Hospital of Southern Norway Trust

Kristiansand, Norway

Hospital of Southern Norway Trust

Kristiansand, Norway
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PubMed | St Vincents University Hospital, McMaster University, Ipswich Hospital NHS Trust, University Hospital Jena and 35 more.
Type: | Journal: American journal of human genetics | Year: 2017

Giant cell arteritis (GCA) is the most common form of vasculitis in individuals older than 50 years in Western countries. To shed light onto the genetic background influencing susceptibility for GCA, we performed a genome-wide association screening in a well-powered study cohort. After imputation, 1,844,133 genetic variants were analyzed in 2,134 case subjects and 9,125 unaffected individuals from ten independent populations of European ancestry. Our data confirmed HLA class II as the strongest associated region (independent signals: rs9268905, p = 1.94 10


PubMed | Winthrop University, Azienda Ospedaliera IRCCS di Reggio Emilia, Military Institute of Medicine, Medical University of Graz and 28 more.
Type: Journal Article | Journal: Annals of the rheumatic diseases | Year: 2015

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients and clinicians values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.


Diamantopoulos A.P.,Hospital of Southern Norway Trust | Diamantopoulos A.P.,Norwegian University of Science and Technology | Larsen A.I.,University of Stavanger | Larsen A.I.,University of Bergen | Omdal R.,University of Stavanger
International Journal of Cardiology | Year: 2013

Tumor necrosis factor-alpha (TNF-α) blockers are widely used in the treatment of chronic inflammatory diseases, especially chronic arthritis. Current guidelines advise against the use of such agents in patients who have a concomitant heart failure. Consequently, a group of patients with a devastating inflammatory disease cannot benefit from an excellent treatment option. After a critical review of the current literature, we conclude that there is not sufficient evidence to warn against such a regimen if recommended standard doses are used. A negative effect on the heart function seems to occur if unconventional high doses of TNF-α blockers are given. The theoretical background for this is discussed. © 2012 Elsevier Ireland Ltd.


PubMed | Diakonhjemmet Hospital, Hospital of Southern Norway Trust, Norwegian University of Science and Technology and University of California at San Diego
Type: Journal Article | Journal: Annals of the rheumatic diseases | Year: 2016

To investigate the association between clinical and ultrasonographic (US) evidence of inflammation in psoriatic arthritis (PsA), as well as to compare clinical and US remission criteria.In this cross-sectional study 141 PsA outpatients were included. Minimal disease activity (MDA), 28-joint Disease Activity Score (DAS28), Disease Activity Index for PSoriatic Arthritis (DAPSA) and modified versions of Composite Psoriatic Disease Activity Index (CPDAI) and Psoriatic ArthritiS Disease Activity Score (PASDAS) were assessed. Remission criteria were explored. US evaluation was performed on 34 joints, in addition to joints being tender/swollen by 66/68 joint count, 30 tendons, 10 entheses and additionally entheses found to be tender by clinical examination of 19 other entheses. Power Doppler (PD) and grey scale global scores on joints, entheses and tendons were assessed. US remission was defined as no PD activity in joints, entheses and tendons.DAPSA and DAS28, but not CPDAI and PASDAS, were associated with PD activity. MDA was fulfilled in 22.7% and the clinical remission criteria in 5.7%-9.9% of the patients. US remission was found in 49.6% of the patients. The prevalence of PD activity at joints, entheses and tendons was similar for patients fulfilling versus not fulfilling MDA/clinical remission criteria. MDA (OR 2.3, p=0.048), DAPSA 3.3 (OR 4.2, p=0.025) and Booleans (OR=7.8, p=0.033) definitions of remission were found to predict US remission.We found major discrepancies between US and clinical findings. DAPSA and DAS28 reflected US findings better than CPDAI and PASDAS. MDA, DAPSA and Booleans remission criteria predicted US remission.


