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28-Joint count disease activity score at 3 months after diagnosis of early rheumatoid arthritis is strongly associated with direct and indirect costs over the following 4 years: the Swedish TIRA project.

https://arctichealth.org/en/permalink/ahliterature137343
Source
Rheumatology (Oxford). 2011 Jul;50(7):1259-67
Publication Type
Article
Date
Jul-2011
Author
Eva Hallert
Magnus Husberg
Thomas Skogh
Author Affiliation
Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden. eva.hallert@liu.se
Source
Rheumatology (Oxford). 2011 Jul;50(7):1259-67
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - diagnosis - economics - therapy
Cohort Studies
Cost of Illness
Disease Progression
Female
Follow-Up Studies
Health Care Costs
Health Expenditures
Humans
Linear Models
Male
Middle Aged
Predictive value of tests
Prospective Studies
Risk assessment
Severity of Illness Index
Sweden
Time Factors
Abstract
To explore possible association between disease activity at 3-month follow-up after RA diagnosis and costs over the following 4 years.
Three-hundred and twenty patients with early (= 1 year) RA were assessed at regular intervals. Clinical and laboratory data were collected and patients reported health-care utilization and number of days lost from work. At 3-month follow-up, patients were divided into two groups according to disease activity, using DAS-28 with a cut-off level at 3.2. Direct and indirect costs and EuroQol-5D over the following 4 years were compared between the groups. Multivariate regression models were used to control for possible covariates.
Three months after diagnosis, a DAS-28 level of = 3.2 was associated with high direct and indirect costs over the following 4 years. Patients with DAS-28 = 3.2 at 3-month follow-up had more visits to physician, physiotherapist, occupational therapist and nurse, higher drug costs, more days in hospital and more extensive surgery compared with patients with 3-month DAS-28
PubMed ID
21292734 View in PubMed
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Activity limitation in rheumatoid arthritis correlates with reduced grip force regardless of sex: the Swedish TIRA project.

https://arctichealth.org/en/permalink/ahliterature13698
Source
Arthritis Rheum. 2005 Dec 15;53(6):886-96
Publication Type
Article
Date
Dec-15-2005
Author
Ingrid Thyberg
Ursula A M Hass
Ulla Nordenskiöld
Björn Gerdle
Thomas Skogh
Author Affiliation
The Swedish Institute for Disability Research, Linköping University, Linköping, and Orebro Universities, Orebro, Sweden. ingrid.thyberg@lio.se
Source
Arthritis Rheum. 2005 Dec 15;53(6):886-96
Date
Dec-15-2005
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Aged
Aged, 80 and over
Arthritis, Rheumatoid - physiopathology
Female
Hand Strength - physiology
Health status
Humans
Male
Middle Aged
Questionnaires
Research Support, Non-U.S. Gov't
Severity of Illness Index
Sex Factors
Sweden
Abstract
OBJECTIVE: To evaluate activity limitations 3 years after diagnosis of early rheumatoid arthritis (RA) in relation to grip force and sex. METHODS: A total of 217 patients, 153 women and 64 men, with recent-onset RA were included. Activity limitations were reported using the Health Assessment Questionnaire (HAQ) and the Evaluation of Daily Activities Questionnaire (EDAQ). The relationships between activity limitations versus grip force (measured by the Grippit), walking speed, functional impairment, grip ability, pain, plasma C-reactive protein, the 28-joint disease activity score and its components, the physician's global assessment of disease activity, and sex were analyzed by partial least squares (PLS). RESULTS: Women had significantly lower grip force and more activity limitations (HAQ and EDAQ) than men. The PLS analyses demonstrated that grip force was the strongest regressor of activity limitation, closely followed by walking speed. However, within subgroups based on grip force (group 1 = grip force 328 N) and including sexes, women and men had corresponding degrees of activity limitation as reported by the HAQ and EDAQ. CONCLUSION: Our results indicate that the more pronounced activity limitations seen in women with RA, as compared with men, may be explained by lower grip force rather than sex.
PubMed ID
16342097 View in PubMed
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Allergic manifestations in patients with rheumatoid arthritis.

