)
  • 5. Alenius, G.
    et al.
    Eriksson, C.
    Dahlqvist, Solbritt Rantapää
    Interleukin-6, an inflammatory marker in patients with psoriatic arthritis?2007In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 66Article in journal (Refereed)
  • 6. Alenius, G
    et al.
    Friberg, C
    Nilsson, S
    Wahlstrom, J
    Dahlqvist, Solbritt Rantapää
    Samuelsson, L
    Analysis of six genetic loci for disease susceptibility in psoriatic arthritis2004In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 63Article in journal (Refereed)
  • 7. Ambrosi, Aurélie
    et al.
    Salomonsson, Stina
    Eliasson, Håkan
    Zeffer, Elisabeth
    Skog, Amanda
    Dzikaite, Vijole
    Bergman, Gunnar
    Fernlund, Eva
    Tingström, Joanna
    Theander, Elke
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Skogh, Thomas
    Öhman, Annika
    Lundström, Ulla
    Mellander, Mats
    Winqvist, Ola
    Fored, Michael
    Ekbom, Anders
    Alfredsson, Lars
    Källberg, Henrik
    Olsson, Tomas
    Gadler, Fredrik
    Jonzon, Anders
    Kockum, Ingrid
    Sonesson, Sven-Erik
    Wahren-Herlenius, Marie
    Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no 3, p. 334-340Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10-20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort.

    METHODS: The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies.

    RESULTS: There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (p<0.05).Seasonal timing of pregnancy influenced the outcome. Gestational susceptibility weeks 18-24 occurring during January-March correlated with a higher proportion of children with heart block and lower vitamin D levels during the same period in a representative sample of Swedish women and a corresponding higher proportion of children with heart block born in the summer (p<0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies.

    CONCLUSION: This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for heart block development in children of Ro/La-positive women. These observations may be useful for counselling when pregnancy is considered.

  • 8. Andersson, K.
    et al.
    Pullerits, R.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Dept Rheumatology and inflammation research, Inst Medicine, Göteborg university, Göteborg.
    Erlandsson, M.
    Silfversward, T.
    Bokarewa, M.
    Oestrogen dependent regulation of micro-rna in rheumatoid arthritis2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 236-237Article in journal (Other academic)
  • 9. Arlestig, L
    et al.
    Johansson, M
    Rantapää-Dahlqvist, Solbritt
    Polymorphisms of genes related to cardiovascular disease in rheumatoid arthritis2005In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 64Article in journal (Refereed)
  • 10. Arlestig, L.
    et al.
    Kokkonen, H.
    Einarsdottir, E.
    Dahlqvist, Solbritt Rantapää
    Low frequency of antibodies against citrullinated vimentin (MCV) and rheumatoid factor (RF) in unaffected members of multi-case families with rheumatoid arthritis (RA) from Northern Sweden2007In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 66, p. 319-320Article in journal (Refereed)
  • 11. Asking, J
    et al.
    Brandt, L
    Bertilsson, L
    Feltelius, N
    Fored, M
    Geborek, P
    Jacobsson, L
    Lindblad, S
    Lysholm, J
    Dahlqvist, Solbritt Rantapää
    Saxne, T
    Klareskog, L
    A national database for co-morbidity in RA to evaluate drug safety. Solid cancers in RA and following anti-TNF treatment2004In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 63Article in journal (Refereed)
  • 12.
    Askling, J
    et al.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Baecklund, E
    Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden.
    Granath, F
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Geborek, P
    Department of Rheumatology, Lund University Hospital, Lund, Sweden.
    Fored, M
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Backlin, C
    Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, Uppsala, Sweden.
    Bertilsson, L
    Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Cöster, L
    Department of Rheumatology, Linköping University Hospital, Linköping, Sweden.
    Jacobsson, LT
    Department of Rheumatology, Malmö University Hospital, Malmö, Sweden.
    Lindblad, S
    Rheumatology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Lysholm, J
    Department of Rheumatology, Falu County Hospital, Falun, Sweden.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Saxne, T
    Department of Rheumatology, Lund University Hospital, Lund, Sweden.
    van Vollenhoven, R
    Rheumatology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Klareskog, L
    Rheumatology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Feltelius, N
    Medical Products Agency, Uppsala, Sweden.
    Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register2009In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, no 5, p. 648-653Article in journal (Refereed)
    Abstract [en]

    Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis ( RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern. Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n = 67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 ( n = 6604) were identified. A general population comparator ( n = 471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these individuals. Results: Among the 6604 anti-TNF-treated RA patients, 26 malignant lymphomas were observed during 26 981 person-years of follow-up, which corresponded to a relative risk (RR) of 1.35 (95% CI 0.82 to 2.11) versus anti-TNF-naive RA patients ( 336 lymphomas during 365 026 person-years) and 2.72 ( 95% CI 1.82 to 4.08) versus the general population comparator ( 1568 lymphomas during 3 355 849 person-years). RA patients starting anti-TNF therapy in 1998-2001 accounted for the entire increase in lymphoma risk versus the two comparators. By contrast, RR did not vary significantly by time since start of first treatment or with the accumulated duration of treatment, nor with the type of anti-TNF agent. Conclusion: Overall and as used in routine care against RA, TNF antagonists are not associated with any major further increase in the already elevated lymphoma occurrence in RA. Changes in the selection of patients for treatment may influence the observed risk.

