Markku J Kauppi | University of Helsinki (original) (raw)

Papers by Markku J Kauppi

Research paper thumbnail of Fibromyalgia is often connected with disability pension: a very long-term follow-up study in Finland

Scandinavian Journal of Rheumatology, Jul 20, 2020

Research paper thumbnail of Coracoclavicular Involvement - an Atypical Manifestation in Rheumatoid Arthritis: SHORT REPORT

Scandinavian Journal of Rheumatology, 1999

ABSTRACT An inception cohort of 74 patients with seropositive and erosive RA were followed up for... more ABSTRACT An inception cohort of 74 patients with seropositive and erosive RA were followed up for 15 years. All 148 shoulders were radiographed with a standard method at the 15-year follow-up. The coracoclavicular region was evaluated from each radiograph. In addition, the distance between the processus coracoideus and the superior margin of the clavicle was measured. Only one clavicle had elongated, shallow erosion on the undersurface at the insertion area of the coracoclavicular ligaments. In this case the distance between the coracoid process and clavicle was 25 mm, whereas the mean distance of all shoulders (n=148) was 17.4 mm (range 9-25 mm). We conclude that resorption on the undersurface of the distal clavicle is an atypical manifestation in rheumatoid arthritis. The origin of this atypical lesion is a not diminished distance between the processus coracoideus and the clavicle. Inflammation of the coracoclavicular ligaments is most likely the reason for this lesion.

Research paper thumbnail of Prevalence of Mutilans-like Hand Deformities in Patients with Seropositive Rheumatoid Arthritis: A prospective 20-year study

Scandinavian Journal of Rheumatology, 1999

Research paper thumbnail of Sleep problems in fibromyalgia and rheumatoid arthritis compared with the general population

PubMed, Mar 31, 2009

Objective: Our aim was to evaluate how frequently problems of quality and quantity of sleep and d... more Objective: Our aim was to evaluate how frequently problems of quality and quantity of sleep and depression occur in patients with fibromyalgia (FM), and compare these findings with those occurring in patients with rheumatoid arthritis (RA) and in the general population. Materials and methods: The patients were recruited from rehabilitation courses in the Rheumatism Foundation Hospital, Finland. There were 37 patients with FM and 31 patients with RA participating in the study. For comparison, we used the results from a general population study of 1284 adult subjects. The data had been collected earlier in a longitudinal cohort study for the Finnish Social Insurance Institution. Results: The patients with FM and RA slept fewer hours a day than the population sample. The FM patients reported more insomnia, less contentment with sleep and more lack of deep and restful sleep in comparison to the RA patients and the participants of the population study. The FM patients also reported significantly more depression and pain than the RA patients (p0.01). It was still shown in a logistic regression analysis that insomnia was almost five times more frequent in FM patients than in RA patients, even when depression and pain were adjusted. Conclusion: The FM patients reported more insomnia-related symptoms than either RA patients or the population sample. The higher prevalence of insomnia-related symptoms among FM patients was not explained by depression or pain. Both patient groups reported somewhat shorter nocturnal sleep than the general population.

Research paper thumbnail of Short-term serum C-reactive protein response after shoulder replacement

Joint Bone Spine, Dec 1, 2002

Research paper thumbnail of Functional Long-term Changes in Patients with Spondylarthropathy

Clinical Rheumatology, May 1, 2002

The objective of the study was to determine the long-term functional outcome of chronic spondylar... more The objective of the study was to determine the long-term functional outcome of chronic spondylarthropathy (SpA) when measured by various functional indices. This information is important in the planning of long-term intervention studies and selection of the best follow-up methods. The study group consisted of 65 patients (21 women and 44 men) with SpA. Their mean age was 49 years and the mean age from diagnosis was 12 years. They completed several questionnaires (developed for the evaluation of functional capacity or the state of health of patients with SpA) at the beginning of the study and 3 years later. The questionnaires were: the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), the Health Assessment Questionnaire for Spondylarthropathies (HAQ-S), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Patient Global Assessment (BAS-G) and Stiffness-VAS (on a visual analogue scale). We also asked the patients to inform us if something had occurred in their lives during the follow-up that might have affected their health. Most of the indices (BASFI, DFI, BASDAI, BAS-G and Stiffness-VAS, but not HAQ-S) showed a statistically significant reduction in the functional capacity or state of health of the patients during the follow-up. Many factors occurring during the 3-year period may have influenced the results of the indices. The natural course of the functional capacity of patients with SpA appears to be one of impairment, when evaluated using these indices. Our experience also showed that it is very difficult to separate any effect of a single treatment intervention (e.g. rehabilitation) in a long-term follow-up study, as so many interfering factors, e.g. life events and health-related factors, may affect the follow-up population over several years.