Hoff M.,St Olavs Hospital | Hoff M.,Norwegian University of Science and Technology | Kavanaugh A.,University of California at San Diego | Haugeberg G.,Norwegian University of Science and Technology | Haugeberg G.,Hospital of Southern Norway Trust
Journal of Rheumatology | Year: 2013

Objective. In rheumatoid arthritis (RA), anti-tumor necrosis factor (anti-TNF) treatment is shown to reduce but not to arrest the rate of hand bone loss. This has not been assessed in psoriatic arthritis (PsA). Our objective was to examine changes in cortical hand bone density in patients with PsA treated with placebo or infliximab (IFX). Methods. Patients in IMPACT II (Induction and Maintenance Psoriatic Arthritis Clinical Trial 2) were randomized to placebo or IFX. After Week 24, all received IFX. In a subset of 120 patients, cortical hand bone density was assessed at Weeks 0, 24, and 54 by digital X-ray radiogrammetry (dxr-BMD) on the same radiographs scored for joint damage. Results. Changes from baseline to 24 weeks in dxr-BMD were -0.30% (SD 1.1%) in the placebo group and -0.08% (SD 1.4%) in the IFX group (p = 0.63). Between baseline and 54 weeks the changes were -0.71% (SD 2.1%) in the placebo group and 0.15% (SD 1.7%) in the IFX group (p = 0.07), and between 24 and 54 weeks -0.41% (SD 1.4%) and 0.23% (SD 0.8%), respectively (p = 0.05). No significant correlation was found between change in dxr-BMD and radiographic damage. Conclusion. This pilot study indicates that hand bone loss in PsA patients treated with anti-TNF can be arrested. Assessment of hand bone density may thus be a potential outcome measure for bone involvement and a response variable to treatment in PsA. Copyright © The Journal of Rheumatology 2013.


Hoff M.,St Olavs Hospital | Hoff M.,Norwegian University of Science and Technology | Gulati A.M.,St Olavs Hospital | Romundstad P.R.,Norwegian University of Science and Technology | And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2015

Background: A wide range in the prevalence (<0.01-0.25%) and incidence (0.5-23.1/100 000) of psoriatic arthritis (PsA) is reported. The main objective of this study was to examine the prevalence and incidence of PsA in central Norway. Method: The patients were recruited from the Nord- Trøndelag Health Study 3, a population study carried out in 2006-2008. All 94 194 inhabitants aged >20 years were invited and 50 806 (54%) responded. The study consisted of a questionnaire (Q1) and a brief medical examination. Q1 included questions if the persons suffered from psoriasis, rheumatoid arthritis (RA) or ankylosing spondylitis (AS). Patients with self-reported psoriasis further answered a specific questionnaire on psoriasis including a questionnaire concerning PsA. In order to identify patients with PsA we used the following criteria: Persons reporting they had or may have PsA; persons answering that they had psoriasis and RA; and persons answering that they had psoriasis and AS. Using this approach, 1278 patients were identified. Hospital files were evaluated by a rheumatologist according to a predefined protocol to verify the diagnosis of PsA. Results: 338 patients, 144 men and 194 women, were verified to have PsA. The prevalence of PsA was 6.7 (95% CI 5.9 to 7.4) per 1000 inhabitants >20 years with no significant difference between men and women. In the 9-year period of 2000-2008, a total of 188 patients were diagnosed with PsA, which give an incidence rate of 41.3/100 000 (35.8-47.6). Conclusions: The prevalence of PsA in central Norway appears to be higher than previously reported. The reason for this is unknown and may include environmental factors, life style factors and genetic differences. © 2014, BMJ Publishing Group. All rights reserved.


