Abstract
Objectives
Studies assessing relative mortality risks across the spectrum of systemic inflammatory rheumatic diseases are largely missing. In this study, we wanted to estimate standard ...mortality ratios (SMRs) and causes of death in an ethnically homogeneous cohort covering all major CTDs and primary systemic vasculitides (PSVs).
Methods
We prospectively followed all incident CTD and PSV cases included in the Norwegian CTD and vasculitis registry (NOSVAR) between 1999 and 2015. Fifteen controls for each patient matched for sex and age were randomly drawn from the Norwegian National Population Registry. Causes of death were obtained from the National Cause of Death Register, death certificates and hospital charts.
Results
The cohort included 2140 patients (1534 with CTD, 606 with PSV). During a mean follow-up time of 9 years, 279 of the patients (13%) died, compared with 2864 of 32 086 (9%) controls (P < 0.001). Ten years after diagnosis, the lowest survival was 60% in dcSSc, 73% in anti-synthetase syndrome (ASS) and 75% in lcSSc. In the CTD group, the highest SMRs were observed in dcSSc (SMR 5.8) and ASS (SMR 4.1). In the PSV group, Takayasu arteritis (SMR 2.5) and ANCA-associated vasculitis (SMR 1.5) had the highest SMRs. Major causes of death were cardiovascular disease (CTD 27%, PSV 28%), neoplasms (CTD 25%, PSV 27%), chronic respiratory disease (CTD 20%, PSV10%) and infections (CTD 9%, PSV 16%).
Conclusion
We observed premature deaths across the spectrum of CTDs and PSVs, with highest SMRs in dcSSc and ASS. The overall mortality was highest in the CTD group.
The etiology of fibromyalgia (FM) is disputed, and there is no established cure. Quantitative data on how this may affect patients' healthcare experiences are scarce. The present study aims to ...investigate FM patients' pain-related healthcare experiences and explore factors associated with high satisfaction and pain relief.
An anonymous, online, and patient-administered survey was developed and distributed to members of the Norwegian Fibromyalgia Association. It addressed their pain-related healthcare experiences from both primary and specialist care. Odds ratios for healthcare satisfaction and pain relief were estimated by binary logistic regression. Directed acyclic graphs guided the multivariable analyses.
The patients (
= 1,626, mean age: 51 years) were primarily women (95%) with a 21.8-year mean pain duration and 12.7 years in pain before diagnosis. One-third did not understand why they had pain, and 56.6% did not know how to get better. More than half had not received satisfactory information on their pain cause from a physician, and guidance on how to improve was reported below medium. Patients regretted a lack of medical specialized competence on muscle pain and reported many unmet needs, including regular follow-up and pain assessment. Physician-mediated pain relief was low, and guideline adherence was deficient. Only 14.8% were satisfied with non-physician health providers evaluating and treating their pain, and 21.5% were satisfied (46.9% dissatisfied) with their global pain-related healthcare. Patients' knowledge of their condition, physicians' pain competence and provision of information and guidance, agreement in explanations and advice, and the absence of unmet needs significantly increased the odds of both healthcare satisfaction and pain relief.
Our survey describes deficiencies in FM patients' pain-related healthcare and suggests areas for improvement to increase healthcare satisfaction and pain relief. (REC# 2019/845, 09.05.19).
To study the long-term effects on symptoms and physical function of a 4-week rehabilitation programme for patients with fibromyalgia, and to determine whether there are any differences if this ...programme is applied in a warm or cold climate.
A total of 132 patients with fibromyalgia were randomized to a rehabilitation programme in a warm or cold climate, or to a control group without intervention. Assessments were performed before and after intervention, and after 3 and 12 months. The main outcome measures were pain, measured by tender point count (TPC), and physical function, measured with the 6-min walk test (6MWT).
There was no difference in any outcome variables at baseline. Persistent reduction in pain measured by TPC occurred only in the warm climatic setting. Mean difference (95% confidence interval (CI)) in TPC between warm and cold climate groups 1 year after the intervention was -1.7 (-2.9 to -0.5) and between the warm climate and the control group -2.2 (-3.3 to -1.0). Three months after the intervention the mean difference between the warm and cold climate groups in pain distribution (McGill mannequin) was -12 (-20 to -5) and between the warm climate and the control group -11 (-18 to -3). There were comparable improvements in physical function (6MWT) between the 2 intervention groups and the control group. The mean difference (95% CI) in 6MWT 1 year after the intervention between the warm climate and the control group was 33 (7-59) m. The corresponding value between the cold climate and the control group was 29 (3-55) m. Grip Strength (95% CI) was increased by 4.6 kg (2.3-6.4) in the warm climate and by 3.2 kg (0.9-5.5) in the cold climate compared with the control group 1 year after the intervention.