https://arctichealth.org/en/permalink/ahliterature13861
Source
APMIS. 2003 Oct;111(10):940-4
Publication Type
Article
Date
Oct-2003
Author
Asa Reckner Olsson
Gun Wingren
Thomas Skogh
Olle Svernell
Jan Ernerudh
Author Affiliation
Division of Occupational and Environmental Medicine, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. asa.reckner.olson@lio.se
Source
APMIS. 2003 Oct;111(10):940-4
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Adult
Arthritis, Rheumatoid - complications - immunology
Case-Control Studies
Humans
Hypersensitivity, Immediate - complications - immunology
Immunoglobulin E - blood
Middle Aged
Models, Immunological
Research Support, Non-U.S. Gov't
Rhinitis - complications - immunology
Sweden
Th1 Cells - immunology
Th2 Cells - immunology
Abstract
A functional dichotomy between Th1- and Th2-type immune responses has been suggested. This study was performed to investigate whether rheumatoid arthritis (RA), a disease with indications of Th1-deviated immune activation, is inversly related to atopic conditions which are Th2-mediated. Two hundred and sixty-three adult cases of RA, fulfilling the American Rheumatism Association (ARA) 1987 Revised Classification Criteria for RA, were identified in 1995 and compared with 541 randomly selected population referents. The presence of atopic manifestations was established through a postal questionnaire and by demonstrating circulating IgE antibodies to common allergens. RA was inversely associated with certain manifestations of rhinitis, which were regarded as the most reliable indicators of atopic disease in the present study. However, no negative association was seen between RA and asthma and eczema, respectively. The main results give some support for an inverse relationship between RA and rhinitis. The prevalence of circulating IgE antibodies was however similar in cases and controls, suggesting that the T-cell commitment mainly occurs in the affected organs.
PubMed ID
14616545 View in PubMed
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Application of the 2012 Systemic Lupus International Collaborating Clinics classification criteria to patients in a regional Swedish systemic lupus erythematosus register.

https://arctichealth.org/en/permalink/ahliterature269451
Source
Arthritis Res Ther. 2015;17:3
Publication Type
Article
Date
2015
Author
Anna Ighe
Örjan Dahlström
Thomas Skogh
Christopher Sjöwall
Source
Arthritis Res Ther. 2015;17:3
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Humans
Internationality
Lupus Erythematosus, Systemic - classification - diagnosis - epidemiology
Male
Middle Aged
Registries
Severity of Illness Index
Sweden - epidemiology
Young Adult
Abstract
In 2012, the Systemic Lupus International Collaborating Clinics (SLICC) network presented a new set of criteria (SLICC-12) to classify systemic lupus erythematosus (SLE). The present study is the first to evaluate the performance of SLICC-12 in an adult European study population. Thus, SLICC-12 criteria were applied to confirmed SLE cases in our regional SLE register as well as to individuals with a fair suspicion of systemic autoimmune disease who were referred to rheumatology specialists at our unit.
We included 243 confirmed SLE patients who met the 1982 American College of Rheumatology (ACR-82) classification criteria and/or the Fries 'diagnostic principle' (presence of antinuclear antibodies on at least one occasion plus involvement of at least two defined organ systems) and 55 controls with possible systemic autoimmune disease, including the presence of any SLE-related autoantibody.
SLICC-12 showed a diagnostic sensitivity of 94% (95% confidence interval (CI), 0.90 to 0.96) compared with 90% (95% CI, 0.85 to 0.93) for the updated set of ACR criteria from 1997 (ACR-97), whereas ACR-82 failed to identify every fifth true SLE case. However, the disease specificity of SLICC-12 reached only 74% (95% CI, 0.60 to 0.84) and did not change much when involvement of at least two different organs was required as an indicator of systemic disease. In addition, SLICC-12 misclassified more of the controls compared to ACR-82, ACR-97 and Fries.
Establishing a standard definition of SLE continues to challenge lupus researchers and clinicians. We confirm that SLICC-12 has advantages with regard to diagnostic sensitivity, whereas we found the diagnostic specificity to be surprisingly low. To accomplish increased sensitivity and specificity figures, a combination of criteria sets for clinical SLE studies should be considered.
Notes
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Cites: J Autoimmun. 2014 Feb-Mar;48-49:10-324461385
PubMed ID
25575961 View in PubMed
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A comparison between IgG- and IgA-class antibodies to cyclic citrullinated peptides and to modified citrullinated vimentin in early rheumatoid arthritis and very early arthritis.