Diamantopoulos A.P.,Norwegian University of Science and Technology | Haugeberg G.,University of Agder | Hetland H.,Hospital of Southern Norway Trust | Soldal D.M.,Hospital of Southern Norway Trust | And 2 more authors.
Arthritis Care and Research | Year: 2014

Objective Color Doppler ultrasonography (CDUS) can detect inflammation in the vessel wall. No studies have evaluated the examination of the common carotid artery by CDUS in the diagnostics of giant cell arteritis (GCA). Our aim was to evaluate the combination of CDUS examination of the temporal, axillary, and common carotid arteries in the diagnosis of GCA. Methods Patients ages ≥50 years who were referred to our department between April 2010 and October 2012 and suspected to have GCA were consecutively examined. A positive clinical evaluation for GCA 6 months after the first evaluation by 3 rheumatologists was considered as the gold diagnostic standard. All patients underwent CDUS of the temporal, axillary, and common carotid arteries. A biopsy of the temporal artery was performed for most patients. Results A total of 88 patients were assessed. Forty-six patients were diagnosed to have GCA by the defined gold standard. Forty-eight patients had a positive CDUS of the temporal artery. Forty-six patients diagnosed with GCA had a positive CDUS of the temporal, common carotid, and axillary arteries (100% sensitivity) and 4 patients had a positive CDUS without having GCA (91% specificity). Among the 39 GCA patients that underwent a biopsy, vasculitis was observed in 26 patients (66%), yielding a sensitivity of 67% and a specificity of 95%. Conclusion CDUS of the common carotid, axillary, and temporal arteries had an excellent sensitivity and high specificity to diagnose GCA. CDUS has the potential to replace biopsy in ordinary clinical care without compromising on sensitivity and specificity. Copyright © 2014 by the American College of Rheumatology.


Rohde G.,University of Agder | Rohde G.,Hospital of Southern Norway Trust | Berg K.H.,University of Agder | Berg K.H.,Hospital of Southern Norway Trust | And 2 more authors.
Health and Quality of Life Outcomes | Year: 2014

Background: Sexual activity and enjoyment are considered to be important components of quality of life (QOL) for adults of all ages. However, limited data are available on the effects of health status on sexual activity in women and men older than 50 years. Thus, our aim was to explore the perceived effects of health status on sexual activity in women and men older than 50 years.Methods: For this purpose we used data from an age and gender matched control study initially designed to study QOL in patients with low-energy wrist fracture. We investigated patients with wrist fractures older than 50 years (n = 181), as well as age- and gender-matched controls (n = 226), who participated in the QOL study. There were minimal differences between patients and controls, thus the groups were pooled (mean age 67 years (8 SD)). Health-related quality of life (HRQOL) was assessed using SF-36 and 15D, and the global quality of life using the Quality of Life Scale (QOLS). To assess perceived effects of health status on sexual activity we used the question on sexuality from the 15D questionnaires. Group comparisons and logistic regression analyses were conducted.Results: The 15D question on sexuality was not answered by 25% of the participants. Health status having a large negative effect on sexual activity was reported by only 13% of the participants. In the multivariate analyses a large negative effect of health status on sexual activity was associated with higher age (60-69 years: OR = 5.7, 95% CI = 1.62-29.2; 70-79 years: OR = 3.60, 95% CI = 0.94-13.9; ≥80 years: OR = 9.04, 95% CI = 1.29-63.4), male gender (OR = 10.8, 95% CI = 3.01-38.9), weight (OR = 1.03, 95% CI = 1.00-1.07), low SF-36 PCS score (OR = 0.88, 95% CI = 0.37-0.93) and a low SF-36 MCS score (OR = 0.92, 95% CI = 0.88-0.96).Conclusion: Only a small proportion of the participants reported their health status to have a large negative effect on sexual activity. Furthermore, health status having a negative effect on sexual activity was associated with decreased HRQOL. Insights into this important topic may increase our awareness as health care workers and help us to address this aspect of QOL in this age group. © 2014 Rohde et al.; licensee BioMed Central Ltd.