  • 13. Askling, J
    et al.
    Brandt, L
    Bertilsson, L
    Feltelius, N
    Fored, M
    Geborek, P
    Jacobsson, L
    Lindblad, S
    Lysholm, J
    Dahlqvist, Solbritt Rantapää
    Saxne, T
    Klareskog, L
    Risk for lymphomas following TNF-blockade. Comparisons with a nationwide co-morbidity database2004In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 63Article in journal (Refereed)
  • 14. Askling, J
    et al.
    Fored, C M
    Brandt, L
    Baecklund, E
    Bertilsson, L
    Coster, L
    Geborek, P
    Jacobsson, L T
    Lindblad, S
    Lysholm, J
    Rantapää-Dahlqvist, Solbritt
    Saxne, T
    Feltelius, N
    Klareskog, L
    Risk of cardiovascular morbidity and mortality following TNF-blockade. Preliminary results of an ongoing Swedish monitoring-programme of biologics in RA2005In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 64, p. 448-449Article in journal (Refereed)
  • 15. Askling, J
    et al.
    Fored, C M
    Brandt, L
    Baecklund, E
    Bertilsson, L
    Coster, L
    Geborek, P
    Jacobsson, L T
    Lindblad, S
    Lysholm, J
    Rantapää-Dahlqvist, Solbritt
    Saxne, T
    Feltelius, N
    Klareskog, L
    Risk of hospitalisation for infections following TNF-blockade. Preliminary results of an ongoing Swedish monitoring-programme of biologics in RA2005In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 64Article in journal (Refereed)
  • 16. Askling, J
    et al.
    Fored, C M
    Brandt, L
    Baecklund, E
    Bertilsson, L
    Coster, L
    Geborek, P
    Jacobsson, L T
    Lindblad, S
    Lysholm, J
    Rantapää-Dahlqvist, Solbritt
    Saxne, T
    Romanus, V
    Klareskog, L
    Feltelius, N
    Risk of tuberculosis in rheumatoid arthritis and following anti-TNF treatment. Preliminary results of an ongoing Swedish monitoring-programme of biologics in RA2005In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 64Article in journal (Refereed)
  • 17. Askling, J
    et al.
    Fored, C M
    Brandt, L
    Baecklund, E
    Bertilsson, L
    Coster, L
    Geborek, P
    Jacobsson, L T
    Lindblad, S
    Lysholms, J
    Rantapää-Dahlqvist, Solbritt
    Saxne, T
    Feltelius, N
    Klareskog, L
    Characteristics of malignant lymphomas following TNF-blockade. Preliminary results of an ongoing Swedish monitoring-programme of biologics in RA2005In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 64, p. 449-450Article in journal (Refereed)
  • 18. Askling, Johan
    et al.
    Baecklund, Eva
    Granath, Fredrik
    Geborek, Pierre
    Fored, Michael
    Backlin, Carin
    Bertilsson, Lennart
    Cöster, Lars
    Jacobsson, Lennart
    Lindblad, Staffan
    Lysholm, Jörgen
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Saxne, Tore
    van Vollenhoven, Ronald
    Klareskog, Lars
    Feltelius, Nils
    Anti-TNF therapy in RA and risk of malignant lymphomas Relative risks and time-trends in the Swedish Biologics Register2008In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, no 5, p. 648-653Article in journal (Refereed)
    Abstract [en]

    Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis (RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern.

    Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n  =  67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 (n  =  6604) were identified. A general population comparator (n  =  471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these individuals.

    Results: Among the 6604 anti-TNF-treated RA patients, 26 malignant lymphomas were observed during 26 981 person-years of follow-up, which corresponded to a relative risk (RR) of 1.35 (95% CI 0.82 to 2.11) versus anti-TNF-naive RA patients (336 lymphomas during 365 026 person-years) and 2.72 (95% CI 1.82 to 4.08) versus the general population comparator (1568 lymphomas during 3 355 849 person-years). RA patients starting anti-TNF therapy in 1998–2001 accounted for the entire increase in lymphoma risk versus the two comparators. By contrast, RR did not vary significantly by time since start of first treatment or with the accumulated duration of treatment, nor with the type of anti-TNF agent.