Research paper thumbnail of Leukaemia during Podophyllotoxin Treatment in a Patient with Juvenile Chronic Arthritis

Scandinavian Journal of Rheumatology, 1996

Research paper thumbnail of Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study

Rheumatology Advances in Practice, 2023

Objective: The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ab... more Objective: The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods: Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in-and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results: Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion: TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.

Research paper thumbnail of Type I collagen degradation does not diminish with RA disease duration

Annals of the Rheumatic Diseases, Apr 1, 2001

Objective-To assess the relation between type I collagen degradation and the duration of rheumato... more Objective-To assess the relation between type I collagen degradation and the duration of rheumatoid arthritis (RA). Methods-The serum concentrations of cross linked carboxyterminal telopeptide of type I collagen (ICTP) measured earlier in a community based series (90 patients) and a hospital based series (59 patients) were re-evaluated with reference to the duration of RA. Results-The serum ICTP showed a positive correlation with the duration of the disease in the hospital based series (r s =0.40, p<0.01) but not in the community based one (r s =0.18, p=0.10). Conclusions-Type I collagen degradation predominantly reflecting pathological bone destruction does not seem to diminish in longlasting RA.

Research paper thumbnail of Survivorship of AGC knee replacement in juvenile chronic arthritis

Journal of Arthroplasty, Feb 1, 2000

This study analyzed the survivorship and results of 77 knee replacements in 52 patients with juve... more This study analyzed the survivorship and results of 77 knee replacements in 52 patients with juvenile chronic arthritis using the nonconstrained Anatomically Graduated Components (AGC; Biomet, Warsaw, IN) prosthesis design. Patients were operated on between tile years 1985 and 1995. The mean duration of the general disease was 24 years (range, 10-56 years), and the mean age of the patients at the time of surgery was 33 years (range, 16-64 years). Bone-grafts were installed into 15 knees, custom-made components were used in 5 knees, and cemented fixation in 4 knees. The patella was resurfaced in 23 knees. Clinical follow-up examinations were conducted 3 months, 1 year, 4 years, and 8 years postoperatively. An interview was arranged at the end of 1998, 3 to 13 years after surgery; 2 patients were not reached, and 2 died during the follow-up. Fifty-five of 73 (75%) knees were subjectively excellent, 18 (.25%) were fair, and none was poor. Radiolucent lines of 1.0 to 1.5 mm were found under 14 tibial trays but not adjacent to femoral components. No deep infections were detected. One knee was revised 4 years after the implantation. The overall survival was 99% (95% confidence interval, 92-100) at 5 years. We consider these results excellent in this demanding patient material. The nonconstrained AGC prosthesis with cementless fixation proved to be feasible in knee replacement in patients with juvenile chronic arthritis.

Research paper thumbnail of Epstein-Barr virus in peripheral blood is associated with response to rituximab therapy in rheumatoid arthritis patients

