Radiographic damage in rheumatoid arthritis (RA) includes erosions and joint space narrowing (JSN). Different mechanisms may underlie their development. The objective of this study was to evaluate ...predictors of these entities separately.
Consecutive early RA patients (symptom duration ≤12 months) from a defined area (Malmö, Sweden) recruited during 1995-2005 were investigated. Radiographs of hands and feet were scored by a trained reader according to the modified Sharp-van der Heijde score. Fat mass and lean mass distribution were measured at baseline using dual energy x-ray absorptiometry. Potential predictors of erosion and JSN progression from inclusion to the 5-year follow-up were evaluated.
Two hundred and thirty-three patients were included. Radiographs at baseline and 5 years were available for 162 patients. The median (interquartile) progression of erosion and JSN scores were 4 (0-8) and 8 (1-16), respectively. Rheumatoid factor (RF) was a robust significant predictor of both erosion and JSN score progression. In adjusted analyses, anti-CCP antibodies predicted erosions while the erythrocyte sedimentation rate was predictive of both outcomes. Smoking and high baseline disease activity (DAS28 > 5.1) predicted progression of erosions. Baseline erosion score was associated with progression of both erosion and JSN progression, while baseline JSN score was predictive only of the progression of JSN. Overweight/obesity (BMI ≥ 25 kg/m
) was a significant negative predictor of JSN score progression (β = - 0.14, p = 0.018, adjusted for RF, age, baseline JSN score) also when additionally adjusting for ever smoking (p = 0.041). Among female patients, this effect was observed in those of estimated post-menopausal age (> 51 years), but not in younger women. The truncal to peripheral fat ratio was associated with less JSN score progression in women, but not in men.
Overweight RA patients had less JSN progression, independent of smoking status. This effect was seen in particular among older women (mainly post-menopausal), but not younger. Truncal fat was associated with less JSN progression in female patients. Smoking predicted erosion progression, and erosions may precede JSN. BMI and fat distribution may influence cartilage damage in early RA and might be related to hormonal factors.
Background and purpose - Reported revision rates due to dislocation after hemiarthroplasty span a wide range. Dislocations treated with closed reduction are rarely reported despite the fact that they ...can be expected to constitute most of the dislocations that occur. We aimed to describe the total dislocation rate on the national level, and to identify risk factors for dislocation.
Patients and methods - We co-processed a national cohort of 25,678 patients in the Swedish Hip Arthroplasty Register, with the National Patient Register (NPR) and Statistics Sweden. Dislocation was defined as the occurrence of any ICD-10 or procedural code related to hip dislocation recorded in the NPR, with a minimum of 1-year-follow-up. In theory, all early dislocations should thereby be traced, including those treated with closed reduction only.
Results - 366/13,769 (2.7%) patients operated on with direct lateral approach dislocated, compared with 850/11,834 (7.2%) of those with posterior approach. Posterior approach was the strongest risk factor for dislocation (OR = 2.7; 95% CI 2.3-3.1), followed by dementia (OR = 1.3; CI 1.1-1.5). The older the patients, the lower the risk of dislocation (OR = 0.98 per year of age; CI 0.98-1.0). Neither bipolar design nor cementless stems influenced the risk.
Interpretation - The choice of posterior approach and dementia was associated with an increased dislocation risk. When hips treated with closed reduction were identified, the frequency of dislocation with use of direct lateral and posterior approach more than doubled and tripled, respectively, compared with when only revisions due to dislocation are measured.
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Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract Introduction The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate ...what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients’ satisfaction with their rehabilitation and to what degree they regained their pre-fracture function. Methods All patients (>20 years, non-pathological fracture, residents in the catchment area, n = 664) having surgery for hip fracture at our hospital during 2011 were included in a retrospective cohort study. From medical records, information was gathered about pre-fracture condition as well as fracture type, surgical details, length of stay and whether the patient entered the hospital through the fast-track system. Medical records were scrutinised for general complications up to six months and for local complications up to one year after surgery. A postal questionnaire was sent one year after surgery inquiring about health status, pain and satisfaction along with multiple-choice questions regarding mobility and rehabilitation. Variables were analysed with linear regression or the proportional odds model. Results The most common general complications were new falls, pneumonia and new fractures. Deep infection was the most frequent local complication. The only significant effect of the fast-track system was shorter time to surgery (78 vs. 62% had surgery within 24 h, p < 0.001). A total of 29% reported to have regained their previous mobility and 30% considered the rehabilitation to be adequate. Mean value for pain VAS was 24 (SD 22) and for satisfaction 28 (SD 25). Absence of general and local complications correlated to satisfaction and hip pain. General complications correlated to loss of function. Higher age correlated to inadequate rehabilitation. Conclusion General complications seem to be the major risk factor, being the only factor affecting functional outcome and together with local complications affecting pain and satisfaction. To avoid general complications, co-operation between orthopaedic surgeons and internists may be crucial in the aftercare of hip fracture patients. A majority did not receive adequate rehabilitation and efforts need to be made to improve the rehabilitation process.