    Conclusion: Overall and as used in routine care against RA, TNF antagonists are not associated with any major further increase in the already elevated lymphoma occurrence in RA. Changes in the selection of patients for treatment may influence the observed risk.

  • 19. Bengtsson, K.
    et al.
    Askling, J.
    Lorentzon, M.
    Rosengren, B.
    Deminger, A.
    Klingberg, E.
    Jacobsson, L. T. H.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Higher risk of incident fracture in patients with ankylosing spondylitis compared to the general population2020In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 79, p. 745-746, article id FRI0310Article in journal (Other academic)
    Abstract [en]

    Background: Ankylosing spondylitis (AS) is characterized by pathologic new bone formation and bone loss. Vertebral fracture (VF) is a known complication of AS, whereas the risk of other major osteoporotic fractures (MOFs) is less studied.

    Objectives: To estimate incidence rates (IRs) of incident fractures (any, VF and other MOF (humerus, forearm and hip)) in patients with AS compared to controls from general population.

    Methods: This is a nationwide, register-based and observational cohort study including patients diagnosed with AS (n=11611, 65% men, mean age 48 years) identified in the National patient register (NPR) 2001 through 2015, and age- and sex-matched controls (n=58050) from the Swedish Population Register. The study period started 1 January 2007 or 3 months after the first AS diagnosis, whichever came later, and ended at the first occurrence of each fracture outcome (identified in the NPR), death, emigration or 31 December 2016. Patients and controls with any prior fracture in NPR within a 6-year period before start of the study period were not included. Any fracture (except skull and phalangeal fractures), VF and other MOF were identified in NPR according to pre-specified ICD codes. Each fracture outcome was analysed separately. Poisson regression was used to calculate IRs and incidence rate ratios (IRRs), overall and stratified by sex. Kaplan-Meier curves were plotted.

    Results: In total 807 (7.0%) of patients with AS and 3201 (5.5%) of matched controls had a history of prior fracture within a 6-year period, and were excluded from further analyses. We noted higher IRs for any fracture, VF and other MOF in AS vs controls, see Figure for Kaplan-Meier curves and Table for IRs and IRRs. In sex-stratified analyses, men with AS (vs. male controls) had a higher relative risk for all fracture outcomes, whereas among women with AS (vs. female controls), a higher relative risk was demonstrated for any fracture and VF. 5-year cumulative incidence for any fracture, VF and other MOF was 6.2%, 1.6% and 1.7%, respectively in AS and 4.3%, 0.3% and 1.2%, respectively in controls.

  • 20. Bengtsson, K.
    et al.
    Klingberg, E.
    Deminger, A.
    Jacobsson, L. T.
    Bergfeldt, L.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg.
    Ankylosing spondylitis related factors predict the presence of cardiac conduction disturbances: a swedish longitudinal cohort study2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 337-338Article in journal (Other academic)
  • 21. Bengtsson, Karin
    et al.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Rheumatology and Inflammation Research, Göteborg, Sweden.
    Klingberg, Eva
    Lindstrom, Ulf
    Dehlin, Mats
    Exarchou, Sofia
    Deminger, Anna
    Askling, Johan
    Jacobsson, Lennart T. H.
    Incidence of extra-articular manifestations in ankylosing spondylitis, proriatic arthritis and undifferentiated spondyloarthritis - results from a national register-based cohort study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1237-1237Article in journal (Other academic)
  • 22. Bengtsson, Karin
    et al.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden .
    Lie, Elisabeth
    Klingberg, Eva
    Dehlin, Mats
    Exarchou, Sofia
    Lindstrom, Ulf
    Askling, Johan
    Jacobsson, Lennart T. H.
    Risk of cardiac rhythm disturbances and aortic regurgitation in different spondyloarthritis subtypes in comparison with general population: a register-based study from Sweden2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no 4, p. 541-548Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe the incidence of atrioventricular (AV) block II-III, atrial fibrillation (AF), pacemaker implantation (PM) and aortic regurgitation in patients with ankylosing spondylitis (AS), undifferentiated spondyloarthritis (uSpA) and psoriatic arthritis (PsA) compared with the general population (GP) and with each other. Methods: A prospective nationwide study with cohorts of patients with AS (n=6448), PsA (n=16063) and uSpA (n=5190) and a GP (n=266435) cohort, identified in 2001-2009 in the Swedish National Patient and Population registers. Follow-up began on 1 January 2006 and ended at event, death, emigration or 31 December 2012. Age-standardised and sex-standardised incidence rates and hazard ratios (HRs) were calculated. Results: The highest incidence rates were noted for AF (5.5-7.4 events per 1000 person-years), followed by PM (1.0-2.0 events per 1000 person-years). HRs for AV block, AF, PM and aortic regurgitation were significantly increased in AS (HRs 2.3, 1.3, 2.1 and 1.9), uSpA (HRs 2.9, 1.3, 1.9 and 2.0) and PsA (HRs 1.5, 1.5, 1.6 and 1.8) compared with the GP cohort. The highest HRs were seen for AV block in male uSpA (HR 4.2) and AS (HR 2.5) compared with GP. Compared with PsA, significantly increased HRs were noted for PM (HR 1.5) in AS and for AV block (HR 1.8) in uSpA. Conclusions: Patients with SpA are at increased risk of aortic regurgitation, cardiac rhythm disturbances and, as a probable consequence, also PM. Particularly for AF, the most common arrhythmia, increased caution is warranted, whereas AV block should be looked for especially in men with AS or uSpA.