Clinical Rheumatology, 2015

Autoreactive B cells infected by Epstein-Barr virus (EBV) are suspected to be involved in the eti... more Autoreactive B cells infected by Epstein-Barr virus (EBV) are suspected to be involved in the etiology of various human chronic autoimmune diseases. This motivated us to study the relationship between peripheral blood EBV load at baseline and treatment response to B cell-depleting therapy in rheumatoid arthritis (RA) patients. Thirty-five RA patients who started treatment with rituximab (RTX) in a routine clinical setting were assessed for baseline disease activity using disease activity score using 28 joint counts (DAS28) (erythrocyte sedimentation rate [ESR]). Treatment response was evaluated 3-7 months after RTX. EBV load in baseline whole blood (WB) samples was determined using quantitative PCR. EBV DNA was detected in 16/35 (46 %) of the WB samples. In these 16 EBV-positive patients, the median viral load was 3.15 (2.68-4.00) log copies/ml. Good/moderate European League Against Rheumatism (EULAR) response was observed in 16/16 of the EBV DNA-positive vs 13/19 EBV DNA-negative patients, p = 0.022. Significant response (DAS28 change &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.2) was observed in 14/16 of the EBV DNA-positive vs 10/19 EBV DNA-negative patients, p = 0.035. The decline in DAS28 after RTX was 2.10 (1.03-4. 78) in the EBV DNA-positive vs 1.47 (-0.7-4.70) in the EBV DNA-negative patients, p = 0.13. EBV load at baseline significantly correlated with change in DAS28 after RTX (τB = -0.261, p = 0.042). Our results suggest that the presence of EBV genome in WB could serve as a predictive marker to RTX therapy in RA.

Research paper thumbnail of Radiographic joint space in rheumatoid elbow joints. A 15-year prospective follow-up study in 74 patients

Objective. To evaluate radiographically the humeroulnar (HU) and humeroradial (HR) joint spaces i... more Objective. To evaluate radiographically the humeroulnar (HU) and humeroradial (HR) joint spaces in patients with long-term rheumatoid arthritis (RA). Methods. An inception cohort of 74 patients with RA were followed for 15 yr. At the end-point, 148 elbows were radiographed by a standard method. The HU and HR joint spaces were examined from the anteroposterior radiographs by measuring the shortest tangential distance in the middle of the joints. Destruction of the elbow joints, assessed with the Larsen method on a scale of 0-5, was studied in relation to the joint-space measurements. Results. Mean (S.D.) HU joint space (n = 148) in RA patients was 2.5 (1.1) mm, range 0-4 mm w2.9 (0.8) mm in men and 2.4 (1.1) mm in womenx. Mean (S.D.) HR joint space (n = 140) was 2.3 (0.9) mm, range 0-4 mm w2.5 (0.8) mm in men and 2.3 (1.0) mm in womenx. HU and HR spaces of the affected joints (Larsen grades 2-5) w1.9 (S.D. 1.1) and 1.8 (0.9) mm respectivelyx were notably narrower than those of the unaffected (Larsen grades 0-1) joints w3.1 (0.7) and 2.9 (0.6) mmx. All the joints graded as Larsen 4 or 5 (n = 13) had a value of 0 mm for both joint spaces. Both the HU and the HR joint-space narrowing was associated with increasing destruction (Larsen grading) of the joint. wr = 2 0.69 (95% CI 2 0.77 to 2 0.60) and r = 2 0.70 (2 0.78 to 2 0.60)x. The monotonic narrowing was significantly increasing from unaffected (Larsen 0, 1), slightly (2), moderately (3) to severely (4, 5) affected joints (P < 0.001). A step in this process occurred between Larsen grades 3 and 4, when the mean joint space diminished from 1.4 and 1.5 respectively to 0 mm. Conclusions. Joint-space narrowing is a frequent consequence of rheumatoid affection of the elbow joint. HR joint space decreases together with HU joint space; however, the HR joint space is already slightly narrower at the start. The narrowing is a rather late phenomenon, occurring only after erosive destruction. This should be borne in mind when using the Larsen method to evaluate changes in the elbow joint.

Research paper thumbnail of The value of synovial fluid analysis in the assessment of knee joint destruction in arthritis in a three year follow up study

Annals of the Rheumatic Diseases, 1999

Research paper thumbnail of Carriers of the aspartylglucosaminuria genetic mutation and chronic arthritis

Annals of the Rheumatic Diseases, 2002

Research paper thumbnail of Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents

Scandinavian Journal of Rheumatology, Jan 11, 2022

OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA... more OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.

