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  • 1.
    Demmelmeier, Ingrid
    et al.
    Karolinska Institutet.
    Åsenlöf, Pernilla
    Uppsala University.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Nordgren, Birgitta
    Karolinska Institutet.
    Opava, Christina H
    Karolinska Institutet ; Karolinska University Hospital.
    Pain rather than self-reported sedentary time explains variation in perceived health and activity limitation in persons with rheumatoid arthritis: a cross sectional study in Sweden2017In: Rheumatology International, ISSN 0172-8172, E-ISSN 1437-160X, Vol. 37, no 6, p. 923-930Article in journal (Refereed)
    Abstract [en]

    To investigate (1) the amount of self-reported time spent sedentary among a large cohort of persons with rheumatoid arthritis (RA), and (2) the contribution of sedentary time to explain perceived health and activity limitation in RA beyond that of previously known correlates. This cross-sectional study used data from a postal questionnaire and the Swedish Rheumatology Quality registers (SRQ). The International Physical Activity Questionnaire was used to assess sedentary time (sitting) and moderate, vigorous and walking activity (MVPA). Sociodemographics, pain, fatigue, fear-avoidance beliefs, anxiety/depression, disease duration, MVPA and sedentary time were included in multiple regression models with perceived health (Visual Analogue Scale 0-100) and activity limitation (Stanford Health Assessment Questionnaire) as dependent variables.

    RESULTS:

    In all 3152 (59%) of 5391 persons identified as eligible from the SRQ, responded to the questionnaire. 2819 individuals with complete data on all study variables were analysed. Mean time (SD) spent sedentary was 257 (213) minutes per day. Sedentary time did not contribute significantly to explain perceived health and only minimally to explain activity limitation. Instead, variation was mainly explained by pain; for perceived health (Beta = 0.780, p < 0.001) and for activity limitation (Beta = 0.445, p < 0.001).The results indicate a non-significant role of sedentary time and a need for increased focus on pain in the management of RA. Future studies should use prospective designs and objective assessment methods to further investigate the associations between sedentary time and health outcomes in persons with R

  • 2.
    Ericson, Lisa
    et al.
    Nordic Health Economics AB.
    Ambring, Anneli
    Björholt, Ingela
    Dahm, Peter
    Opioid rotation in patients initiated on oxycodone or morphine: a register study.2013In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 6, p. 379-86Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Strong opioids are recommended for the treatment of moderate to severe pain. However, some patients do not achieve a successful treatment outcome due to intolerable adverse events and/or inadequate analgesia, thus may benefit from switching to another opioid, a procedure known as "opioid rotation." The type of opioid at treatment initiation may influence the risk of opioid rotation and the objective of this study was to assess such rotation after treatment initiation with two alternative treatments, controlled-release (CR) oxycodone versus CR morphine in patients suffering from non-cancer pain.

    METHOD: The study reported here was a real-life study based on Swedish register data: the Prescribed Drug, National Patient, and Cause of Death registers. The captured data cover the entire Swedish population treated in specialist care. A statistical analysis plan was agreed and signed before data were accessed.

    RESULTS: Data from 50,223 cases were included in the analyses. The risk of rotation was 19% higher in patients initiating treatment with morphine compared with oxycodone (hazard ratio 1.19; 95% confidence interval 1.11-1.27; P < 0.001), after adjusting for such baseline variables that were both significantly correlated with the outcome variable (time to rotation) and significantly different between the groups; age at index date, osteoarthritis and number of pain-related drugs.

    CONCLUSION: Patients with non-cancer pain who initiated treatment with CR morphine had a higher risk of opioid rotation than patients initiated with CR oxycodone.

  • 3.
    Pernow, Ylva
    et al.
    Karolinska Institutet.
    Shahror, Rami
    Örebro University.
    Acharya, Shikha
    Örebro University.
    Jahnson, Lena
    Örebro University Hospital.
    Vumma, Ravi
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Venizelos, Nikolaos
    Örebro University.
    Aberrant tryptophan transport in cultured fibroblast from patients with Male Idiopathic Osteoporosis: an in vitro study2018In: Bone Reports, ISSN 2352-1872, Vol. 8, p. 25-28Article in journal (Refereed)
    Abstract [en]

    It has been demonstrated, that long-term chronic tryptophan deficiency, results in decreased serotonin synthesis, which may lead to low bone mass and low bone formation. Findings from studies in male patients with idiopathic osteoporosis suggested a decreased transport of tryptophan in erythrocytes of osteoporotic patients, indicating that serotonin system defects may be involved in the etiology of low bone mass. Tryptophan is the precursor of serotonin, and a disturbed transport of tryptophan is implicated in altered serotonin synthesis. However, no study has investigated the tryptophan transport kinetics in MIO patients. The aim of this study is to investigate the kinetic parameters of tryptophan transport in fibroblasts derived from MIO patients compared to age and sex matched controls.

