Low-energy trauma and fragility fractures represent a major public health problem. The societal cost of the fragility fractures that occurred in Sweden 2010 has been estimated at €4 billion. In rheumatoid arthritis (RA), patient outcomes have improved greatly in recent years. However, the therapeutic decision making is still hampered by a lack of effective validated biomarkers. The cost of RA in Sweden 2010 has been estimated at €600 million, of which biologic drugs was €180 million. Digital X-ray radiogrammetry (DXR) is a method to measure bone mineral density (BMD) in the metacarpals of the hand. It can be applied opportunistically in several workflows where a person is already at an X-ray machine, including fracture repositioning follow up, mammography screening and hand imaging in RA. This thesis explored DXR-BMD as a marker to identify individuals who would benefit from anti-osteoporotic treatment, change rate of DXR-BMD as a biomarker in RA and under what conditions historical X-ray images can be used to estimate DXR-BMD. An automated method for measurement of joint space width in metacarpophalangeal and interphalangeal joints was also developed and evaluated as a biomarker in RA. Low DXR-BMD was predictive for hip fractures and predicted fragility fractures to a comparable degree as other BMD measurement sites. Rapid decrease of DXR-BMD was a strong and independent predictor for progression of radiographic damage in RA when manual radiographic progression scores were not available. Change of metacarpal joint space width was a statistically significant but weak predictor of joint space narrowing score progression. Guidelines and considerations for use of historical X-ray radiographs for DXR-BMD measurements in clinical trials have been developed and published.

I Sverige drabbas varje år ca 200-250 barn och ungdomar av sjukdomen juvenil idiopatisk artrit (JIA). JIA är en av de vanligaste orsakerna till kortvarig och långvarig funktionsnedsättning och försämring av livskvalitet under barnaåren. Hela familjen påverkas när en familjemedlem blir sjuk. Syfte: Syftet med denna studie var att belysa hur en långvarig sjukdom som JIA upplevs av barn, ungdomar och deras familjer. Metod: Metoden som användes var en allmän litteraturöversikt. Totalt inkluderades 7 kvantitativa och 5 kvalitativa artiklar. Resultat: Vid analysen identifierades ett huvudtema upplevelser av att vara annorlunda. Resultatet visar att upplevelserna av att leva med JIA är mycket individuella men gemensamt för många av familjerna är en känsla av att vara annorlunda. Konklusion: När ett barn eller ungdom drabbas av en långvarig sjukdom påverkas hela familjen. Livssituationen förändras, även föräldrarnas och syskonens livsvärld blir förändrad. Varje barn och ungdom som drabbas av sjukdomen JIA är unik och har sin egen livsvärld. Som sjuksköterska är det betydelsefullt att se hela individen och involvera dess familj i omvårdnaden. / In Sweden 200-250 children and youths are affected with juvenile idiopathic arthritis (JIA) every year. JIA is one of the most common causes of short-term and long-term disability and impairment of quality of life during childhood. The entire family is affected when a family member becomes ill. Aim: The aim with this study was to illustrate how a prolonged disease as JIA is experienced by children, youths and their families. Method: The method used was a general literature overview. In total 7 quantitative and 5 qualitative articles. Result: During analysis one main themes were identified. This was experiences of being different. The result showed that the experiences of living with JIA is individual but common for many of the families is a sense of being different. Conclusion: When a child or youth is struck by protracted disease, this also affects family members. The life situation is affected, and also the life situation for parents, brothers and sisters is changed. Every child and youth who is affected by JIA is unique, and has its own reality. As a nurse it is meaningful to see the entire individual, and to involve its family in to the nursing.

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease associated with pain, stiffness and increased psychosocial burden. The purpose of this study was to investigate through an ABAB single-case design the impact of a yoga intervention on pain and morning stiffness in adolescent females with JIA. A secondary aim was to assess the impact of this intervention on self-efficacy, mindfulness, and health-related quality of life (HRQOL). Two adolescents with JIA participated in three yoga groups and daily home yoga practice with a DVD. Participants engaged in daily self-monitoring of pain and stiffness and completed questionnaires assessing psychosocial functioning at pre- and post-intervention. A three-month follow-up on primary and secondary measures was conducted. Primary outcomes were evaluated using visual inspection and the conservative dual criterion (CDC) method. Results suggested that for one participant, there were no overall systematic changes in pain or stiffness as a result of the intervention; however, trends toward changes in pain were present during the final phases of the study. For the second participant, systematic changes were observed across most but not all phases for morning stiffness, whereas results for pain were less consistent. Modest changes were revealed on secondary outcome measures; however, not consistently in the direction of hypotheses. Lack of stable baseline data for both participants was a significant limitation of the study and is discussed. More research is needed to determine if the yoga intervention utilized in this study is an effective method for reducing pain and stiffness and enhancing psychosocial functioning in adolescent girls with JIA.