  • 23.
    Berglin, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Esberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dahlqvist, J.
    Sjowall, J.
    Lundquist, Anders
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Lejon, Kristina
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Mohammad, A. J.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Protein profiling in individuals before onset of anca-associated vasculitis2020In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 79, p. 372-372Article in journal (Other academic)
  • 24.
    Berglin, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Johansson, T.
    Umeå University, Faculty of Medicine, Department of Medical Biochemistry and Biophysics.
    Sundin, U.
    Jidell, Erik
    Wadell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Hallmans, Göran
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Radiological outcome in rheumatoid arthritis is predicted by presence of antibodies against cyclic citrullinated peptide before and at disease onset, and by IgA-RF at disease onset2006In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 65, no 4, p. 453-458Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the significance of antibodies against cyclic citrullinated peptide (anti-CCP) and rheumatoid factors (RFs), before the onset of rheumatoid arthritis and when presenting as early disease (baseline), for disease activity and progression. METHODS: 93 of a cohort of 138 patients with early rheumatoid arthritis (<12 months of symptoms) had donated blood before symptoms of rheumatoid arthritis (defined as pre-patients) and were identified from among blood donors within the Medical Biobank of northern Sweden. Disease activity (erythrocyte sedimentation rate (ESR), C reactive protein, joint score, global visual analogue scale) and radiological destruction in hands and feet (Larsen score) were assessed at baseline and after two years. Anti-CCP antibodies and RFs were analysed using enzyme immunoassays. HLA shared epitope (SE) alleles (DRB1*0401/0404) were identified. RESULTS: Patients with anti-CCP antibodies before disease onset had significantly higher Larsen score at baseline and after two years. In multiple regression analyses baseline values of anti-CCP/IgA-RF/IgG-RF/IgM-RF, swollen joint count, and Larsen score significantly predicted radiological outcome at two years. In logistic regression analyses, baseline values of anti-CCP antibodies/IgA-RF, therapeutic response at six months, and swollen joint count/ESR significantly predicted radiological progression after two years. The baseline titre of anti-CCP antibodies was higher in patients with radiological progression and decreased significantly in those with response to therapy. SE allele carriage was associated with a positive test for anti-CCP antibodies in pre-patients and in early rheumatoid arthritis. CONCLUSIONS: Presence of anti-CCP antibodies before disease onset is associated with more severe radiological damage. The titre of anti-CCP antibodies is related to disease severity.

  • 25.
    Berglin, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Mohammad, A. J.
    Dahlqvist, J.
    Eriksson, C.
    Umeå University.
    Sjöwall, J.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Anti-neutrophil cytoplasmatic antibodies predate symptom onset of anca-associated vasculitis: a case-control study2020In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 79, p. 1065-1066Article in journal (Other academic)
  • 26. Bokarewa, M
    et al.
    Brink, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Erlandsson, M
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Survivin but NOT fms-like tyrosine kinase ligand (FLT3L) is up-regulated before onset of rheumatoid arthritis2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. 193-193Article in journal (Refereed)
  • 27.
    Bower, Hannah
    et al.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Frisell, Thomas
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Di Giuseppe, Daniela
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Delcoigne, Bénédicte
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Alenius, Gerd-Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Baecklund, Eva
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Chatzidionysiou, Katerina
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Feltelius, Nils
    Swedish Medical Products Agency, Uppsala, Sweden.
    Forsblad-D'elia, Helena
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kastbom, Alf
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Klareskog, Lars
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Lindqvist, Elisabet
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Lindström, Ulf
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Turesson, Carl
    Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Sjöwall, Christopher
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Askling, Johan
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, no 8, p. 1086-1093Article in journal (Refereed)
    Abstract [en]

    Objectives: To estimate absolute and relative risks for all-cause mortality and for severe COVID-19 in inflammatory joint diseases (IJDs) and with antirheumatic therapies.

