Background: Knee osteoarthritis (OA) is the most common form of arthritis in older adults. Knee OA is associated with limitations in physical function. Functional limitations are also associated with another geriatric condition, frailty. Frailty is characterized by reduced strength, endurance and physiological function. Purpose: The primary purpose of this study is to determine if there is a difference in radiographic or symptomatic knee OA severity between non-frail and pre-frail women with knee OA. Secondary objectives include: a) the relationship between radiographic and symptomatic OA severity with serum inflammatory cytokines, and b) if there is a difference in inflammatory cytokines between non-frail and pre-frail women with knee OA. Methods: We included 21 community-dwelling women with knee OA. Frailty was assessed using the Fried Frailty Phenotype. Knee OA severity was characterized by the Kellgren and Lawrence (KL) score and the Knee Injury and Osteoarthritis Outcome Questionnaire (KOOS). Inflammatory cytokines included serum interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis alpha (TNF α) and C reactive protein (CRP). Results: Data from 20 participants (66.1 [9.6] years, BMI 29.7 [4.9] kg/m2, non-frail=55%; pre-frail=45%) were analyzed. Radiographic severity was not different between frailty groups (p= 0.11). There was no difference in symptomatic knee OA severity, measured using the KOOS subscales, between frailty groups (p>0.17). Radiographic OA severity and inflammatory markers were not associated (p>0.30). There was a negative relationship between TNF α and self-reported pain (r=0.26), no relationships between inflammatory cytokines with any other KOOS sub-scales. Lastly, there was no difference in any inflammatory cytokines between non-frail and pre-frail groups. Conclusion: Despite the relatively young age, nearly 50% of our participants were pre-frail. Pre-frailty was unrelated to the severity of the knee OA, or inflammatory cytokines. TNF α may be involved in the experience of pain in these women. While it appears women with knee OA frequently demonstrate pre-frail status, more work is necessary to examine the link between these diseases. / Thesis / Master of Science (MSc) / Arthritis is a chronic disease that has a debilitating effect on the lives of more than 4.6 million Canadians. In 2015, the cumulative economic burden of osteoarthritis was 195.2 billion dollars and is expected to increase significantly in the next two years. Knee osteoarthritis is the most common form of arthritis in older adults. Knee osteoarthritis is associated with increased pain, decreased physical function and decreased quality of life (QOL). In vulnerable older adults increased exhaustion, decreased physical function and muscle loss can increase the risk of developing frailty. Frail older adults are at higher risk of adverse health outcomes such as falls, hospitalization and death. Previous research has shown that older adults with knee OA are at higher risk of developing frailty however, it is not understood what underlying mechanisms increase this risk. This thesis provides fundamental information aimed at understanding potential mechanisms associated with knee osteoarthritis and frailty in women. Our study found that despite their relatively young age, nearly half of the women with knee OA are pre-frail. This data shows that inflammatory cytokines in particular, tumor necrosis factor alpha is related to symptomatic knee osteoarthritis severity in particular, self-reported pain. Overall, early detection of frailty is important when managing this condition. These data suggest that chronic knee pain associated with OA may be a useful trigger for early assessments of frailty in women.

Bakgrund: Reumatoid artrit är en obotlig sjukdom som påverkar kroppens leder. Diagnostiserade patienter kommer att handskas med bland annat smärtor, trötthet och stelhet som försvårar deras liv. Som sjuksköterska ansvarar man för patienters omvårdnad och främjar deras hälsa. Syfte: Syftet var att beskriva vuxna patienters upplevelser av att leva med reumatoid artrit. Metod: En litteraturöversikt med nio kvalitativa artiklar och en artikel med mixad metod av kvalitativ och kvantitativ. Sökningen gjordes på CINAHL Complete och PubMed. Resultat: I resultatet framträdde tre huvudteman; Patienters vardag med reumatoid artrit, Den psykiska påfrestningen av reumatoid artrit och Strategier för att hantera reumatoid artrit. Resultatet visar att reumatoid artrit påverkar patienters liv utifrån flera aspekter med smärta i fokus. Det framkom även vikten av vårdpersonalens förståelse och stöd för patienterna. Sammanfattning: Smärta är en stor faktor för patienters försämrade livskvalité. Medan stöd från omgivning påverkar patienters välbefinnande positivt. Vad för hjälp som patienterna behöver kan skilja mycket. Därför skall sjuksköterskans möte med patienter utgå utifrån personcentrerad vård. / Background: Rheumatoid arthritis is an incurable disease that affects the body’s joints. Diagnosed patients will deal with pains, fatigue and stiffness that will affect their lives. It is the registered nurse’s responsibility to take care of the patients and promote their health.  Aim: The aim was to describe adult patients experiences of living with rheumatoid arthritis. Method: A literature review was done with ten qualitative articles and one article with mixed method qualitative and quantitative. The article search was done on CINAHL Complete and PubMed. Results: In the results, three main themes appeared; Patients everyday life with rheumatoid arthritis, The physiological impact of rheumatoid arthritis and Different strategies to deal with rheumatoid arthritis. The results show that rheumatoid arthritis affects patients’ lives in many aspects with mainly pain in focus. It was also noted the importance of health care workers understanding and support for the patients.  Summary: Pain is a big factor for patient’s decreased life quality. While support from their surroundings affect patients’ wellbeing positively. The type of help the patients need varies. That is why the registered nurse should proceed every meeting according to person centered care.