Varje år diagnostiseras cirka 200 barn med juvenil idiopatisk artrit (JIA) i Sverige. Det är inte bara inom specialistvården sjuksköterskor möter barn med JIA, utan även inom allmän sjukvård. Syftet med studien var att belysa omvårdnad för barn med juvenil idiopatisk artrit. Studien är en litteraturstudie. Resultatet belyser vad som är viktigt vid omvårdnaden för barn med JIA. Detta presenteras i tre teman: Bemötande, Information och undervisning och Emotionellt stöd. Ett bra bemötande är viktigt för att barnen skall känna tillit till sjukvården. Det är viktigt att göra barnen delaktiga. Barnen är experter på upplevelsen av sin egen sjukdom. Barnen behöver få emotionellt stöd för att kunna hantera sin vardag. Stödet kan komma från sjuksköterskorna eller Internetsidor. För att barnen skall kunna hantera sin sjukdom och sin situation krävs undervisning och information. Information kan ges i form av broschyrer och böcker samt från sjuksköterskorna och Internet. Önskvärt hade varit om grundutbildningen för sjuksköterskor innefattade omvårdnad för barn. De kunskaper grundutbildade sjuksköterskor har med sig efter examen kan tas tillvara genom att de kan uppmärksamma symtomen som ett barn med JIA har, och utefter det forma omvårdnadsåtgärder. Forskning på JIA är begränsad ur ett omvårdnadsperspektiv, och kunskapsluckorna behöver uppmärksammas. / Every year about 200 children are diagnosed with juvenile idiopathic arthritis (JIA) in Sweden. It is not only in specialized care nurses meet children who suffer from JIA, but also in universal health care. The aim of the study was to express the nursing care for children with juvenile idiopathic arthritis. This study is a literature study. The result highlights what is important in the nursing care of nursing children with JIA. This is presented in three themes: Attitudes, Information and teaching and Emotional support. A good attitude towards the children is very important so they feel a trust to the health care. It is important to make the children involved. Children are experts on the experience of their own illness. The children need emotional support to handle their everyday life. The support can come from the nurse or from Internet pages. If children shall be able to manage their condition and their situation, it requires education and information. The information can be provided from brochures, books, the nurse or the Internet. It would be desirable if nursing school would include nursing children. The knowledge a regular nurse has after the graduation can be taken advantage because they can pay attention to the symptoms a child with JIA has and shape nursing interventions. The research within JIA is limited from a nursing perspective, and knowledge gaps need attention.