    Methods: Through Swedish nationwide multiregister linkages, we selected all adult patients with rheumatoid arthritis (RA, n=53 455 in March 2020), other IJDs (here: spondyloarthropathies, psoriatic arthritis and juvenile idiopathic arthritis, n=57 112), their antirheumatic drug use, and individually matched population referents. We compared annual all-cause mortality March-September 2015 through 2020 within and across cohorts, and assessed absolute and relative risks for hospitalisation, admission to intensive care and death due to COVID-19 March-September 2020, using Cox regression.

    Results: During March-September 2020, the absolute all-cause mortality in RA and in other IJDs was higher than 2015-2019, but relative risks versus the general population (around 2 and 1.5) remained similar during 2020 compared with 2015-2019. Among patients with IJD, the risks of hospitalisation (0.5% vs 0.3% in their population referents), admission to intensive care (0.04% vs 0.03%) and death (0.10% vs 0.07%) due to COVID-19 were low. Antirheumatic drugs were not associated with increased risk of serious COVID-19 outcomes, although for certain drugs, precision was limited.

    Conclusions: Risks of severe COVID-19-related outcomes were increased among patients with IJDs, but risk increases were also seen for non-COVID-19 morbidity. Overall absolute and excess risks are low and the level of risk increases are largely proportionate to those in the general population, and explained by comorbidities. With possible exceptions, antirheumatic drugs do not have a major impact on these risks.

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  • 28. Bowes, John
    et al.
    Loehr, Sabine
    Budu-Aggrey, Ashley
    Uebe, Steffen
    Bruce, Ian N.
    Feletar, Marie
    Marzo-Ortega, Helena
    Helliwell, Philip
    Ryan, Anthony W.
    Kane, David
    Korendowych, Eleanor
    Alenius, Gerd-Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Giardina, Emiliano
    Packham, Jonathan
    McManus, Ross
    FitzGerald, Oliver
    Brown, Matthew A.
    Behrens, Frank
    Burkhardt, Harald
    McHugh, Neil
    Huffmeier, Ulrike
    Ho, Pauline
    Reis, Andre
    Barton, Anne
    PTPN22 is associated with susceptibility to psoriatic arthritis but not psoriasis: evidence for a further PsA-specific risk locus2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no 10, p. 1882-1885Article in journal (Refereed)
    Abstract [en]

    Objectives Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis; it has a higher estimated genetic component than psoriasis alone, however most genetic susceptibility loci identified for PsA to date are also shared with psoriasis. Here we attempt to validate novel single nucleotide polymorphisms selected from our recent PsA Immunochip study and determine specificity to PsA. Methods A total of 15 single nucleotide polymorphisms were selected (P-Immunochip <1x10(-4)) for validation genotyping in 1177 cases and 2155 controls using TaqMan. Meta-analysis of Immunochip and validation data sets consisted of 3139 PsA cases and 11 078 controls. Novel PsA susceptibility loci were compared with data from two large psoriasis studies (WTCCC2 and Immunochip) to determine PsA specificity. Results We found genome-wide significant association to rs2476601, mapping to PTPN22 (p=1.49x10(-9), OR=1.32), but no evidence for association in the psoriasis cohort (p=0.34) and the effect estimates were significantly different between PsA and psoriasis (p=3.2x10(-4)). Additionally, we found genome-wide significant association to the previously reported psoriasis risk loci; NOS2 (rs4795067, p=5.27x10(-9)). Conclusions For the first time, we report genome-wide significant association of PTPN22 (rs2476601) to PsA susceptibility, but no evidence for association to psoriasis.