Research paper thumbnail of Patients with rheumatic diseases share similar patterns of healthcare resource utilization

Scandinavian Journal of Rheumatology, 2019

Research paper thumbnail of Hyperuricaemia: prevalence and association with mortality in an elderly Finnish population

BMJ Open

ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess... more ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess its association with comorbidities and mortality.DesignProspective cohort study.SettingGood Ageing in Lahti Region study, Finland 2002–2012 (mortality data analysed until 2018).Participants2673 participants (mean age 64 years; 47% men).Primary and secondary outcome measuresPrevalence of hyperuricaemia in the study population was detected. Associations between hyperuricaemia and mortality were assessed using multivariable adjusted Cox proportional hazards models.MethodsData from a prospective, population-based study of elderly people (52–76 years) in the Lahti region, Finland, were used. Information on serum uric acid (SUA) levels as well as several other laboratory variables, comorbidities, lifestyle habits and socioeconomic factors was collected, and the association between SUA level and mortality in a 15-year follow-up period was analysed.ResultsOf 2673 elderly Finnish persons include...

Research paper thumbnail of Cluster analysis identifies unmet healthcare needs among patients with rheumatoid arthritis

Scandinavian Journal of Rheumatology, Sep 13, 2021

Objective: To identify the patterns of healthcare resource utilization and unmet needs of persist... more Objective: To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis. Method: Patients attending the Jyväskylä Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010-2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward's method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0-100), and total annual health service-related direct costs (€) as clustering variables. Results: Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities. Conclusions: The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.

Research paper thumbnail of SAT0479 Bloodstream Infections (BSI) in Finnish Children with Juvenile Idiopathic Arthritis in 2004-2011

Annals of the Rheumatic Diseases, 2013

Objectives Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumo... more Objectives Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumonia due to modern diseasemodifying anti-rheumatic treatment. In this nationwide retrospective study with clinical data, we describe the pneumonia episodes among children with JIA. Methods Patients under 18 years of age with JIA and pneumonia during 1998-2014 were identified in the National Hospital Discharge Register in Finland. Each individual patient record was reviewed, and detailed data on patients with JIA and pneumonia were retrieved, recorded, and analyzed. If the patient was hospitalized or received intravenous antibiotics, the pneumonia was considered serious. Results There were 157 episodes of pneumonia among 140 children with JIA; 111 episodes (71%) were serious (80% in 1998-2006 and 66% in 2007-2014). The mean age of the patients was 9 years. Forty-eight percent had active JIA and 46% had comorbidities. Disease-modifying anti-rheumatic drugs (DMARD) were used at the time of 135 episodes (86%): methotrexate (MTX) by 62% and biologic DMARDs (bDMARD) by 30%. There was no significant difference in the use of bDMARDs, MTX and glucocorticoids between the patient groups with serious and non-serious pneumonia episodes. During six of the episodes, intensive care was needed. Two patients (1.3%) died, the remaining ones recovered fully. Conclusions Although the incidence of pneumonia and the use of immunosuppressive treatment among children with JIA increased from 1998 to 2014, the proportion of serious pneumonias in these patients decreased. There was no significant difference in the use of anti-rheumatic medication between patients with serious and non-serious pneumonia. Key Points • The incidence of serious pneumonias decreased from 1998 to 2014 among children with juvenile idiopathic arthritis (JIA). • There was no significant difference in the use of the disease-modifying anti-rheumatic medication between JIA patients with serious and non-serious pneumonias. • Active JIA, comorbidities, and combination medication were associated with nearly half of the pneumonias.

Research paper thumbnail of Hyperuricaemia: prevalence and association with mortality in an elderly Finnish population

BMJ Open

ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess... more ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess its association with comorbidities and mortality.DesignProspective cohort study.SettingGood Ageing in Lahti Region study, Finland 2002–2012 (mortality data analysed until 2018).Participants2673 participants (mean age 64 years; 47% men).Primary and secondary outcome measuresPrevalence of hyperuricaemia in the study population was detected. Associations between hyperuricaemia and mortality were assessed using multivariable adjusted Cox proportional hazards models.MethodsData from a prospective, population-based study of elderly people (52–76 years) in the Lahti region, Finland, were used. Information on serum uric acid (SUA) levels as well as several other laboratory variables, comorbidities, lifestyle habits and socioeconomic factors was collected, and the association between SUA level and mortality in a 15-year follow-up period was analysed.ResultsOf 2673 elderly Finnish persons include...