Haugeberg G.,Hospital of Southern Norway Trust | Haugeberg G.,Norwegian University of Science and Technology | Hansen I.J.W.,Hospital of Southern Norway Trust | Soldal D.M.,Hospital of Southern Norway Trust | Sokka T.,Jyvaskyla Central Hospital
Arthritis Research and Therapy | Year: 2015

Introduction: In the new millennium, clinical outcomes in patients with rheumatoid arthritis (RA) have improved. Despite a large number of register data, there is a lack of data reflecting the entire outpatient RA population, and in particular long-term data. The main aim of this study was to explore changes in clinical disease status and treatment in an RA outpatient clinic population monitored with recommended outcome measures over a 10-year period. Methods: Standard data collected included demographic data, erythrocyte sedimentation rate, C-reactive protein, clinical measures of disease activity (Disease Activity Score in 28 joint counts [DAS28], Clinical Disease Activity Index [CDAI], Simplified Disease Activity Index [SDAI] and global assessments) and patient-reported outcomes (measures of physical function, joint pain, fatigue, patient global assessment and morning stiffness). Treatment with disease-modifying antirheumatic drugs (DMARDs) was also recorded, as well as rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) status. Results: In the RA population, the mean age was approximately 64years and disease duration was 10-12 years. About 70% were females; approximately 20% were current smokers; and 65-70% were positive for RF and ACPA. During follow-up, disease activity improved significantly. When we applied the DAS28, CDAI, SDAI and Boolean criteria for remission, the proportions of patients in remission increased from 21.3%, 8.1%, 5.8% and 3.8%, respectively, in 2004 to 55.5%, 31.7%, 31.8% and 17.7%, respectively, in 2013. The proportions of patients with DAS28, CDAI and SDAI low disease activity status were 16.0%, 34.0%, and 34.9%, respectively, in 2004 and 17.8%, 50.4% and 50.8%, respectively, in 2013. A significant improvement in patient-reported outcome was seen only for the full 10-years, but not for the last 4years, of the study period. The proportion of patients taking synthetic (about 60%) and biologic (approximately 30%) DMARDs was stable over the last 4years of the study period, with no significant change observed, whereas the proportion of patients being treated with prednisolone was reduced significantly from 61% in 2010 to 54% in 2013. Conclusions: The encouraging data we present suggest that the vast majority of patients with RA monitored in outpatient clinics in the new millennium can expect to achieve a status of clinical remission or low disease activity. © 2015 Haugeberg et al.


Hip fracture is associated with increased mortality. Our aim was to study potential risk factors, including osteoporosis, associated with short- and long-term mortality in a prospectively recruited cohort of fragility hip fracture patients. Fragility hip fracture patients aged >50 years admitted to a county hospital in Southern Norway in 2004 and 2005 were consecutively identified and invited for assessment. Patients with high energy or pathological fractures, patients with confusion, serious infections or who were non-residents in the catchment area were excluded. As part of a clinical routine, data were collected using questionnaires. Standardized bone density measurements of lumbar spine and hip were performed. Potential predictors of hip fracture mortality were tested using univariate and multivariate logistic regression analysis. A total of 432 hip fracture patients (129 males and 303 females) were prospectively identified. Among them 296 (85 males and 211 females) patients [mean age 80.7 (SD 9.1)] were assessed at the Osteoporosis center. Variables independently associated with short-term mortality (after 1 year) were in females older age [Odds Ratio (OR) 6.95] and in males older age (OR 5.74) and pulmonary disease (OR 3.20), whereas no associations were observed with mortality for 3 months after the fragility hip fracture. Variables independently associated with 5 years mortality in males was osteoporosis (OR 3.91) and older age (OR 6.95), and in females was dementia (OR 4.16) and older age (OR 2.80). Apart from known predictors as age and comorbidity osteoporosis in our study was identified as a potential independent predictor of long-term hip fracture mortality in males. This is of particular importance as treatment with bisphosphonates after hip fracture has been shown to reduce hip fracture mortality and may be a clinical target to reduce the burden of the disease. Further studies however are needed to confirm the validity of this finding.

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