https://arctichealth.org/en/permalink/ahliterature135637
Source
J Rheumatol. 2011 Jul;38(7):1265-72
Publication Type
Article
Date
Jul-2011
Author
Anna Svärd
Alf Kastbom
Maria K Söderlin
Åsa Reckner-Olsson
Thomas Skogh
Author Affiliation
Rheumatology Clinic, Falun Hospital, Falun, Sweden. anna.svard@ltdalarna.se
Source
J Rheumatol. 2011 Jul;38(7):1265-72
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Arthritis - diagnosis - epidemiology - immunology
Arthritis, Rheumatoid - diagnosis - epidemiology - immunology
Cohort Studies
Diagnosis, Differential
Disease Progression
Epitopes
Follow-Up Studies
Humans
Immunoglobulin A - blood
Immunoglobulin G - blood
Incidence
Peptides, Cyclic - immunology
Predictive value of tests
Prospective Studies
Sensitivity and specificity
Smoking - adverse effects
Sweden - epidemiology
Vimentin - immunology
Abstract
Because of their slightly higher sensitivity, it has been argued that antibodies to modified citrullinated vimentin (anti-MCV) are superior to antibodies to cyclic citrullinated peptides (anti-CCP), while others claim that anti-CCP is preferable because of higher diagnostic specificity for rheumatoid arthritis (RA). We evaluated IgG- and IgA-class anti-MCV and anti-CCP as diagnostic and prognostic markers in early arthritis.
Two Swedish arthritis populations were examined: 215 patients with early RA (= 12 months' duration) from the Swedish TIRA-1 cohort, and 69 patients with very early arthritis (= 3 months' duration) from the Kronoberg Arthritis Incidence cohort, in which 22% were diagnosed with RA. IgG anti-CCP and anti-MCV antibodies were analyzed with commercial kits. These tests were modified for IgA-class antibody detection. Results were related to disease course, smoking habits, and shared epitope status.
In the TIRA-1 cohort, occurrence of IgG anti-MCV and IgG anti-CCP showed a 93% overlap, although IgG anti-MCV had higher diagnostic sensitivity. Twenty-four percent tested positive for IgA anti-MCV compared to 29% for IgA anti-CCP. In the Kronoberg Arthritis Incidence cohort, 15% tested positive for IgG anti-MCV and 6% for IgA anti-MCV, compared to 10% positive for IgG anti-CCP and 3% positive for IgA anti-CCP, revealing that anti-CCP had higher diagnostic specificity for RA. As previously reported for IgA anti-CCP, IgA anti-MCV antibodies occurred in a small proportion of high-level IgG antibody-positive sera and were associated with a more aggressive disease course. Smokers were more often positive for antibodies to citrullinated proteins, most strikingly among the patients who were IgA anti-MCV-positive.
The occurrences of IgG-class anti-MCV and anti-CCP in early RA largely overlap. The sensitivity of anti-MCV is slightly higher, while the diagnostic specificity is higher for anti-CCP. In both instances a positive test predicts an unfavorable disease course, possibly slightly more so for anti-MCV. Although associated with a more active disease over time, IgA-class anti-CCP or anti-MCV do not add any diagnostic advantage.
PubMed ID
21459947 View in PubMed
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Designing a decision support system for existing clinical organizational structures: considerations from a rheumatology clinic.

https://arctichealth.org/en/permalink/ahliterature166858
Source
J Med Syst. 2006 Oct;30(5):325-31
Publication Type
Article
Date
Oct-2006
Author
Orjan Dahlström
Ingrid Thyberg
Ursula Hass
Thomas Skogh
Toomas Timpka
Author Affiliation
Department of Behavioural Sciences, Linköping University, Linköping, Sweden. orjda@ibv.liu.se
Source
J Med Syst. 2006 Oct;30(5):325-31
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care Facilities
Decision Support Systems, Clinical - organization & administration
Diffusion of Innovation
Female
Focus Groups
Humans
Male
Middle Aged
Rheumatology
Sweden
Abstract
The aim of this study was to identify the social and organizational requirements for a decision support system (DSS) to be implemented in a clinical rheumatology setting, utilizing data-mining techniques. Field observations and focus group interviews were used for data collection. The decision-making was found to be situated, patient-focused, and long-term in nature. At the same time, the main part of peer-to-peer communication was informal. Patient records were involved in almost every decision. The conclusion is that the main challenges, when introducing a DSS at a rheumatology unit, are adapting the system to informal communication structures and integrating it with patient records. Considering incentive structures, understanding workflow and incorporating awareness are relevant issues when addressing these issues in future studies.
PubMed ID
17068995 View in PubMed
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Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern.