Apie 70% vaikų, sergančių lėtiniais artritais, suaugusiųjų amžių pasiekia su tam tikru negalios lygiu ir kasdienės veiklos apribojimu. Todėl ypač aktualu nagrinėti vaikams lėtinių artritų priežastis bei prognostinius veiksnius ankstyvose sąnarių ligos stadijose. Mūsų darbo tikslas buvo nustatyti ar ūminėje ligos fazėje nustatomų laboratorinių, imunologinių ir interleukinų (MRP8/14 (kalprotektinas), IL-6, IL-33) rodiklių pokyčiai, funkcinės būklės vertinimas bei ligos aktyvumas gali prognozuoti vaikams lėtinę sąnarių ligą. Atliktas tyrimas parodė, kad artritu susirgusiems vaikams MRP8/14 (kalprotektino) ir Il-6 koncentracijos buvo reikšmingai didesnės nei kontrolinės grupės vaikams tiek serume, tiek sinoviniame skystyje (p<0,01). Kalprotektinas ir IL-6 ūminėje ligos stadijoje stipriai koreliavo su ligos aktyvumo rodikliais (ENG, CRB, sąnarių pobūdžiu (poliartritu), rytiniu sąnarių sustingimu). Taip pat nustatėme, kad didelės kalprotektino (> 5785 ng/ml) ir IL-6 (> 5,5 pg/ml) koncentracijos ūminėje artrito stadijoje buvo nustatytos tiems pacientams, kuriems sąnarių liga įgavo lėtinę eigą. Vertinome tai, kaip reikšmingus lėtinės sąnarių ligos kriterijus. Šiame darbe sergančių artritų vaikų funkcinė būklė ir vaiko gyvenimo kokybė pirmą kartą Lietuvoje buvo įvertinta naujai įdiegiamu ne tik Lietuvoje, bet ir pasaulyje, įvairiapusiu jaunatvinių artritų vertinimo klausimynu JAMAR, bei duomenys palyginti su seniau Lietuvoje naudojamu vaiko sveikatos būklės vertinimo klausimynu... [toliau žr. visą tekstą] / The earlier studies proved that nearly 70% of children with chronic arthritis reach the adulthood with a certain level of disability and restriction of daily activities. Therefore, it is very important to analyse the causes of arthritis and prognostic factors in the early stages of disease. The aim of our study was to determine whether the changes of laboratory, immunological and interleukins (MRP8/14 (calprotectin), IL-6, IL-33) indexes, assessment of functional condition, and disease activity may predict a chronic arthritis in children. The study showed that MRP8/14 (calprotectin) and Il-6 concentrations in the serum and synovial fluid of children with arthritis were significantly higher than in the control group of healthychildren (p<0.01). During the acute stage of disease, calprotectin and IL-6 concentrations strongly correlated with variables of disease activity (ESR, CRP, polyarthritis, morning stiffness of joints). Also, the analysis showed that high concentrations of calprotectin (> 5785ng/ml) and IL-6 (> 5.5 pg/ml) at the acute stage of arthritis were determined for those patients, whose were developed chronic arthritis. It was evaluated as significant criterion of the chronic joint disease. For the first time in Lithuania, the functional ability and the quality of life in children with arthritis were assessed using a newly introduced multidimensional assessment questionnaire for juvenile arthritis (JAMAR), and data was compared... [to full text]

Apie 70% vaikų, sergančių lėtiniais artritais, suaugusiųjų amžių pasiekia su tam tikru negalios lygiu ir kasdienės veiklos apribojimu. Todėl ypač aktualu nagrinėti vaikams lėtinių artritų priežastis bei prognostinius veiksnius ankstyvose sąnarių ligos stadijose. Mūsų darbo tikslas buvo nustatyti ar ūminėje ligos fazėje nustatomų laboratorinių, imunologinių ir interleukinų (MRP8/14 (kalprotektinas), IL-6, IL-33) rodiklių pokyčiai, funkcinės būklės vertinimas bei ligos aktyvumas gali prognozuoti vaikams lėtinę sąnarių ligą. Atliktas tyrimas parodė, kad artritu susirgusiems vaikams MRP8/14 (kalprotektino) ir Il-6 koncentracijos buvo reikšmingai didesnės nei kontrolinės grupės vaikams tiek serume, tiek sinoviniame skystyje (p<0,01). Kalprotektinas ir IL-6 ūminėje ligos stadijoje stipriai koreliavo su ligos aktyvumo rodikliais (ENG, CRB, sąnarių pobūdžiu (poliartritu), rytiniu sąnarių sustingimu). Taip pat nustatėme, kad didelės kalprotektino (> 5785 ng/ml) ir IL-6 (> 5,5 pg/ml) koncentracijos ūminėje artrito stadijoje buvo nustatytos tiems pacientams, kuriems sąnarių liga įgavo lėtinę eigą. Vertinome tai, kaip reikšmingus lėtinės sąnarių ligos kriterijus. Šiame darbe sergančių artritų vaikų funkcinė būklė ir vaiko gyvenimo kokybė pirmą kartą Lietuvoje buvo įvertinta naujai įdiegiamu ne tik Lietuvoje, bet ir pasaulyje, įvairiapusiu jaunatvinių artritų vertinimo klausimynu JAMAR, bei duomenys palyginti su seniau Lietuvoje naudojamu vaiko sveikatos būklės vertinimo klausimynu... [toliau žr. visą tekstą] / The earlier studies proved that nearly 70% of children with chronic arthritis reach the adulthood with a certain level of disability and restriction of daily activities. Therefore, it is very important to analyse the causes of arthritis and prognostic factors in the early stages of disease. The aim of our study was to determine whether the changes of laboratory, immunological and interleukins (MRP8/14 (calprotectin), IL-6, IL-33) indexes, assessment of functional condition, and disease activity may predict a chronic arthritis in children. The study showed that MRP8/14 (calprotectin) and Il-6 concentrations in the serum and synovial fluid of children with arthritis were significantly higher than in the control group of healthychildren (p<0.01). During the acute stage of disease, calprotectin and IL-6 concentrations strongly correlated with variables of disease activity (ESR, CRP, polyarthritis, morning stiffness of joints). Also, the analysis showed that high concentrations of calprotectin (> 5785ng/ml) and IL-6 (> 5.5 pg/ml) at the acute stage of arthritis were determined for those patients, whose were developed chronic arthritis. It was evaluated as significant criterion of the chronic joint disease. For the first time in Lithuania, the functional ability and the quality of life in children with arthritis were assessed using a newly introduced multidimensional assessment questionnaire for juvenile arthritis (JAMAR), and data was compared... [to full text]