Research paper thumbnail of Fibromyalgia is often connected with disability pension: a very long-term follow-up study in Finland

Scandinavian Journal of Rheumatology, Jul 20, 2020

Research paper thumbnail of Coracoclavicular Involvement - an Atypical Manifestation in Rheumatoid Arthritis: SHORT REPORT

Scandinavian Journal of Rheumatology, 1999

ABSTRACT An inception cohort of 74 patients with seropositive and erosive RA were followed up for... more ABSTRACT An inception cohort of 74 patients with seropositive and erosive RA were followed up for 15 years. All 148 shoulders were radiographed with a standard method at the 15-year follow-up. The coracoclavicular region was evaluated from each radiograph. In addition, the distance between the processus coracoideus and the superior margin of the clavicle was measured. Only one clavicle had elongated, shallow erosion on the undersurface at the insertion area of the coracoclavicular ligaments. In this case the distance between the coracoid process and clavicle was 25 mm, whereas the mean distance of all shoulders (n=148) was 17.4 mm (range 9-25 mm). We conclude that resorption on the undersurface of the distal clavicle is an atypical manifestation in rheumatoid arthritis. The origin of this atypical lesion is a not diminished distance between the processus coracoideus and the clavicle. Inflammation of the coracoclavicular ligaments is most likely the reason for this lesion.

Research paper thumbnail of Prevalence of Mutilans-like Hand Deformities in Patients with Seropositive Rheumatoid Arthritis: A prospective 20-year study

Scandinavian Journal of Rheumatology, 1999

Research paper thumbnail of Sleep problems in fibromyalgia and rheumatoid arthritis compared with the general population

PubMed, Mar 31, 2009

Objective: Our aim was to evaluate how frequently problems of quality and quantity of sleep and d... more Objective: Our aim was to evaluate how frequently problems of quality and quantity of sleep and depression occur in patients with fibromyalgia (FM), and compare these findings with those occurring in patients with rheumatoid arthritis (RA) and in the general population. Materials and methods: The patients were recruited from rehabilitation courses in the Rheumatism Foundation Hospital, Finland. There were 37 patients with FM and 31 patients with RA participating in the study. For comparison, we used the results from a general population study of 1284 adult subjects. The data had been collected earlier in a longitudinal cohort study for the Finnish Social Insurance Institution. Results: The patients with FM and RA slept fewer hours a day than the population sample. The FM patients reported more insomnia, less contentment with sleep and more lack of deep and restful sleep in comparison to the RA patients and the participants of the population study. The FM patients also reported significantly more depression and pain than the RA patients (p0.01). It was still shown in a logistic regression analysis that insomnia was almost five times more frequent in FM patients than in RA patients, even when depression and pain were adjusted. Conclusion: The FM patients reported more insomnia-related symptoms than either RA patients or the population sample. The higher prevalence of insomnia-related symptoms among FM patients was not explained by depression or pain. Both patient groups reported somewhat shorter nocturnal sleep than the general population.

Research paper thumbnail of Short-term serum C-reactive protein response after shoulder replacement

Joint Bone Spine, Dec 1, 2002

Research paper thumbnail of Functional Long-term Changes in Patients with Spondylarthropathy

Clinical Rheumatology, May 1, 2002

The objective of the study was to determine the long-term functional outcome of chronic spondylar... more The objective of the study was to determine the long-term functional outcome of chronic spondylarthropathy (SpA) when measured by various functional indices. This information is important in the planning of long-term intervention studies and selection of the best follow-up methods. The study group consisted of 65 patients (21 women and 44 men) with SpA. Their mean age was 49 years and the mean age from diagnosis was 12 years. They completed several questionnaires (developed for the evaluation of functional capacity or the state of health of patients with SpA) at the beginning of the study and 3 years later. The questionnaires were: the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), the Health Assessment Questionnaire for Spondylarthropathies (HAQ-S), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Patient Global Assessment (BAS-G) and Stiffness-VAS (on a visual analogue scale). We also asked the patients to inform us if something had occurred in their lives during the follow-up that might have affected their health. Most of the indices (BASFI, DFI, BASDAI, BAS-G and Stiffness-VAS, but not HAQ-S) showed a statistically significant reduction in the functional capacity or state of health of the patients during the follow-up. Many factors occurring during the 3-year period may have influenced the results of the indices. The natural course of the functional capacity of patients with SpA appears to be one of impairment, when evaluated using these indices. Our experience also showed that it is very difficult to separate any effect of a single treatment intervention (e.g. rehabilitation) in a long-term follow-up study, as so many interfering factors, e.g. life events and health-related factors, may affect the follow-up population over several years.