  • 29.
    Brink, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Hansson, M.
    Mathson-Alm, L.
    Cornillet, M.
    Ronnelid, J.
    Skriner, K.
    Serre, G.
    Holmdahl, R.
    Klareskog, L.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Acpa against different citrullinated peptides identify specific phenotypes of rheumatoid arthritis2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, p. 792-792Article in journal (Other academic)
  • 30.
    Brink, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Hansson, Monika
    Ronnelid, Johan
    Klareskog, Lars
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    The autoantibody repertoire in periodontitis: a role in the induction of autoimmunity to citrullinated proteins in rheumatoid arthritis? Antibodies against uncitrullinated peptides seem to occur prior to the antibodies to the corresponding citrullinated peptides2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no 7Article in journal (Refereed)
  • 31.
    Brink, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Johansson, L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Nygren, E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Ärlestig, L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Vitamin d in individuals before onset of rheumatoid arthritis: relation to vitamin d binding protein and its associated genetic variants2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 282-282Article in journal (Other academic)
  • 32.
    Brink, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Ronnelid, Johan
    Hansson, Monika
    Mathsson, Linda
    Serre, Guy
    Jakobsson, Per-Johan
    Holmdahl, Rikard
    Klareskog, Lars
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Antibodies against native collagen and citrullinated proteins precede the development of rheumatoid arthritis with a consecutive pattern2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, p. A22-A22Article in journal (Other academic)
  • 33.
    Brink, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Verheul, M. K.
    Ronnelid, J.
    Toes, R. E.
    Klareskog, L.
    Trouw, L. L.
    Rantapää Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Anti-carbamylated protein antibodies precede the onset of symptoms of rheumatoid arthritis in a Swedish biobank cohort2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, p. 397-398Article in journal (Other academic)
  • 34. Burgers, L. E.
    et al.
    Siljehult, Filip
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    ten Brinck, R. M.
    van Steenbergen, H. W.
    Landewe, R. B.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    van der Helm-van Mil, A. H.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Performance of the EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis - a longitudinal study2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, p. 82-82Article in journal (Other academic)
  • 35. Crowson, Cynthia S.
    et al.
    Rollefstad, Silvia
    Ikdahl, Eirik
    Kitas, George D.
    van Riel, Piet L. C. M.
    Gabriel, Sherine E.
    Matteson, Eric L.
    Kvien, Tore K.
    Douglas, Karen
    Sandoo, Aamer
    Arts, Elke
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Innala, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Karpouzas, George
    Dessein, Patrick H.
    Tsang, Linda
    El-Gabalawy, Hani
    Hitchon, Carol
    Pascual Ramos, Virginia
    Contreras Yanez, Irazu
    Sfikakis, Petros P.
    Zampeli, Evangelia
    Gonzalez-Gay, Miguel A.
    Corrales, Alfonso
    van de laar, Mart
    Vonkeman, Harald E.
    Meek, Inger
    Samb, Anne Grete
    Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no 1, p. 48-54Article in journal (Refereed)
    Abstract [en]

    Objectives: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. Methods: In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. Results: 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics). Conclusions: In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

  • 36. Dahlqvist, Solbritt Rantapää
    et al.
    De Jong, B A W
    Berglin, E
    Hallmans, G
    Wadell, G
    Stenlund, H
    Sundin, U
    Anti-CCP antibodies and IGA-rheumatoid factor predict the development of rheumatoid arthritis2003In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 62Article in journal (Refereed)
  • 37. Dahlqvist, Solbritt Rantapää
    et al.
    Lundström, B
    Holmgren, G
    Trichorhinophalangeal syndrome type-i and systemic lupus-erythematosus with complement c4a homozygous null alleles in the same family1989In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 48, p. 760-764Article in journal (Refereed)
  • 38. Dehlin, M. I.
    et al.
    Drivelegka, P.
    Sigurdardottir, V.
    Angeras, O.
    Jacobsson, L. T.
    Forsblad-D'elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Hyperuricemia is associated with increased coronary artery calcification in men but not women2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, p. 375-375Article in journal (Other academic)
  • 39. Dehlin, M. I.
    et al.
    Drivelegka, P.
    Sigurdardottir, V.
    Angerås, O.
    Jacobsson, L. T.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Urate correlates to coronary artery calcification but not to intima media thickness2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 655-656Article in journal (Other academic)
  • 40. Delcoigne, B.
    et al.
    Ljung, Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Provan, S. A.
    Glintborg, B.
    Lederballe Gron, K.
    Hetland, M. L.
    Steen Krogh, N.
    Trokovic, N.
    Relas, H.
    Turesson, C.
    Michelsen, B.
    Askling, J.
    SHORT- AND LONGER-TERM RISKS FOR ACUTE CORONARY SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS STARTING TREATMENT WITH DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS: A COLLABORATIVE OBSERVATIONAL HEAD-TO-HEAD STUDY ACROSS FIVE NORDIC RHEUMATOLOGY REGISTERS2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, p. 63-64, article id OP0114Article in journal (Other academic)
  • 41. Delcoigne, Benedicte
    et al.
    Di Giuseppe, Daniela
    Askling, Johan
    Ljung, Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Karolinska Institutet, Department of Medicine, Stockholm, Sweden.
    The influence of patient demographics on disease activity measurments in theumatoid arthritis2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1423-1424Article in journal (Other academic)
    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.