In rheumatoid arthritis (RA), a key event is infiltration of inflammatory immune cells into the synovial lining, possibly aggravated by dysregulation of cellular adhesion molecules. Therefore, single nucleotide polymorphisms of 14 genes involved in cellular adhesion processes (CAST, ITGA4, ITGB1, ITGB2, PECAM1, PTEN, PTPN11, PTPRC, PXN, SELE, SELP, SRC, TYK2, and VCAM1) were analyzed for association with RA. Association analysis was performed consecutively in three European RA family sample groups (Nfamilies = 407). Additionally, we investigated differential allelic expression, a possible functional consequence of genetic variants. SELP (selectin P, CD62P) SNP-allele rs6136-T was associated with risk for RA in two RA family sample groups as well as in global analysis of all three groups (ptotal = 0.003). This allele was also expressed preferentially (p,1026) with a two- fold average increase in regulated samples. Differential expression is supported by data from Genevar MuTHER (p1 = 0.004; p2 = 0.0177). Evidence for influence of rs6136 on transcription factor binding was also found in silico and in public datasets reporting in vitro data. In summary, we found SELP rs6136-T to be associated with RA and with increased expression of SELP mRNA. SELP is located on the surface of endothelial cells and crucial for recruitment, adhesion, and migration of inflammatory cells into the joint. Genetically determined increased SELP expression levels might thus be a novel additional risk factor for RA.

Darbo tikslas. Įvertinti kineziologinio teipavimo poveikį pacientų, sergančių reumatoidiniu artritu, rankos funkcijai. Darbo uždaviniai: 1. Nustatyti pacientų rankos funkcijos pokyčius taikant kineziologinį teipavimą kartu su kineziterapija. 2. Nustatyti pacientų rankos funkcijos pokyčius taikant kineziterapiją. 3. Palyginti pacientų rankos funkcijos pokyčius abiejose grupėse. Tyrimo metodai. Goniometrija plaštakos judesių amplitudei vertinti (buvo vertinamas plaštakos lenkimas, tiesimas, stipininis ir alkūninis nukrypimas), dinamometrija plaštakos raumenų griebimo jėgai vertinti, modifikuotas Keitel indeksas rankos funkcinei būklei vertinti, Artrito poveikio vertinimo skalė rankos funkcijai vertinti. Tyrimo dalyviai. Tyrime dalyvavo 22 LSMUL Všį Kauno Klinikų Konsultacinės Poliklinikos, Kauno Dainavos poliklinikos ir Kauno Kalniečių poliklinikos pacientai, sergantys RA. Visos tiriamosios - moterys. Tiriamųjų amžiaus vidurkis - 61,18±1,34m. Vidutinė ligos trukmė – 5,73±0,45m. Visos tiriamosios atsitiktinai buvo suskirstytos į dvi grupes: 1. Tiriamojoje grupėje buvo 10 moterų, kurioms buvo taikomas kineziologinis teipavimas ir kineziterapija. 2. Kontrolinę grupę sudarė 12 moterų. Kontrolinei grupei buvo taikoma tik kineziterapija. Kineziterapijos programa truko 2 mėnesius (t.y. 9 savaites), procedūros atliekamos 3 kartus per savaitę. Ištyrimas buvo atliekamas prieš tyrimą ir tyrimo pabaigoje. Išvados: 1. Taikant kineziologinį teipavimą ir kineziterapiją po tyrimo buvo... [toliau žr. visą tekstą] / The aim of the research. To evaluate the effect of Kinesiology Taping on hand function in patients with Rheumatoid Arthritis. The goals of the research. 1. To estimate the changes of hand function applying Kinesiology Taping and physical therapy. 2. To estimate the changes of hand function applying only physical therapy. 3. To compare the changes of hand function applying Kinesiology Taping and physical therapy, and physical therapy alone. The methods of the research. Wristʼs range of motion was measured by goniometry method, the handgrip strength was assessed using dynamometer. Modyfied Keitel function test and Arthritis Impact Measurement Scale was used to evaluate hand function. The participants of the research. The study involved 22 subjects (100 pct. women) who had Rheumatoid arthritis. Mean age - 61,18±1,34 years. Subjects were randomly divided into two groups: the research group consisted of 10 individuals, Kinesiology Taping was applied to them together with physical therapy, and the control group consisted of 15 individuals, only physical therapy procedures was applied to them. The physical therapy program lasted for 2 months (9 weeks), the procedures was performed three times a week. The evaluation was performed twice: before and after procedures. Conclusions: 1. After the physical therapy program the wristʼs range of motion, handgrip strength and hand function significantly increased when applying Kinesiology Taping and physical therapy (p<0.05). 2. After the... [to full text]