    Fibroblast cells were cultured from skin biopsies obtained from 14 patients diagnosed with Male Idiopathic Osteoporosis and from 13 healthy age-sex matched controls, without a diagnosis of osteoporosis. Transport of the amino acid tryptophan across the cell membrane was measured by the cluster tray method. The kinetic parameters, maximal transport capacity (Vmax) and affinity constant (Km) were determined by using the Lineweaver-Burke plot equation.

    The results of this study have shown a significantly lower mean value for Vmax (p = 0.0138) and lower Km mean value (p = 0.0009) of tryptophan transport in fibroblasts of MIO patients compared to the control group. A lower Vmax implied a decreased tryptophan transport availability in MIO patients.

    In conclusion, reduced cellular tryptophan availability in MIO patients might result in reduced brain serotonin synthesis and its endogenous levels in peripheral tissues, and this may contribute to low bone mass/formation. The findings of the present study could contribute to the etiology of idiopathic osteoporosis and for the development of novel approaches for diagnosis, treatment and management strategies of MIO.

  • 4.
    Sandholm, Kerstin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Persson, Barbro
    Uppsala University.
    Skattum, Lillemor
    Lund University.
    Eggertsen, Gösta
    Karolinska Institutet;Karolinska University Hospital.
    Nyman, Dag
    Aland Cent Hosp, Finland.
    Gunnarsson, Iva
    Karolinska Institutet;Karolinska University Hospital.
    Svenungson, Elisabet
    Karolinska Institutet;Karolinska University Hospital.
    Nilsson, Bo
    Uppsala University.
    Nilsson Ekdahl, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Uppsala University.
    Evaluation of a Novel Immunoassay for Quantification of C1q for Clinical Diagnostic Use2019In: Frontiers in Immunology, ISSN 1664-3224, E-ISSN 1664-3224, Vol. 10, article id 7Article in journal (Refereed)
    Abstract [en]

    Objectives: C1q is a valuable biomarker of disease activity in systemic lupus erythematosus (SLE). The "gold standard" assay, rocket immunoelectrophoresis (RIE), is time-consuming, and thus a shift to soluble immune precipitation techniques such as nephelometry has occurred. However, quantification of C1q with these techniques has been questioned as a result of the antibody binding properties of C1q. In the present work, we have compared results using various techniques (RIE, nephelometry, and ELISA) and have developed and validated a new magnetic bead-based sandwich immunoassay (MBSI). Methods: C1q was quantified by nephelometry and the new sandwich immunoassay in 45 serum samples analyzed using RIE. C1q was also assessed in plasma using RIE and sandwich immunoassay in samples from SLE patients with nephritis (n = 69), SLE patients without nephritis (n = 310) as classified by BILAG score, and matched controls (n = 322). In addition, cerebrospinal fluid (CSF) samples from 31 patients, previously analyzed with ELISA, were also analyzed with the MBSI to test the behavior of this new assay in the lower detection range. Results: We found a strong correlation between the new MBSI, RIE, and ELISA, but not with nephelometry. The MBSI demonstrated lower levels of C1q in SLE patients than in matched controls (p < 0.0001), and patients with nephritis had lower levels than patients without nephritis (p < 0.01). Similarily, RIE showed significant differences between the patient groups (p < 0.0001). An association was also found between the levels of C1q and the SLE disease activity index (SLEDAI). Furthermore, there was good correlation between the values obtained by MBSI and ELISA, in both serum (r = 0.960) and CSF (r = 0.786), underscoring the ability of both techniques to measure low concentrations of C1q with high accuracy. Conclusion: The sandwich immunoassay correlated well with RIE, but soluble immune precipitation techniques, such as nephelometry, did not appear suitable alternatives, since C1q itself, and possibly anti-C1q antibodies, interfered with the measurements. The new sandwich immunoassay is therefore a good replacement for RIE in monitoring SLE disease activity.

  • 5.
    Sjöström, Rita
    et al.
    Mid Sweden University.
    Asplund, Ragnar
    Jämtland County Council.
    Alricsson, Marie
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Education, Psychology and Sport Science. Mid Sweden University.
    Back to work: evaluation of a multidisciplinary rehabilitation program with emphasis on mental symptoms; A two-year follow up2012In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 5, p. 145-151Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this investigation was to analyze temporal changes in anxiety, depression, and stress in patients with musculoskeletal pain for a period of up to 2 years after a multidisciplinary rehabilitation program, in relation to sick-listing (registered with The Swedish Social Insurance Agency [Forsakringskassan] for sickness benefit).