  • 42.
    Delcoigne, Benedicte
    et al.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Ljung, Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Provan, Sella A.
    Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
    Glintborg, Bente
    The DANBIO Registry and Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Lund Hetland, Merete
    The DANBIO Registry and Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Lederballe Grøn, Kathrine
    Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark.
    Peltomaa, Ritva
    Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
    Relas, Heikki
    Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
    Turesson, Carl
    Department of Rheumatology, Skåne University Hospital, Skåne, Lund, Sweden.
    Gudbjornsson, Bjorn
    Faculty of Medicine, University Hospital of Iceland, Reykjavik, Iceland; Department of Rheumatology, Centre for Rheumatology Research, Reykjavik, Iceland.
    Michelsen, Brigitte
    Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway.
    Askling, Johan
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs: Results from four Nordic countries2022In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 81, no 6, p. 789-797Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare the 1-year, 2-year and 5-year incidences of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) starting any of the biologic disease-modifying antirheumatic drugs (bDMARDs) currently available in clinical practice and to anchor these results with a general population comparator.

    Methods: Observational cohort study, with patients from Denmark, Finland, Norway and Sweden starting a bDMARD during 2008-2017. Time to first ACS was identified through register linkages. We calculated the 1-year, 2-year and 5-year incidence rates (IR) (on drug and ever since treatment start) and used Cox regression (HRs) to compare ACS incidences across treatments taking ACS risk factors into account. Analyses were further performed separately in subgroups defined by age, number of previous bDMARDs and history of cardiovascular disease. We also compared ACS incidences to an individually matched general population cohort.

    Results: 24 083 patients (75% women, mean age 56 years) contributing 40 850 treatment courses were included. During the maximum (5 years) follow-up (141 257 person-years (pyrs)), 780 ACS events occurred (crude IR 5.5 per 1000 pyrs). Overall, the incidence of ACS in RA was 80% higher than that in the general population. For all bDMARDs and follow-up definitions, HRs were close to 1 (etanercept as reference) with the exception of the 5-year risk window, where signals for abatacept, infliximab and rituximab were noted.

    Conclusion: The rate of ACS among patients with RA initiating bDMARDs remains elevated compared with the general population. As used in routine care, the short-term, intermediate-term and longer-term risks of ACS vary little across individual bDMARDs.

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  • 43.
    d'Elia, Helena Forsblad
    et al.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg.
    Bjurman, C
    Rehnberg, E
    Kvist, G
    Konttinen, Y T
    Interleukin 6 and its soluble receptor in a central role at the neuroimmunoendocrine interface in Sjogren syndrome: an explanatory interventional study.2009In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, no 2Article in journal (Refereed)
  • 44. Deminger, A.
    et al.
    Klingberg, E.
    Lorentzon, M.
    Carlsten, H.
    Jacobsson, L. T.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg.
    Changes in volumetric bone mineral density and bone microarchitecture in patients with ankylosing spondylitis. a five-year prospective study using hrpqct2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, p. 916-916Article in journal (Other academic)
  • 45. Deminger, Anna
    et al.
    Klingberg, Eva
    Nurkkala, Merja
    Carlsten, Hans
    Jacobsson, Lennart T. H.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Sahlgrenska Academy at University of Gothenburg, Department of Rheumatology and Inflammation Research, Göteborg, Sweden.
    Hepatocyte growth factor is a predictor of development of new syndesmophytes in men with ankylosing spondylitis. A five year prospective study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, p. 1240-1240Article in journal (Other academic)
    Abstract [en]

    Background: Patients with ankylosing spondylitis (AS) have an increased risk of spinal new bone formation characterized by the development of syndesmophytes. Knowledge of predictors for development of syndesmophytes is limited. Hepatocyte growth factor (HGF) has regulatory effects on a variety of cells in many different organs. HGF signaling can affect both osteoclast and osteoblast lineages and has been shown to promote osteogenesis. Cross-sectional association between increased HGF and increased modified Stoke Ankylosing Spine Score (mSASSS) has previously been shown [1], whereas knowledge of HGF as a predictor for new bone formation is lacking.

    Objectives: To study serum HGF as a predictor for development of new syndesmophytes in patients with AS followed for five years.

    Methods: Serum levels of HGF was analyzed using ELISA in patients with AS (modified NY-criteria) and in healthy controls (HC) at baseline. Spinal lateral radiographs were obtained at baseline and at the 5-year follow-up and assessed for development of new syndesmophytes using mSASSS. Univariate and multivariable logistic regression analyses were used to assess predictors for development of ≥ 1 new syndesmophyte.