Research paper thumbnail of Leukaemia during Podophyllotoxin Treatment in a Patient with Juvenile Chronic Arthritis

Scandinavian Journal of Rheumatology, 1996

Research paper thumbnail of Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study

Rheumatology Advances in Practice, 2023

Objective: The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ab... more Objective: The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods: Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in-and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results: Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion: TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.

Research paper thumbnail of Type I collagen degradation does not diminish with RA disease duration

Annals of the Rheumatic Diseases, Apr 1, 2001

Objective-To assess the relation between type I collagen degradation and the duration of rheumato... more Objective-To assess the relation between type I collagen degradation and the duration of rheumatoid arthritis (RA). Methods-The serum concentrations of cross linked carboxyterminal telopeptide of type I collagen (ICTP) measured earlier in a community based series (90 patients) and a hospital based series (59 patients) were re-evaluated with reference to the duration of RA. Results-The serum ICTP showed a positive correlation with the duration of the disease in the hospital based series (r s =0.40, p<0.01) but not in the community based one (r s =0.18, p=0.10). Conclusions-Type I collagen degradation predominantly reflecting pathological bone destruction does not seem to diminish in longlasting RA.

Research paper thumbnail of Survivorship of AGC knee replacement in juvenile chronic arthritis

Journal of Arthroplasty, Feb 1, 2000

This study analyzed the survivorship and results of 77 knee replacements in 52 patients with juve... more This study analyzed the survivorship and results of 77 knee replacements in 52 patients with juvenile chronic arthritis using the nonconstrained Anatomically Graduated Components (AGC; Biomet, Warsaw, IN) prosthesis design. Patients were operated on between tile years 1985 and 1995. The mean duration of the general disease was 24 years (range, 10-56 years), and the mean age of the patients at the time of surgery was 33 years (range, 16-64 years). Bone-grafts were installed into 15 knees, custom-made components were used in 5 knees, and cemented fixation in 4 knees. The patella was resurfaced in 23 knees. Clinical follow-up examinations were conducted 3 months, 1 year, 4 years, and 8 years postoperatively. An interview was arranged at the end of 1998, 3 to 13 years after surgery; 2 patients were not reached, and 2 died during the follow-up. Fifty-five of 73 (75%) knees were subjectively excellent, 18 (.25%) were fair, and none was poor. Radiolucent lines of 1.0 to 1.5 mm were found under 14 tibial trays but not adjacent to femoral components. No deep infections were detected. One knee was revised 4 years after the implantation. The overall survival was 99% (95% confidence interval, 92-100) at 5 years. We consider these results excellent in this demanding patient material. The nonconstrained AGC prosthesis with cementless fixation proved to be feasible in knee replacement in patients with juvenile chronic arthritis.

Research paper thumbnail of Epstein-Barr virus in peripheral blood is associated with response to rituximab therapy in rheumatoid arthritis patients

