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Englund M.,Musculoskeletal science | Englund M.,Boston University
Best Practice and Research: Clinical Rheumatology

The knee is one of the most common joints affected by osteoarthritis (OA), frequently with clinical presentation by middle age or even earlier. Accumulating evidence supports that knee OA progression is often driven by biomechanical forces, and the pathological response of tissues to such forces leads to structural joint deterioration, knee symptoms and reduced function. Well-known biomechanical risk factors for progression include joint malalignment and meniscal tear. The high risk of OA after knee injury demonstrates the critical role of biomechanical factors also in incident disease in susceptible individuals. However, our knowledge of the contributing biomechanical mechanisms in the development of early disease and their order of significance is limited. Part of the problem is our current lack of understanding of early-stage OA, when it starts and how to define it. © 2009 Elsevier Ltd. All rights reserved. Source

Olofsson T.,Lund University | Petersson I.F.,Lund University | Eriksson J.K.,Karolinska Institutet | Englund M.,Musculoskeletal science | And 8 more authors.
Annals of the Rheumatic Diseases

Objective: To identify predictors of sick leave and disability pension in patients with early rheumatoid arthritis (RA). Methods: Individuals aged 19-59 years diagnosed with early RA (=12 months symptom duration) were identified in the Swedish Rheumatology Quality Register (1999-2007; n=3029). We retrieved days of sick leave and disability pension from the Swedish Social Insurance Agency and baseline predictors of total work days lost during 3 years after RA diagnosis were investigated using linear regression. Due to effect modification by baseline work ability (defined as work days lost the month before diagnosis), analyses were stratified into three categories: full=0 work days lost the month before diagnosis; partial=1-29 work days lost; and none=30 work days lost. Results: 71% of patients with full baseline work ability still had full work ability after 3 years compared with 36% (p<0.001) and 18% (p<0.001) of those with partial and no work ability at baseline, respectively. Elevated baseline levels of HAQ and DAS28, higher age, lower education level and unemployment were associated with more work days lost during 3 years in all strata of baseline work ability (all p<0.05). In a separate analysis, more objective variables (ESR, CRP and swollen joints) were not. Generally, the largest regression coefficients were seen for patients with partial baseline work ability. Conclusions: Work ability at RA diagnosis was the most important predictor of 3-year sick leave and disability pension. Taking this into account, HAQ, DAS28, age and education level were also significant predictors, whereas ESR and CRP were not. Source

Englund M.,Musculoskeletal science | Englund M.,Lund University | Englund M.,Boston University | Joud A.,Musculoskeletal science | And 6 more authors.

Objectives: To gain updated estimates of prevalence and incidence of RA and proportion on biological treatment in southern Sweden. Methods: Inpatient and outpatient health care provided to residents in the southernmost county of Sweden (1.2 million inhabitants) is registered in the Skåne Health Care Register (SHCR). We identified residents aged ≥20 years who had received a diagnosis of RA at least twice during 2003-08. Valid point prevalence estimates by 31 December 2008 were obtained by linkage to the Swedish population register, and information on biological treatment was obtained from the South Swedish Arthritis Treatment Group register. We also tested our estimates of RA occurrence in a series of sensitivity analyses to investigate the effect of altered case criteria and the uncertainty generated by clinical visits without diagnoses. Results: The prevalence of RA in adults was estimated to 0.66% (women = 0.94%, men = 0.37%). The prevalence peaked at age 70-79 years (women = 2.1%, men = 1.1%) before dropping in those aged ≥80 years. Of prevalent cases, 20% had ongoing biological treatment, a percentage that was highest in women aged 40-49 years (36%). The incidence of RA in 2008 was estimated as 50/100 000 (women = 68/100 000, men = 32/100 000). Conclusions: When compared with a previous report from southern Sweden, the prevalence of RA seems not to have declined in the last decade. The proportion of patients with ongoing biological treatment was slightly higher in women than men. SHCR data are promising additions to other methods to gain frequency estimates of clinically important disease in a timely and cost-efficient manner. © The Author 2010. Source

Olofsson T.,Musculoskeletal science | Olofsson T.,Lund University | Englund M.,Musculoskeletal science | Englund M.,Boston University | And 7 more authors.
Annals of the Rheumatic Diseases

Objective: To investigate the effect of tumour necrosis factor (TNF) antagonist treatment of patients with rheumatoid arthritis (RA) on sick leave (SL) and disability pension (DP) in a population-based setting in southern Sweden. Methods: All patients with RA in the South Swedish Arthritis Treatment Group register living in the county of Skåne (population 1.2 million), who started their first treatment with a TNF antagonist between January 2004 and December 2007 and were 18-58 years at treatment start (n=365), were identified. For each patient with RA, four matched reference subjects from the general population were randomly selected. Data were linked to the Swedish Social Insurance Agency register and the point prevalence of SL and DP as well as days of SL and DP per month were calculated from 360 days before until 360 days after treatment start. Results: At treatment start 38.6% of the patients with RA were registered for SL. During the first 6 months this share dropped to 28.5% (decrease by 26.2%, p<0.001). This level remained stable throughout the first treatment year. Comparing patients with RA to the reference group the relative risk of being on SL was 6.6 (95% CI 5.2 to 8.5) at initiation of anti-TNF treatment and 5.2 (95% CI 4.0 to 6.8) 1 year after that. The corresponding figures for DP were 3.4 (95% CI 2.7 to 4.2) and 3.2 (95% CI 2.7 to 3.9). Conclusions: There was a marked decline in SL during the first 6 months of TNF antagonist treatment in patients with RA in southern Sweden, maintained throughout the first year, which was not offset by a corresponding increase in DP. Source

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