    Results: Serum HGF and radiographs at baseline and follow-up were available for 163 patients, 88 men and 75 women, baseline mean age 50±12 years. AS patients had higher serum HGF than HC (n=80), p=0.050. In the AS group, 36 patients (22%) developed ≥ 1 syndesmophyte, 27 men and 9 women. In the total AS group, neither did baseline serum HGF differ between those who developed ≥ 1 new syndesmophyte and those who did not progress, nor did it predict development of ≥ 1 new syndesmophyte in the univariate analysis, p=0.25. Interestingly, men who developed ≥1 new syndesmophyte had higher serum HGF than the non-progressors (1706±454 vs 1420±338 pg/mL, p=0.001) and increased serum HGF at baseline predicted development of ≥ 1 syndesmophyte (OR per 1 SD HGF 2.39, 95% CI 1.31 to 4.36) in the univariate analysis. Serum HGF did not predict new syndesmophytes in women, p=0.13. Multivariable analysis for men including age, smoking, baseline syndesmophyte and serum HGF showed high HGF (OR per 1SD 1.90, 95% CI 1.01 to 3.59) and ≥1 baseline syndesmophyte (OR 3.48, 95% CI 1.09 to 11.07) to independently predict development of ≥ 1 new syndesmophyte. If baseline CRP was included in the multivariable model, serum HGF and baseline syndesmophytes remained the significant predictors.

    Conclusion: High baseline serum HGF was shown to independently predict the development of at least one new syndesmophyte over five years in men with AS.

  • 46. Di Giuseppe, D.
    et al.
    Frisell, T.
    Ernestam, S.
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Lindqvist, E.
    Lindstrom, U.
    Sjowall, C.
    Askling, J.
    Assessment of biosimilars using real world data: the complexity of choosing a comparator and understanding uptake2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, p. 452-453Article in journal (Other academic)
  • 47. Engdahl, C.
    et al.
    Raufer, J.
    Harre, U.
    Bondt, A.
    Pfeifle, R.
    Kroenke, G.
    Scherer, H. U.
    Forsblad, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Department of Rhemtology and Inflammation reserch, CBAR, Institue of Medicine, Gothenburg, Sweden.
    Schett, G.
    Estrogen influences the sialylation profile and inflammatory properties of antibodies – a potential explanation for the sex differences and increased risk for ra in postmenopausal women2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, p. 775-775Article in journal (Other academic)
  • 48.
    Eriksson, Catharina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Engstrand, S
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Sundqvist, K-G
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Autoantibody formation in patients with rheumatoid arthritis treated with anti-TNF alpha2005In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 64, no 3, p. 403-407Article in journal (Refereed)
    Abstract [en]

    Background: Research on autoantibody formation in patients treated with TNFα inhibitors has produced contradictory results.

    Objective: To study the prevalence of autoantibodies in patients with rheumatoid arthritis treated with the TNFα inhibitor infliximab.

    Methods: 53 patients (48 female, 11 male) treated with infliximab for rheumatoid arthritis were followed for autoantibody production before treatment and after 14, 30, and 54 weeks. Six patients treated with etanercept were studied for comparison. The analyses included antibodies against nuclear antigens (ANA), extractable nuclear antigens, double stranded (ds)DNA (by ELISA, IIF on Crithidia luciliae for IgM and IgG, and Farr assay), nucleosomes, cardiolipin, smooth muscle, mitochondria, proteinase 3, and myeloperoxidase antigens.

    Results: The number of patients treated with infliximab who developed antibodies against dsDNA of both IgG and IgM class (tested by IIF) increased significantly. The prevalence of patients positive for IgG class increased to 66% at 30 weeks and 45% at 54 weeks, and of IgM class to 85% and 70%, respectively. The titre and number of patients expressing antibodies against nucleosomes and ANA also increased significantly. The number of rheumatoid factor or anticardiolipin positive patients was stable and there was no increase in antibodies against the other antigens. A lupus-like syndrome was seen in one patient. No patient treated with etanercept developed any of these autoantibodies.

    Conclusions: Patients treated with infliximab may develop anti-dsDNA antibodies of both IgM and IgG class, anti-nucleosome antibodies, and ANA, with a gradual increase until 30 weeks.

  • 49. Exarchou, S.
    et al.
    Di Giuseppe, D.
    Alenius, Gerd-Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Klingberg, E.
    Sigurdardottir, V.
    Wedrén, S.
    Lindström, U.
    Turesson, C.
    Jacobsson, L. T. H.
    Askling, J.
    Wallman, J. K.
    MORTALITY IN PATIENTS WITH PSORIATIC ARTHRITIS IN SWEDEN2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, p. 130-131, article id OP0218Article in journal (Other academic)
  • 50. Exarchou, Sofia
    et al.
    Lie, Elisabeth
    Lindström, Ulf
    Askling, Johan
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Turesson, Carl
    Kristensen, Lars Erik
    Jacobsson, Lennart Th
    Mortality in ankylosing spondylitis: results from a nationwide population-based study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no 8, p. 1466-1472Article in journal (Refereed)
    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.

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