https://arctichealth.org/en/permalink/ahliterature130943
Source
Ann Rheum Dis. 2012 Mar;71(3):334-40
Publication Type
Article
Date
Mar-2012
Author
Aurélie Ambrosi
Stina Salomonsson
Håkan Eliasson
Elisabeth Zeffer
Amanda Skog
Vijole Dzikaite
Gunnar Bergman
Eva Fernlund
Joanna Tingström
Elke Theander
Annika Rydberg
Thomas Skogh
Annika Öhman
Ulla Lundström
Mats Mellander
Ola Winqvist
Michael Fored
Anders Ekbom
Lars Alfredsson
Henrik Källberg
Tomas Olsson
Fredrik Gadler
Anders Jonzon
Ingrid Kockum
Sven-Erik Sonesson
Marie Wahren-Herlenius
Author Affiliation
Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Source
Ann Rheum Dis. 2012 Mar;71(3):334-40
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antibodies, Antinuclear - blood
Autoimmune Diseases - epidemiology - immunology
Birth Order
Child
Child, Preschool
Family Characteristics
Female
Heart Block - congenital - epidemiology - immunology
Humans
Infant
Infant, Newborn
Maternal Age
Parity
Pregnancy
Pregnancy Complications - epidemiology - immunology
Prenatal Exposure Delayed Effects
Recurrence
Risk factors
Seasons
Sex Factors
Sweden - epidemiology
Vitamin D - blood
Young Adult
Abstract
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.
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.
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
PubMed ID
21953338 View in PubMed
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Disease activity and disability in women and men with early rheumatoid arthritis (RA): an 8-year followup of a Swedish early RA project.

https://arctichealth.org/en/permalink/ahliterature126417
Source
Arthritis Care Res (Hoboken). 2012 Aug;64(8):1101-7
Publication Type
Article
Date
Aug-2012
Author
Eva Hallert
Mathilda Björk
Orjan Dahlström
Thomas Skogh
Ingrid Thyberg
Author Affiliation
Linköping University, Sweden. eva.hallert@liu.se
Source
Arthritis Care Res (Hoboken). 2012 Aug;64(8):1101-7
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - diagnosis - epidemiology - physiopathology
Cohort Studies
Disability Evaluation
Female
Follow-Up Studies
Humans
Male
Middle Aged
Sex Characteristics
Sweden - epidemiology
Abstract
To compare women and men regarding the course of disease activity and disability over 8 years from diagnosis of recent-onset rheumatoid arthritis (RA).
A total of 149 patients were followed in the Swedish TIRA study (Early Intervention in RA) for 8 years from RA diagnosis (1996-1998) regarding 28-joint count Disease Activity Score (DAS28), pain (visual analog scale), grip force, Grip Ability Test (GAT), Signals of Functional Impairment (SOFI; hand, upper/lower extremity), walking speed, activity limitation (Health Assessment Questionnaire [HAQ]), and prescribed disease-modifying antirheumatic drugs (DMARDs).
Disease activity pattern over time was similar in women and men, showing improvement during the first year and a stable situation during 6 years thereafter. However, at the 7- and 8-year followup times, deterioration was seen with a less favorable course in women. HAQ score did not differ between sexes at diagnosis, but at all followup times women had significantly higher scores than men. Women also had lower grip force and lower walking speed, but higher upper extremity mobility. DMARD prescription was similar for both sexes. Over 8 years, disease duration, sex, biologic agents, grip force, SOFI hand, and pain intensity together explained 43% of the variation in DAS28, whereas grip force, SOFI lower extremity, GAT, and pain intensity could together explain 55% of variations in HAQ score.
Disease activity was fairly well managed, but disability gradually worsened. Despite similar medication, women had more disability than men. The discrepancy between disease activity and disability indicates unmet needs for multiprofessional interventions to prevent progressing disability, and patients at risk for disability need to be identified early in the process.
PubMed ID
22392813 View in PubMed
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Elevated free secretory component in early rheumatoid arthritis and prior to arthritis development in patients at increased risk.