A rehabilitation programme for fibromyalgia may have a long-term effect on pain, as measured by TPC and pain distribution, when applied in a warm climatic setting, and may improve physical function regardless of the climatic setting.
Background: We propose that the distribution of skin lesions in psoriasis may be assessed using parametric maps on a pixel‐by‐pixel basis.
Material and methods: We processed 428 patient‐drawn ...self‐descriptions of the psoriasis lesions on a supplied body template. We compared 195 patients with a confirmed diagnosis of psoriatic arthritis (PsA) with 89 who had this diagnosis rejected (Psor). Additionally, 28 Psor cases supplied drawings performed after 3 weeks of climate therapy (PsorCT) to test the treatment efficacy. The drawings were scanned, lesion areas were segmented, followed by construction of parametric maps of lesion distributions and calculation of statistical differences between groups.
Results and discussion: In PsorCT, the lesions occupied 11.2% (0–42%) median (min.–max.) of the body area. The area decreased to 2.4% (6–11%) after heliotherapy. The differences were statistically significant for all the areas studied and spread evenly over the body surface. PsA had a relatively low psoriasis lesion occupancy of 2.5% (0–42%) compared with Psor 9.8% (0–34%), which is attributed to the difference in recruitment. Correcting for this, we demonstrate a clear tendency for the head, palms, feet, groin and nails to be preferred lesion sites in PsA in contrast to psoriasis.
Conclusion: Pixel‐based analysis of self‐reported skin lesion distributions is a powerful tool to assess systematic differences due to treatment or disease variants.
Adult rheumatic and psoriatic patients in Norway have been offered state-funded treatment in a warm climate since 1976. The offer has since then been extended to other patient groups with chronic ...diseases. We here present a program, which mainly consists of intensive physical treatment in a warm, sunny and dry climate, for adults with chronic rheumatic disease. The article is based on available statistics and literature found by searching Medline, PubMed and Cochrane. Patients are selected for the program according to diagnosis, physical function and disease severity and activity. The majority of the patients have rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis. The treatment is demanding and is not suitable for all. There are two closing dates for applications, 1. October and 1. February.
Fibromyalgia and drug therapy Forseth, Karin Øien; Gran, Jan Tore
Tidsskrift for den Norske Lægeforening,
2006-May-25, Letnik:
126, Številka:
11
Journal Article
Fibromyalgi Forseth, Karin Øien
Norsk epidemiologi,
10/2009, Letnik:
18, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Unexplained pain and aches have been well known for centuries. In the modern time the concept fibrositis/ fibromyalgia has been applied to the phenomenon of idespread pain without known aetiology. ...Fibromyalgia (FM) is characterised by widespread, diffuse pain that is moving around. Typical for this condition is also morning stiffness and non restorative sleep, positive tender points (TP) and a number of associated, unspecific symptoms as feeling of swollenness, headache, depression etc.Positive TP are defined anatomic locations that feel painful when being palpated with a pressure of 4 kg/cm2. The TP have been considered as the hallmark of FM and is central in the classification criteria constructed to identify the disease (ACR-90 criteria).FM is not considered as a specific disease entity, but rather a continuum with respect of pain distribution, number of positive TP and number and intensity of associated symptoms. Nevertheless, due to the often overwhelming impact of pain and fatigue in those who fulfil the criteria, it is appropriate to keep FM as a diagnosis.During the last two decades about a dozen epidemiological studies has been performed to describe the prevalence in the general population. The average results lie between three and four percent with a range from 1.2% to 6.6%. The differences is probably mainly due to discrepancies in applied methodology, but one cannot rule out that some populations may have more FM than others. Incidence is not well known, one study performed on women indicates a high incidence.Mortality has until recently not been studied. There are now some few studies with somewhat scattered results. However, the major finding is higher mortality among individuals with FM, especially due to cancer.Whether this is a function of lifestyle or the presence of pain remains to be clarified. The main risk factor is the female gender; only about 10-30% of the FM population are men. Studies have shown that depression, longstanding localised pain especially in the back and the presence of a relatively large number of associated symptoms also are risk factors. FM develops in the majority of cases over many years. This knowledge may contribute to prevent FM before it actually manifests as such. FM has a large co-morbidity, especially with inflammatory rheumatological diseases. It is important to be aware of this to avoid overtreatment in patients with longstanding inflammatory diseases that have developed FM in addition. On the other hand it is also important to know that patients with FM also may get inflammatory diseases. It is an especially big overlap between FM and Sjögren’s syndrome. FM is a frequent condition that has a big impact on working ability. In Norway about five present of all who are receiving disability pension do have the diagnosis of FM. In spite of that approximately 50% of females’ application for disability pension are refused, FM is the most common diagnosis among those who are receiving pension. The development of the criteria has opened for international research on a considerable scale. This has lead to better understanding of the aetiopathogenesis and promising treatment possibilities in the future.
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