Background: The aim of this cross-sectional study was to investigate potential associations between periodontal inflamed surface area (PISA) and tooth loss with disease-related parameters in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods: Patients who attended the Department of Nephrology and Rheumatology, University Medical Centre Goettingen, Germany, were included. The oral examination comprised the detection of the number of remaining teeth and periodontal condition based on staging and grading matrix. Based on periodontal pockets with positive bleeding on probing, the periodontal inflamed surface area (PISA) was determined. Disease related parameters were extracted from the patients’ records. Results: In total, 101 (RA) and 32 participants (AS) were included. Patients with RA had 22.85 ± 4.26 and AS patients 24.34 ± 5.47 remaining teeth (p < 0.01). Periodontitis stage III and IV was present in 91% (RA) and 81.2% (AS) of patients (p = 0.04). Associations between PISA and disease-related parameters were not found in both groups (p > 0.05). In RA, a higher age (p < 0.01), C-reactive protein (p = 0.02), disease activity (p < 0.01) and prednisolone intake (p < 0.01) were associated with fewer remaining teeth. In AS, a higher age (p = 0.02) and increased Bath Ankylosing Spondylitis Metrology Index (p = 0.02) were associated with a lower number of remaining teeth. Conclusions: Tooth loss is associated with disease activity, especially in RA individuals. Dental care to prevent tooth loss might be recommendable to positively influence oral health condition and disease activity in RA and SA patients.

Background Rheumatoid arthritis, or rheumatoid joint inflammation, is the most common inflammatory joint disease, affecting 0.5–1.0 percent of the Western population. The disease develops gradually over several weeks to months, with symmetric inflammation in the hands and feet. Those affected are at risk of premature death. Aim The aim was to describe patients' experiences of living with rheumatoid arthritis. Method This literature review includes eleven original studies with the aim of describing the current state of knowledge in current research. The two electronic research databases, Cinahl Complete and PubMed, were used to gather information on rheumatoid arthritis. Findings were then thematized using Friberg's four-step model. Results The analysis resulted in four themes: Experiences of living with pain and fatigue; Experiences of a lack of social life; Support from family and healthcare; and Strategies for managing rheumatoid arthritis. The disease has a negative impact on participants' lives in several aspects, including physical, psychological, social, and economic. Summary Nurses need knowledge of how patients with rheumatoid arthritis experience living with the disease to assist them in managing their daily lives, provide information about the disease, and motivate lifestyle changes. / Bakgrund Reumatoid artrit eller ledgångsreumatism är den vanligaste av de inflammatoriska ledsjukdomar som drabbar 0,5–1,0 procent av den västerländska befolkningen. Sjukdomen utvecklas smygande från flera veckor till månader med symmetrisk inflammation i händerna och fötterna. De drabbade riskerar att dö i förtid. Syfte Syftet var att beskriva patienters upplevelser av att leva med Reumatoid artrit. Metod I denna litteraturöversikt ingår elva originalstudier med målet att beskriva kunskapsläget inom aktuell forskning. De två elektroniska forskningsdatabaserna Cinahl Complete och PubMed användes för att samla in information om Reumatoid artrit. Sedan tematiserades fynd med hjälp av Fribergs fyrstegsmodell.  Resultat Analysen resulterade i fyra teman: Upplevelser av att leva med smärta och trötthet; Upplevelser av brist på socialt liv, Stöd från familj och vården och Strategier att hantera Reumatoid artrit. Sjukdomen har en negativ inverkan på deltagarnas liv i flera aspekter både fysiskt, psykiskt, socialt och ekonomiskt.  Sammanfattning Sjuksköterskor behöver kunskap om hur patienter med RA upplever att leva med sjukdomen för att kunna hjälpa patienterna att hantera sin vardag, förmedla information om sjukdomen och motivera till livsstilsförändringar.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24991号 / 医博第5025号 / 新制||医||1069(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 生田 宏一, 教授 椛島 健治, 教授 上野 英樹 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: This bioinformatics study aimed to reveal potential cross-talk genes, related pathways, and transcription factors between periimplantitis and rheumatoid arthritis (RA). Methods: The datasets GSE33774 (seven periimplantitis and eight control samples) and GSE106090 (six periimplantitis and six control samples) were included from the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO). A differential expression analysis (p < 0.05 and |logFC (fold change)| ≥ 1) and a functional enrichment analysis (p < 0.05) were performed. Based on this, a protein–protein interaction (PPI) network was constructed by Cytoscape. RA-related genes were extracted from DisGeNET database, and an overlap between periimplantitis-related genes and these RA-related genes was examined to identify potential cross-talk genes. Gene expression was merged between two datasets, and feature selection was performed by Recursive Feature Elimination (RFE) algorithm. For the feature selection cross-talk genes, support vector machine (SVM) models were constructed. The expression of these feature genes was determined from GSE93272 for RA. Finally, a network including cross-talk genes, related pathways, and transcription factors was constructed. Results: Periimplantitis datasets included 138 common differentially expressed genes (DEGs) including 101 up- and 37 downregulated DEGs. The PPI interwork of periimplantitis comprised 1,818 nodes and 2,517 edges. The RFE method selected six features, i.e., MERTK, CD14, MAPT, CCR1, C3AR1, and FCGR2B, which had the highest prediction. Out of these feature genes, CD14 and FCGR2B were most highly expressed in periimplantitis and RA. The final activated pathway–gene network contained 181 nodes and 360 edges. Nuclear factor (NF) kappa B signaling pathway and osteoclast differentiation were identified as potentially relevant pathways. Conclusions: This current study revealed FCGR2B and CD14 as the most relevant potential cross-talk genes between RA and periimplantitis, which suggests a similarity between RA and periimplantitis and can serve as a theoretical basis for future research.