Clinical Rheumatology, 2015

Autoreactive B cells infected by Epstein-Barr virus (EBV) are suspected to be involved in the eti... more Autoreactive B cells infected by Epstein-Barr virus (EBV) are suspected to be involved in the etiology of various human chronic autoimmune diseases. This motivated us to study the relationship between peripheral blood EBV load at baseline and treatment response to B cell-depleting therapy in rheumatoid arthritis (RA) patients. Thirty-five RA patients who started treatment with rituximab (RTX) in a routine clinical setting were assessed for baseline disease activity using disease activity score using 28 joint counts (DAS28) (erythrocyte sedimentation rate [ESR]). Treatment response was evaluated 3-7 months after RTX. EBV load in baseline whole blood (WB) samples was determined using quantitative PCR. EBV DNA was detected in 16/35 (46 %) of the WB samples. In these 16 EBV-positive patients, the median viral load was 3.15 (2.68-4.00) log copies/ml. Good/moderate European League Against Rheumatism (EULAR) response was observed in 16/16 of the EBV DNA-positive vs 13/19 EBV DNA-negative patients, p = 0.022. Significant response (DAS28 change &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.2) was observed in 14/16 of the EBV DNA-positive vs 10/19 EBV DNA-negative patients, p = 0.035. The decline in DAS28 after RTX was 2.10 (1.03-4. 78) in the EBV DNA-positive vs 1.47 (-0.7-4.70) in the EBV DNA-negative patients, p = 0.13. EBV load at baseline significantly correlated with change in DAS28 after RTX (τB = -0.261, p = 0.042). Our results suggest that the presence of EBV genome in WB could serve as a predictive marker to RTX therapy in RA.

Research paper thumbnail of Radiographic joint space in rheumatoid elbow joints. A 15-year prospective follow-up study in 74 patients

Objective. To evaluate radiographically the humeroulnar (HU) and humeroradial (HR) joint spaces i... more Objective. To evaluate radiographically the humeroulnar (HU) and humeroradial (HR) joint spaces in patients with long-term rheumatoid arthritis (RA). Methods. An inception cohort of 74 patients with RA were followed for 15 yr. At the end-point, 148 elbows were radiographed by a standard method. The HU and HR joint spaces were examined from the anteroposterior radiographs by measuring the shortest tangential distance in the middle of the joints. Destruction of the elbow joints, assessed with the Larsen method on a scale of 0-5, was studied in relation to the joint-space measurements. Results. Mean (S.D.) HU joint space (n = 148) in RA patients was 2.5 (1.1) mm, range 0-4 mm w2.9 (0.8) mm in men and 2.4 (1.1) mm in womenx. Mean (S.D.) HR joint space (n = 140) was 2.3 (0.9) mm, range 0-4 mm w2.5 (0.8) mm in men and 2.3 (1.0) mm in womenx. HU and HR spaces of the affected joints (Larsen grades 2-5) w1.9 (S.D. 1.1) and 1.8 (0.9) mm respectivelyx were notably narrower than those of the unaffected (Larsen grades 0-1) joints w3.1 (0.7) and 2.9 (0.6) mmx. All the joints graded as Larsen 4 or 5 (n = 13) had a value of 0 mm for both joint spaces. Both the HU and the HR joint-space narrowing was associated with increasing destruction (Larsen grading) of the joint. wr = 2 0.69 (95% CI 2 0.77 to 2 0.60) and r = 2 0.70 (2 0.78 to 2 0.60)x. The monotonic narrowing was significantly increasing from unaffected (Larsen 0, 1), slightly (2), moderately (3) to severely (4, 5) affected joints (P < 0.001). A step in this process occurred between Larsen grades 3 and 4, when the mean joint space diminished from 1.4 and 1.5 respectively to 0 mm. Conclusions. Joint-space narrowing is a frequent consequence of rheumatoid affection of the elbow joint. HR joint space decreases together with HU joint space; however, the HR joint space is already slightly narrower at the start. The narrowing is a rather late phenomenon, occurring only after erosive destruction. This should be borne in mind when using the Larsen method to evaluate changes in the elbow joint.

Research paper thumbnail of The value of synovial fluid analysis in the assessment of knee joint destruction in arthritis in a three year follow up study

Annals of the Rheumatic Diseases, 1999

Research paper thumbnail of Carriers of the aspartylglucosaminuria genetic mutation and chronic arthritis

Annals of the Rheumatic Diseases, 2002

Research paper thumbnail of Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents

Scandinavian Journal of Rheumatology, Jan 11, 2022

OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA... more OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.