    Methods: Ten persons with full-time sick leave (absence from work for medical reasons) (group 1) and 49 with part-time or no sick leave (group 2) at the end of the 2-year study period participated. It was shown in a previous study that group 1 had higher pain rating and higher subjective physical disability than group 2, with little or no improvement during and after rehabilitation. In the present study, all participants were evaluated with the Hospital Anxiety and Depression scale and a self-rated stress test.

    Results: Participants with full-time sick leave during the study period (group 1) showed improved stress levels but no change in anxiety and depression levels. Anxiety, depression, and stress changed more favorably in participants with part-time or no sick leave than in those with full-time sick leave.

    Conclusion: The results of this study indicate that investigation and appropriate treatment of psychological symptoms, including anxiety and depression, are important in multidisciplinary rehabilitation of patients with musculoskeletal disorders

  • 6.
    Sjöström, Rita
    et al.
    Strömsund Health Centre.
    Asplund, Ragnar
    Karolinska Institutet.
    Alricsson, Marie
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science. Mid Sweden Univ, Dept Hlth Sci, Ostersund.
    Evaluation of a multidisciplinary rehabilitation program with emphasis on musculoskeletal disorders: A 5-year follow-up2013In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 45, no 2, p. 175-182Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to perform a 5-year follow-up of a 7-week multidisciplinary rehabilitation program focusing on pain, physical disability, anxiety and depression as well as stress and sick leave and to compare the results from the baseline, a 2-year follow-up and this 5-year follow-up. PARTICIPANTS: Out of 60 participants of the original rehabilitation program 54 were followed-up after 5 years. METHODS: The rehabilitation program was individually adapted and consisted of physical activity in several forms as well as theoretical and practical education. At baseline (start of study) and 2 and 5 years after completion of the rehabilitation program all participants were evaluated in terms of sick leave, pain rating (Visual Analogue Scale), the Disability Rating Index, Hospital Anxiety and Depression Scale, and Stress Test. RESULTS: Between the start of the program and the 5-year follow-up pain rating (P < 0.017) and the rate of full-time sick leave (P < 0.0005) decreased. Physical disability, anxiety, depression and stress were maintained from the 2-year follow-up until the 5-year follow-up. CONCLUSIONS: The rehabilitation program seemed to have had an effect on the participant's ability to manage with symptoms long after the end of the rehabilitation program. Most participants had returned to work, and reported less pain. The improvements made in physical disability and mental health prior to the 2-year follow-up were maintained at the 5-year follow-up occasion.

  • 7.
    Stening, Kent
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Eriksson, Olle
    Linköpings Universitet.
    Henriksson, KG
    Linköpings Universitet.
    Brynhildsen, Jan
    Linköpings Universitet.
    Lindh-Åstrand, Lotta
    Linköpings Universitet.
    Berg, Göran
    Linköpings Universitet.
    Hammar, Mats
    Linköpings Universitet.
    Amandusson, Åsa
    Uppsala Universitet.
    Blomqvist, Anders
    Linköpings Universitet.
    Hormonal replacement therapy does not affect self-estimated pain or experimental pain responses in post-menopausal women suffering from fibromyalgia: a double-blind, randomized placebo-controlled trial2011In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 50, no 3, p. 544-551Article in journal (Refereed)
    Abstract [en]

    Objectives. FM is a condition that preferentially affects women. Sex hormones, and in particular oestrogens, have been shown to affect pain processing and pain sensitivity, and oestrogen deficit has been considered a potentially promoting factor for FM. However, the effects of oestrogen treatment in patients suffering from FM have not been studied. Here, we examined the effect of transdermal oestrogen substitution treatment on experimental as well as self-estimated pain in women suffering from FM.

    Methods. Twenty-nine post-menopausal women were randomized to either 8 weeks of treatment with transdermal 17β-oestradiol (50 µg/day) or placebo according to a double-blind protocol. A self-estimation of pain, a set of quantitative sensory tests measuring thresholds to temperature, thermal pain, cold pain and pressure pain, and a cold pressor test were performed on three occasions: before treatment, after 8 weeks of treatment and 20 weeks after cessation of treatment.

    Results. Hormonal replacement treatment significantly increased serum oestradiol levels as expected (P < 0.01). However, no differences in self-estimated pain were seen between treatment and placebo groups, nor were there any differences between the two groups regarding the results of the quantitative sensory tests or the cold pressor test at any of the examined time points.

    Conclusion. Eight weeks of transdermal oestradiol treatment does not influence perceived pain, pain thresholds or pain tolerance as compared with placebo treatment in post-menopausal women suffering from FM.

  • 8.
    Åsenlöf, Pernilla
    et al.
    Uppsala Universitet.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Demmelmeier, Ingrid
    Karolinska Institutet.
    Nordgren, Birgitta
    Karolinska Institutet.
    Opava H, Christina
    Karolinska Institutet.
    Sedentary time among adults with rheumatoid arthritis. The PARA 2010 study2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl 3, p. 766-Article in journal (Other academic)
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