Abstract As the world's population ages, the prevalence of osteoporosis and its resultant fragility fractures is set to increase dramatically. This chapter focuses on current frameworks and major ...initiatives related to the implementation of fracture liaison services (FLS) and orthogeriatrics services (OGS), Models of Care designed to reliably implement secondary fracture prevention measures for individuals presenting to health services with fragility fractures. The current evidence base regarding the impact and effectiveness of FLS and OGS is also considered.
OBJECTIVES:To evaluate vitamin D status and effects of vitamin D intervention on bone mineral density (BMD) and content (BMC) in children with fair and dark skin in Sweden during winter.
METHODS:In a ...two-center prospective double-blinded randomized intervention study 5–7-year old children (n = 206) with fair and dark skin in Sweden (55°N- 63°N) received daily vitamin D supplements of 25 μg, 10 μg or placebo (2 μg) during three winter months. We measured BMD and BMC for total body (TB), total body less head (TBLH), femoral neck (FN) and spine at baseline and four months later. Intake of vitamin D and calcium, serum 25-hydroxy vitamin D S-25(OH)D and related parameters were analyzed.
RESULTS:Despite lower S-25(OH)D in dark than fair skinned children, BMD of TB (p = 0.012) and TBLH (p = 0.002) and BMC of TBLH (p = 0.04) were higher at baseline and follow-up in those with dark skin. Delta (Δ) BMD and BMC of TB and TBLH did not differ between intervention and placebo groups, but FN-BMC increased more among dark skinned children in the 25 μg (p = 0.038) and 10 μg (p = 0.027) groups compared to placebo. We found no associations between Δ S-25(OH)D, P-PTH, P-ALP and Δ BMC or BMD, respectively.
CONCLUSIONS:BMD and BMC remained higher in dark than fair-skinned children despite lower vitamin D status. Even though, no difference in general was found in BMD or BMC following vitamin D intervention, the increase in FN-BMC in dark-skinned children may suggest an influence on bone in those with initially insufficient vitamin D status.
In this longitudinal, prospective, and population‐based study (n = 1044), seven BTMs were assessed before and after trauma in 113 elderly women (85 with fractures). Markers were not altered in the ...immediate postfracture period but were clearly elevated during fracture repair. Recent fracture should thus be taken into account when markers are used in clinical practice.
Introduction: Fracture may influence the levels of bone turnover markers (BTM) and have implications for their use in clinical practice. In this longitudinal, prospective, and population‐based study, we assessed prefracture levels of BTMs and compared them with postfracture levels of the same individuals immediately after fracture and during fracture repair. This is the first study in which the effect of fracture on bone markers has been evaluated with prefracture samples available.
Materials and Methods: Serum and urine were collected at the emergency unit from 85 women (77.9 ± 1.8 yr) who sustained a fracture after low‐energy trauma and 28 controls (77.8 ± 2.0 yr) with similar trauma but no fracture. All were participants of the Malmö OPRA study (n = 1044), and pretrauma samples were collected 1.05 ± 0.85 yr before. Bone turnover was assessed by seven different BTMs reflecting different stages of bone metabolism {C‐terminal cross‐linked telopeptides of type I collagen S‐CTX, S‐TRACP5b, N‐terminal propeptides of type I collagen S‐PINP, serum osteocalcin (S‐OC1–49 and S‐TotalOC), urinary deoxypyridinoline U‐DPD, and urinary osteocalcin U‐OC}.
Results: BTMs sampled within a few hours after fracture were not altered from preinjury levels. Both bone formation and bone resorption markers were, however, significantly increased 4 mo after fracture. The elevation was most pronounced after hip fracture. Bone turnover remained elevated up to 12 mo after fracture.
Conclusions: We believe this study extends our knowledge on the skeletal postfracture metabolic processes. In addition, it may provide a basis for future means to monitor pharmacological intervention promoting fracture healing.
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