Susirgus lėtiniais artritais, žymiai pablogėja ligonio gyvenimo kokybė, savirūpa, atsiranda informacijos apie ligą bei jos gydymą poreikis. Tai ypač tampa aktualu pacientams, kuriems taikoma biologinė terapija, kai su liga kovoti nebepadeda įprastas medikamentinis gydymas. Tikslas – ištirti sergančių lėtiniais artritais gyvenimo kokybę, savirūpą ir žinias taikant biologinę terapiją. Uždaviniai: 1) ištirti ir palyginti sergančių lėtiniais artritais gyvenimo kokybę prieš biologinę terapiją ir jos pokyčius po 4 mėn.; 2) ištirti ir palyginti sergančių lėtiniais artritais savirūpą prieš biologinę terapiją ir praėjus 4 mėn. po jos taikymo; 3) įvertinti sergančių lėtiniais artritais žinias apie biologinę terapiją prieš jos taikymą ir praėjus 4 mėn. po jos taikymo. Tyrimo metodai – 2013 m. vasario - spalio mėn. atlikta anoniminė anketinė apklausa. Tyrime dalyvavo LSMU reumatologijos skyriaus pacientai, sergantys lėtiniais artritais: reumatoidiniu artritu, ankiloziniu spondilitu, psoriaziniu artritu, kurie atitiko atrankos kriterijus biologinei terapijai. Tyrimui naudotas ,,SF-36’’ gyvenimo kokybės klausimynas, kasdieninės veiklos klausimynas (HAQ) bei autorės papildomai kurti klausimai. Respondentams buvo pateiktos anketos prieš biologinę terapiją ir po jos, praėjus 4 mėn. Gautas Lietuvos Sveikatos mokslų universiteto Medicinos akademijos Bioetikos centro leidimas 2013-02-07, Nr. BEK - KS(M)-241 tyrimo atlikimui. Rezultatai: analizuojant bendrai gyvenimo kokybės fizinę ir psichinę... [toliau žr. visą tekstą] / In case of the diagnosis with chronic arthritis, patients’ quality of life and self-care start to deteriorate significantly, the need of information about the disease and its treatment arises. It becomes relevant in particular to patients, treated with biological therapy as traditional treatment with drugs is ineffective. The aim – to research the quality of life, self-care and knowledge of chronic arthritis patients treated with biological therapy. Tasks: 1) to research and to compare the quality of life of patients with chronic arthritis prior to biological therapy and its changes in 4 months period, 2) to research and to compare self-care of patients with chronic arthritis prior to biological therapy and after the period of 4 months treatment, 3) to evaluate the knowledge of patients with chronic arthritis about biological therapy prior to its treatment and after 4 months. The research methods – from February till October, 2013 an anonymous questionnaire was conducted. Patients, diagnosed with chronic arthritis such as: rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, corresponding the selection criteria for biological therapy from Rheumatology department at LUHS, partipated in the research. ,,SF-36“ the life quality questionnaire, the health assesment questionnaire ( HAQ) as well as extra questions, made by the author, were applied in the research. Respondents were provided with the questionnaire forms prior to biological therapy and... [to full text]

Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.