Research paper thumbnail of Patients with rheumatic diseases share similar patterns of healthcare resource utilization

Scandinavian Journal of Rheumatology, 2019

Research paper thumbnail of Hyperuricaemia: prevalence and association with mortality in an elderly Finnish population

BMJ Open

ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess... more ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess its association with comorbidities and mortality.DesignProspective cohort study.SettingGood Ageing in Lahti Region study, Finland 2002–2012 (mortality data analysed until 2018).Participants2673 participants (mean age 64 years; 47% men).Primary and secondary outcome measuresPrevalence of hyperuricaemia in the study population was detected. Associations between hyperuricaemia and mortality were assessed using multivariable adjusted Cox proportional hazards models.MethodsData from a prospective, population-based study of elderly people (52–76 years) in the Lahti region, Finland, were used. Information on serum uric acid (SUA) levels as well as several other laboratory variables, comorbidities, lifestyle habits and socioeconomic factors was collected, and the association between SUA level and mortality in a 15-year follow-up period was analysed.ResultsOf 2673 elderly Finnish persons include...

Research paper thumbnail of Cluster analysis identifies unmet healthcare needs among patients with rheumatoid arthritis

Scandinavian Journal of Rheumatology, Sep 13, 2021

Objective: To identify the patterns of healthcare resource utilization and unmet needs of persist... more Objective: To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis. Method: Patients attending the Jyväskylä Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010-2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward's method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0-100), and total annual health service-related direct costs (€) as clustering variables. Results: Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities. Conclusions: The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.

Research paper thumbnail of SAT0479 Bloodstream Infections (BSI) in Finnish Children with Juvenile Idiopathic Arthritis in 2004-2011

Annals of the Rheumatic Diseases, 2013

Objectives Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumo... more Objectives Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumonia due to modern diseasemodifying anti-rheumatic treatment. In this nationwide retrospective study with clinical data, we describe the pneumonia episodes among children with JIA. Methods Patients under 18 years of age with JIA and pneumonia during 1998-2014 were identified in the National Hospital Discharge Register in Finland. Each individual patient record was reviewed, and detailed data on patients with JIA and pneumonia were retrieved, recorded, and analyzed. If the patient was hospitalized or received intravenous antibiotics, the pneumonia was considered serious. Results There were 157 episodes of pneumonia among 140 children with JIA; 111 episodes (71%) were serious (80% in 1998-2006 and 66% in 2007-2014). The mean age of the patients was 9 years. Forty-eight percent had active JIA and 46% had comorbidities. Disease-modifying anti-rheumatic drugs (DMARD) were used at the time of 135 episodes (86%): methotrexate (MTX) by 62% and biologic DMARDs (bDMARD) by 30%. There was no significant difference in the use of bDMARDs, MTX and glucocorticoids between the patient groups with serious and non-serious pneumonia episodes. During six of the episodes, intensive care was needed. Two patients (1.3%) died, the remaining ones recovered fully. Conclusions Although the incidence of pneumonia and the use of immunosuppressive treatment among children with JIA increased from 1998 to 2014, the proportion of serious pneumonias in these patients decreased. There was no significant difference in the use of anti-rheumatic medication between patients with serious and non-serious pneumonia. Key Points • The incidence of serious pneumonias decreased from 1998 to 2014 among children with juvenile idiopathic arthritis (JIA). • There was no significant difference in the use of the disease-modifying anti-rheumatic medication between JIA patients with serious and non-serious pneumonias. • Active JIA, comorbidities, and combination medication were associated with nearly half of the pneumonias.

Research paper thumbnail of Hyperuricaemia: prevalence and association with mortality in an elderly Finnish population

BMJ Open

ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess... more ObjectiveTo establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess its association with comorbidities and mortality.DesignProspective cohort study.SettingGood Ageing in Lahti Region study, Finland 2002–2012 (mortality data analysed until 2018).Participants2673 participants (mean age 64 years; 47% men).Primary and secondary outcome measuresPrevalence of hyperuricaemia in the study population was detected. Associations between hyperuricaemia and mortality were assessed using multivariable adjusted Cox proportional hazards models.MethodsData from a prospective, population-based study of elderly people (52–76 years) in the Lahti region, Finland, were used. Information on serum uric acid (SUA) levels as well as several other laboratory variables, comorbidities, lifestyle habits and socioeconomic factors was collected, and the association between SUA level and mortality in a 15-year follow-up period was analysed.ResultsOf 2673 elderly Finnish persons include...