This purpose of the study is to examine the difference in the health-related quality of life (HRQOL) between individuals who suffer from physician-diagnosed arthritis compared with individuals who do not suffer from physician-diagnosed arthritis in a population of university students, faculty, and staff. The study sampled from a population of students, faculty, and staff at the University of Central Florida. Through the implantation of a cross-sectional ecological design, differences between the two groups were measured with a survey that measures health-related quality of life, such as the 36-Item Short Form Health Survey (SF-36). The SF-36 questionnaire was distributed to subjects through a campus-wide email system and was administered through Qualtrics, an online survey program. Literature suggests lower SF-36 scores for individuals suffering from arthritis, but is lacking in investigating the effect of arthritis on college-aged students, particularly within the 18-24 age group. The study aims to close this gap in the literature. SPSS software was used to analyze results through tests of association, like ANOVA, which measured differences in the SF-36 scores of subjects with physician-diagnosed arthritis and subjects without physician-diagnosed arthritis. Results showed a significant difference in the HR-QOL scores between individuals with arthritis and individuals without arthritis, as well as age, gender, ethnicity, and the presence of joint pain.

Rheumatoid Arthritis (RA) is an autoimmune disorder that results in inflamed joints and osteoporosis. Previous studies have shown that Mycobacterium avium subspecies Paratuberculosis (MAP) has a role in the downregulation of active osteocalcin in Crohn’s disease (CD). Since RA and CD have a similar pathology, we hypothesize that active inflammation following MAP infection will result in downregulation of active osteocalcin in RA patients. In this study, a total of 82 individuals (48 RA and 34 healthy) were examined for MAP status and for active osteocalcin. Out of the 48 RA patients, 18 were MAP positive compared to only 1 out of 34 healthy control (P-values < 0.05). Overall, active osteocalcin levels between RA (2.70 ± 0.87 ng/mL) were significantly lower than healthy controls (5.84 ± 1.42 ng/mL, P-values < 0.05). MAP positive RA patients active osteocalcin levels were lower (0.60 ± 0.31 ng/mL) than MAP negative RA patients (3.85 ± 1.31 ng/mL). The active osteocalcin level in healthy MAP positive controls were lower (1.65 ng/mL) than healthy MAP negative controls (5.96 ± 1.45 ng/mL). The level of active osteocalcin in all MAP positive patients was significantly lower (0.66 ± 0.29 ng/mL) than all MAP negative patients (4.95 ± 0.98 ng/mL, P-values < 0.05). The correlation between presence of MAP in RA individuals and downregulation of active osteocalcin supports a role of MAP as a pathogenic element in RA. In addition, we tested three Single Nucleotide Polymorphisms (SNPs) in TNFα, TNFRSF1A and TNFRSF1B by TaqMan genotyping from peripheral blood samples of the 82 subjects. These SNPs were used to determine whether they influence the levels of osteocalcin in RA and healthy patients. Patients with the SNP TNFRSF1B:rs3397 who had TT genotype had a significantly lower osteocalcin level compared with patients without SNP who had CC genotype (0.98 ± 0.35 ng/mL vs. 1.86 ± 0.61 ng/mL). Overall, there was a correlation of the presence of these SNPs and the downregulation of osteocalcin in RA.

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