https://arctichealth.org/en/permalink/ahliterature309077
Source
Rheumatology (Oxford). 2020 05 01; 59(5):979-987
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Date
05-01-2020
Author
Klara Martinsson
Karin Roos Ljungberg
Michael Ziegelasch
Jan Cedergren
Per Eriksson
Vladimir Klimovich
Åsa Reckner
Irina Griazeva
Christopher Sjöwall
Marina Samoylovich
Thomas Skogh
Jonas Wetterö
Alf Kastbom
Author Affiliation
Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Source
Rheumatology (Oxford). 2020 05 01; 59(5):979-987
Date
05-01-2020
Language
English
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Acute Disease
Adult
Anti-Citrullinated Protein Antibodies - immunology
Arthritis, Rheumatoid - blood - drug therapy - immunology
Autoantibodies - blood
Biomarkers - blood
Case-Control Studies
Chronic Disease
Enzyme-Linked Immunosorbent Assay
Female
Hospitals, University
Humans
Male
Middle Aged
Musculoskeletal Pain - physiopathology
Pain Measurement
Prognosis
Prospective Studies
Risk assessment
Secretory Component - blood
Severity of Illness Index
Sweden
Abstract
Considering growing evidence of mucosal involvement in RA induction, this study investigated circulating free secretory component (SC) in patients with either recent-onset RA or with ACPA and musculoskeletal pain.
Two prospective cohorts were studied: TIRA-2 comprising 452 recent-onset RA patients with 3 years of clinical and radiological follow-up, and TIRx patients (n = 104) with ACPA IgG and musculoskeletal pain followed for 290 weeks (median). Blood donors and three different chronic inflammatory diseases served as controls. Free SC was analysed by sandwich ELISA.
Serum levels of free SC were significantly higher in TIRA-2 patients compared with TIRx and all control groups (P
PubMed ID
31504979 View in PubMed
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Infections preceding early arthritis in southern Sweden: a prospective population-based study.

https://arctichealth.org/en/permalink/ahliterature13907
Source
J Rheumatol. 2003 Mar;30(3):459-64
Publication Type
Article
Date
Mar-2003
Author
Maria K Söderlin
Hannu Kautiainen
Mirja Puolakkainen
Klaus Hedman
Maria Söderlund-Venermo
Thomas Skogh
Marjatta Leirisalo-Repo
Author Affiliation
Department of Internal Medicine, Växjö Central Hospital, Växjö, Sweden. maria.soderlin@ltkronoberg.se
Source
J Rheumatol. 2003 Mar;30(3):459-64
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Arthritis, Reactive - epidemiology - microbiology - virology
Campylobacter Infections - epidemiology
Campylobacter jejuni
Chlamydia Infections - epidemiology
Chlamydophila pneumoniae
Female
HLA-B27 Antigen - analysis
Humans
Incidence
Lyme Disease - epidemiology
Male
Parvoviridae Infections - epidemiology
Parvovirus B19, Human
Patient Dropouts
Prospective Studies
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
OBJECTIVE: To detect evidence of infections preceding early arthritis in Southern Sweden and to compare the clinical outcome of remission during a 6-month followup for patients with and without signs of prior infection. METHODS: Adult patients with arthritis of less than 3 months' duration were referred from primary health care centers to rheumatologists. All patients were systematically screened for infections caused by Salmonella typhimurium and Salmonella enteritidis, Yersinia enterocolitica, Campylobacter jejuni, Borrelia burgdorferi, Chlamydia trachomatis, Chlamydia pneumoniae, and parvovirus B19. RESULTS: Seventy-one patients were included in this study. Twenty-seven (38%) patients had reactive arthritis (ReA), 17 (24%) undifferentiated arthritis, 15 (21%) rheumatoid arthritis (RA), 4 (6%) psoriatic arthritis, and the rest (11%) other diagnoses. Of all the patients, 45% had evidence of a recent infection preceding the arthritis, as indicated by laboratory tests and/or disease history. C. jejuni dominated the ReA group. The occurrence of recent C. trachomatis, B. burgdorferi, C. pneumoniae, and parvovirus B19 infections was low. Overall, 58% of the patients went into remission during the 6-month followup. Of the patients with a preceding infection, 69% went into remission as compared to 38% of the patients without a preceding infection (p = 0.011). Thirty-three percent of the patients with RA were in remission after 6 months. CONCLUSION: In this population-based cohort, 45% of the patients presenting with a new-onset arthritis had had a prior infection. Campylobacter ReA dominated the ReA group. There were only a few cases preceded by infections by C. trachomatis, B. burgdorferi, C. pneumoniae, and parvovirus B19 infections. Remission during the first 6 months was especially frequent in the group of patients with a prior infection, but the remission rate was relatively high even for arthritis without prior infection.
Notes
Comment In: J Rheumatol. 2003 Mar;30(3):425-912610794
PubMed ID
12610801 View in PubMed
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13 records – page 1 of 2.